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Diagnostic value of haemoglobin A 1c in post‐partum screening of women with gestational diabetes mellitus
Author(s) -
Kim K.S.,
Kim S.K.,
Cho Y.W.,
Park S. W.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13119
Subject(s) - medicine , gestational diabetes , diabetes mellitus , confidence interval , obstetrics , pregnancy , glucose tolerance test , receiver operating characteristic , gestation , endocrinology , insulin resistance , genetics , biology
Aims The aim of this study was to evaluate whether women with gestational diabetes mellitus could be screened using HbA 1c for glucose metabolism status at 6–12 weeks post‐partum. Methods We enrolled 699 pregnant women diagnosed with gestational diabetes mellitus from October 2005 to December 2013. A 75–g oral glucose tolerance test ( OGTT ) and HbA 1c measurement were performed at 6–12 weeks after delivery. Results The prevalence of overt diabetes and pre‐diabetes were 5.2% ( n = 36) and 49.1% ( n = 343), respectively, when using the 75–g OGTT as the gold standard. HbA 1c alone identified 2.9% ( n = 20) as having overt diabetes and 32.2% ( n = 225) as having pre‐diabetes. When American Diabetes Association cut‐offs were applied, the sensitivity and specificity for HbA 1c to diagnose overt diabetes were 19.4% and 98.0%, respectively. Pre‐diabetes, according to the HbA 1c criterion, had 41.2% sensitivity and 72.2% specificity. The misclassifications identified 97 positive differences, 233 negative differences and 369 ties ( P < 0.05). The area under the receiver operating characteristic curves for detecting diabetes and pre‐diabetes were 0.615 [95% confidence interval (95% CI ), 0.515 to 0.716] and 0.588 (95% CI , 0.545 to 0.630), respectively. Conclusions HbA 1c may not be sensitive enough for an accurate diagnosis, but it is highly specific for diagnosing overt diabetes at 6–12 weeks post‐partum in women with previous gestational diabetes mellitus.