Retnakaran Ravi, Pu Jiajie, Hanley Anthony J, Zinman Bernard
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
Division of Endocrinology, University of Toronto, Toronto, Canada.
Diabetes Obes Metab. 2025 Sep;27(9):4754-4762. doi: 10.1111/dom.16513. Epub 2025 Jun 5.
Women with gestational diabetes (GDM) are advised to undergo an oral glucose tolerance test (OGTT) within 6 months postpartum, owing to their elevated risk of developing pre-diabetes/diabetes. However, the optimal approach to glycemic surveillance in the years thereafter is unclear. We thus sought to compare OGTT, fasting glucose and A1c for chronic monitoring of women with previous GDM.
At both 3-years and 5-years postpartum, 111 women with previous GDM had glucose tolerance assessed with A1c, fasting glucose and OGTT, with concomitant evaluation of insulin sensitivity/resistance (Matsuda index, HOMA-IR) and beta-cell function (Insulin Secretion-Sensitivity Index-2 (ISSI-2), insulinogenic index/HOMA-IR (IGI/HOMA-IR)).
At 3-years postpartum, no women were identified with dysglycemia (pre-diabetes/diabetes) by fasting glucose alone. Instead, dysglycemia was diagnosed in 10 women by A1c alone, 24 women by OGTT alone and 16 women by both A1c and OGTT. Beta-cell function progressively worsened from those diagnosed by A1c alone to OGTT alone to those meeting both criteria (ISSI-2: p < 0.001; IGI/HOMA-IR: p = 0.01). At 5-years, dysglycemia was diagnosed in 13 women by A1c alone, 27 by OGTT alone and 21 by both measures. Beta-cell function again progressively decreased from A1c alone to OGTT alone to both (ISSI-2: p < 0.001; IGI/HOMA-IR: p < 0.001) but was now accompanied by worsening insulin sensitivity/resistance (Matsuda index: p < 0.001; HOMA-IR: p = 0.002) and rising fasting glucose (p = 0.008) across these groups.
In women with previous GDM, dysglycemia on OGTT identifies a higher risk metabolic phenotype than when diagnosed by A1c, suggestive of more informative and robust glycemic surveillance by OGTT.
由于患有妊娠期糖尿病（GDM）的女性发展为糖尿病前期/糖尿病的风险升高，建议她们在产后6个月内进行口服葡萄糖耐量试验（OGTT）。然而，此后数年血糖监测的最佳方法尚不清楚。因此，我们试图比较OGTT、空腹血糖和糖化血红蛋白（A1c）用于既往患有GDM女性的长期监测效果。
在产后3年和5年时，对111名既往患有GDM的女性进行了糖化血红蛋白、空腹血糖和OGTT的葡萄糖耐量评估，并同时评估胰岛素敏感性/抵抗（松田指数、稳态模型评估的胰岛素抵抗指数（HOMA-IR））和β细胞功能（胰岛素分泌-敏感性指数-2（ISSI-2）、胰岛素生成指数/HOMA-IR（IGI/HOMA-IR））。
在产后3年时，仅通过空腹血糖未发现有血糖异常（糖尿病前期/糖尿病）的女性。相反，仅通过糖化血红蛋白诊断出10名血糖异常女性，仅通过OGTT诊断出24名，通过糖化血红蛋白和OGTT均诊断出16名。从仅通过糖化血红蛋白诊断的女性到仅通过OGTT诊断的女性，再到符合两项标准的女性，β细胞功能逐渐恶化（ISSI-2：p<0.001；IGI/HOMA-IR：p=0.01）。在产后5年时，仅通过糖化血红蛋白诊断出13名血糖异常女性，仅通过OGTT诊断出27名，通过两种方法均诊断出21名。β细胞功能再次从仅通过糖化血红蛋白诊断的女性到仅通过OGTT诊断的女性，再到两项均符合诊断的女性逐渐下降（ISSI-2：p<0.001；IGI/HOMA-IR：p<0.001），但此时这些组的胰岛素敏感性/抵抗恶化（松田指数：p<0.001；HOMA-IR：p=0.002）且空腹血糖升高（p=0.008）。
对于既往患有GDM的女性，OGTT检测出血糖异常所识别出的代谢表型风险高于糖化血红蛋白诊断时，这表明OGTT用于血糖监测更具信息价值且更为可靠。
