Markers for undiagnosed type 2 diabetes mellitus during pregnancy-A population-based retrospective cohort study.
2型糖尿病
HbA1c
diabetes mellitus
gestational diabetes mellitus
pregnancy
type 2 diabetes
妊娠
妊娠期糖尿病
糖化血红蛋白
糖尿病
Journal
Journal of diabetes
ISSN: 1753-0407
Titre abrégé: J Diabetes
Pays: Australia
ID NLM: 101504326
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
29
06
2019
revised:
01
09
2019
accepted:
04
09
2019
pubmed:
10
9
2019
medline:
21
10
2020
entrez:
10
9
2019
Statut:
ppublish
Résumé
To examine possible markers for undiagnosed type 2 diabetes in early-onset gestational diabetes mellitus (GDM). A population-based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50-g glucose challenge test, 100-g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression. Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%-100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2-109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value. Early-onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery. 背景: 验证早发性妊娠期糖尿病中未被诊断2型糖尿病的可能标志物 方法: 研究人员对2005年至2018年分娩、孕期24周前诊断为妊娠糖尿病的妇女进行了一项基于人群的回顾性队列研究。将50g葡萄糖激发试验、100g口服葡萄糖耐量试验和第一次糖化血红蛋白(HbA1c)检测结果作为妊娠6~12周后诊断为2型糖尿病的标志物, 提示妊娠期糖尿病前期。计算每个标志物ROC曲线下面积(AUC)。以逐步多因素Logistic回归方法, 分析这些指标和附加指标的独立性。 结果: 69417例孕妇中, 有妊娠糖尿病3321例(5%)。其中261名妇女(8%)在第24周前被诊断为妊娠糖尿病, 219名妇女(84%)有可供分析的数据。其中11例(5%)妊娠后出现2型糖尿病。在多因素分析中, 糖化血红蛋白升高是未诊断2型糖尿病最准确的标志物(AUC 91%, 95%CI[81%~100%]), 也是唯一独立的未诊断2型糖尿病标志物([OR]19; 95%CI[3.2~109])。在ROC分析中, 以5.8%为临界值预测2型糖尿病的敏感度为89%, 特异度为86%, 阴性预测值为99.4%, 阳性预测值为23%。 结论: 可将早期发生且伴随糖化血红蛋白≥5.8%的GDM作为2型糖尿病处理, 明确的诊断则需要待分娩后。.
Sections du résumé
BACKGROUND
BACKGROUND
To examine possible markers for undiagnosed type 2 diabetes in early-onset gestational diabetes mellitus (GDM).
METHODS
METHODS
A population-based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50-g glucose challenge test, 100-g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression.
RESULTS
RESULTS
Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%-100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2-109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value.
CONCLUSIONS
CONCLUSIONS
Early-onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery.
背景: 验证早发性妊娠期糖尿病中未被诊断2型糖尿病的可能标志物 方法: 研究人员对2005年至2018年分娩、孕期24周前诊断为妊娠糖尿病的妇女进行了一项基于人群的回顾性队列研究。将50g葡萄糖激发试验、100g口服葡萄糖耐量试验和第一次糖化血红蛋白(HbA1c)检测结果作为妊娠6~12周后诊断为2型糖尿病的标志物, 提示妊娠期糖尿病前期。计算每个标志物ROC曲线下面积(AUC)。以逐步多因素Logistic回归方法, 分析这些指标和附加指标的独立性。 结果: 69417例孕妇中, 有妊娠糖尿病3321例(5%)。其中261名妇女(8%)在第24周前被诊断为妊娠糖尿病, 219名妇女(84%)有可供分析的数据。其中11例(5%)妊娠后出现2型糖尿病。在多因素分析中, 糖化血红蛋白升高是未诊断2型糖尿病最准确的标志物(AUC 91%, 95%CI[81%~100%]), 也是唯一独立的未诊断2型糖尿病标志物([OR]19; 95%CI[3.2~109])。在ROC分析中, 以5.8%为临界值预测2型糖尿病的敏感度为89%, 特异度为86%, 阴性预测值为99.4%, 阳性预测值为23%。 结论: 可将早期发生且伴随糖化血红蛋白≥5.8%的GDM作为2型糖尿病处理, 明确的诊断则需要待分娩后。.
Autres résumés
Type: Publisher
(chi)
背景: 验证早发性妊娠期糖尿病中未被诊断2型糖尿病的可能标志物 方法: 研究人员对2005年至2018年分娩、孕期24周前诊断为妊娠糖尿病的妇女进行了一项基于人群的回顾性队列研究。将50g葡萄糖激发试验、100g口服葡萄糖耐量试验和第一次糖化血红蛋白(HbA1c)检测结果作为妊娠6~12周后诊断为2型糖尿病的标志物, 提示妊娠期糖尿病前期。计算每个标志物ROC曲线下面积(AUC)。以逐步多因素Logistic回归方法, 分析这些指标和附加指标的独立性。 结果: 69417例孕妇中, 有妊娠糖尿病3321例(5%)。其中261名妇女(8%)在第24周前被诊断为妊娠糖尿病, 219名妇女(84%)有可供分析的数据。其中11例(5%)妊娠后出现2型糖尿病。在多因素分析中, 糖化血红蛋白升高是未诊断2型糖尿病最准确的标志物(AUC 91%, 95%CI[81%~100%]), 也是唯一独立的未诊断2型糖尿病标志物([OR]19; 95%CI[3.2~109])。在ROC分析中, 以5.8%为临界值预测2型糖尿病的敏感度为89%, 特异度为86%, 阴性预测值为99.4%, 阳性预测值为23%。 结论: 可将早期发生且伴随糖化血红蛋白≥5.8%的GDM作为2型糖尿病处理, 明确的诊断则需要待分娩后。.
Identifiants
pubmed: 31498952
doi: 10.1111/1753-0407.12985
doi:
Substances chimiques
Biomarkers
0
Glycated Hemoglobin A
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
205-214Informations de copyright
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
Références
Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008;31:899-904.
Wier LM, Witt E, Burgess J, Elixhauser A. Hospitalizations Related to Diabetes in Pregnancy, 2008: Statistical Brief #102. Rockville, MD: Agency for Healthcare Research and Quality; 2010. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb102.pdf
DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. PrevChronicDis. 2014;11:E104.
Purdy LP, Hantsch CE, Molitch ME, et al. Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care. 1996;19:1067-1074.
Temple RC, Aldridge VA, Sampson MJ, Greenwood RH, Heyburn PJ, Glenn A. Impact of pregnancy on the progression of diabetic retinopathy in Type 1 diabetes. DiabetMed. 2001;18:573-577.
Bryant SN, Herrera CL, Nelson DB, Cunningham FG. Diabetic ketoacidosis complicating pregnancy. J Neonatal PerinatalMed. 2017;10:17-23.
Bell R, Bailey K, Cresswell T, Hawthorne G, Critchley J, Lewis-Barned N. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG. 2008;115:445-452.
Rosenn B, Miodovnik M, Combs CA, Khoury J, Siddiqi TA. Glycemic thresholds for spontaneous abortion and congenital malformations in insulin-dependent diabetes mellitus. Obstet Gynecol. 1994;84:515-520.
McCarthy EA, Williamson R, Shub A. Pregnancy outcomes for women with pre-pregnancy diabetes mellitus in Australian populations, rural and metropolitan: a review. AustNZJ Obstet Gynaecol. 2019;59(2):183-194.
Rashid FB, Khatoon H, Hasnat MA, Amin R, Azad AK. Perinatal complications in diabetes mellitus with pregnancy: comparison between gestational diabetes mellitus (GDM) and diabetes mellitus prior to pregnancy. MymensinghMedJ. 2017;26:124-130.
Son KH, Lim NK, Lee JW, Cho MC, Park HY. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes. Diabet Med. 2015;32:477-486.
ACOG Practice Bulletin No. 201: pregestational diabetes mellitus. Obstet Gynecol. 2018;132:e228-e248.
ACOG Practice Bulletin No. 190 summary: gestational diabetes mellitus. Obstet Gynecol. 2018;131:406-408.
Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997;20:1183-1197.
Gregg EW, Cadwell BL, Cheng YJ, et al. Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S. Diabetes Care. 2004;27:2806-2812.
2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42:S13-S28.
Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144:768-773.
Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979;28:1039-1057.
Langer O, Brustman L, Anyaegbunam A, Mazze R. The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy. AmJ ObstetGynecol. 1987;157:758-763.
Langer O, Anyaegbunam A, Brustman L, Divon M. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy. Am J Obstet Gynecol. 1989;161:593-599.
Roeckner JT, Sanchez-Ramos L, Jijon-Knupp R, Kaunitz AM. Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;215:287-297.
Gestational diabetes mellitus. Practice Bulletin No. 180. American college of obstetricians and gynecologists. Obstet Gynecol. 2017;130:e17-e31.
Jakobsdottir J, Gorin MB, Conley YP, Ferrell RE, Weeks DE. Interpretation of genetic association studies: markers with replicated highly significant odds ratios may be poor classifiers. PLoSGenet. 2009;5:e1000337.
Weijers RN, Bekedam DJ, Goldschmidt HM, Smulders YM. The clinical usefulness of glucose tolerance testing in gestational diabetes to predict early postpartum diabetes mellitus. ClinChemLab Med. 2006;44:99-104.
Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008;179:229-234.
Zep, R. C. A. SAS macro for estimating power for roc curves in one-sample and two-sample cases. 20th Annual Conference 1995, 1004-1006. 1995. Ref Type: Conference Proceeding
Radin MS. Pitfalls in hemoglobin A1c measurement: when results may be misleading. J GenInternMed. 2014;29:388-394.
Lind T, Cheyne GA. Effect of normal pregnancy upon the glycosylated haemoglobins. BrJ Obstet Gynaecol. 1979;86:210-213.
Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia. 2016;59:1403-1411.
Mendoza LC, Harreiter J, Simmons D, et al. Risk factors for hyperglycemia in pregnancy in the DALI study differ by period of pregnancy and OGTT time point. EurJ Endocrinol. 2018;179:39-49.
Greenberg LR, Moore TR, Murphy H. Gestational diabetes mellitus: antenatal variables as predictors of postpartum glucose intolerance. Obstet Gynecol. 1995;86:97-101.
Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL. Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Am.J Obstet Gynecol. 2002;186:751-756.
Vejrazkova D, Vcelak J, Vankova M, et al. Steroids and insulin resistance in pregnancy. J Steroid BiochemMolBiol. 2014;139:122-129.
Harreiter J, Simmons D, Desoye G, et al. Nutritional lifestyle intervention in obese pregnant women, including lower carbohydrate intake, is associated with increased maternal free fatty acids, 3-beta-Hydroxybutyrate, and fasting glucose concentrations: a secondary factorial analysis of the European multicenter, randomized controlled DALI lifestyle intervention trial. Diabetes Care. 2019;42:1380-1389.
Skupien J, Cyganek K, Malecki MT. Diabetic pregnancy: an overview of current guidelines and clinical practice. CurrOpinObstet Gynecol. 2014;26:431-437.
Tucholski K, Otto-Buczkowska E. The role of leptin in the regulation of carbohydrate metabolism. EndokrynolPol. 2011;62:258-262.
Otto-Buczkowska E, Chobot A. Role of ghrelin and leptin in the regulation of carbohydrate metabolism. Part II Leptin. Postepy HigMedDosw(Online). 2012;66:799-803.
Otto-Buczkowska E, Chobot A. Role of ghrelin and leptin in the regulation of carbohydrate metabolism. Part I Ghrelin. Postepy HigMedDosw(Online). 2012;66:795-798.
Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. AmJ Obstet Gynecol. 1999;180:903-916.
Buchanan TA, Xiang AH. Gestational diabetes mellitus. J ClinInvest. 2005;115:485-491.
ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol. 2018;131:e49-e-64.
Meijnikman AS, De Block CEM, Dirinck E, et al. Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population. Int J Obes(Lond). 2017;41:1615-1620.
Yefet E, Suleiman A, Garmi G, Hatokay A, Nachum Z. Evaluation of postpartum anaemia screening to improve anaemia diagnosis and patient care: a prospective non-randomized before-and-after anaemia screening protocol implementation study. SciRep. 2019;9:7810.