Open Access妊娠期间未诊断2型糖尿病的标志物‐‐‐‐一项基于人群的回顾性队列研究
Author(s) -
Yefet Enav,
Jeda Elad,
Tzur Ayellet,
Nachum Zohar
Publication year - 2020
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12985
Subject(s) - medicine , gestational diabetes , diabetes mellitus , type 2 diabetes , retrospective cohort study , population , receiver operating characteristic , odds ratio , pregnancy , logistic regression , area under the curve , obstetrics , type 1 diabetes , cohort , gestation , endocrinology , genetics , environmental health , biology
Background To examine possible markers for undiagnosed type 2 diabetes in early‐onset gestational diabetes mellitus (GDM). 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 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 Early‐onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery.