Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA<inf>1c</inf> in an Indian cohort

Gupta, Y; Kapoor, D; Desai, A; Praveen, D; Joshi, R; Rozati, R; Bhatla, N; Prabhakaran, D; Reddy, P; Patel, A; Tandon, N

Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA<inf>1c</inf> in an Indian cohort

Gupta, Y Kapoor, D Desai, A Praveen, D Joshi, R Rozati, R Bhatla, N Prabhakaran, D Reddy, P

Patel, A Tandon, N

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Publication Type:: Journal Article
Citation:: Diabetic Medicine, 2017, 34 (1), pp. 37 - 43
Issue Date:: 2017-01-01

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Field	Value	Language
dc.contributor.author	Gupta, Y	en_US
dc.contributor.author	Kapoor, D	en_US
dc.contributor.author	Desai, A	en_US
dc.contributor.author	Praveen, D	en_US
dc.contributor.author	Joshi, R	en_US
dc.contributor.author	Rozati, R	en_US
dc.contributor.author	Bhatla, N	en_US
dc.contributor.author	Prabhakaran, D	en_US
dc.contributor.author	Reddy, P https://orcid.org/0000-0002-0709-9352	en_US
dc.contributor.author	Patel, A	en_US
dc.contributor.author	Tandon, N	en_US
dc.date.available	2016-02-25	en_US
dc.date.issued	2017-01-01	en_US
dc.identifier.citation	Diabetic Medicine, 2017, 34 (1), pp. 37 - 43	en_US
dc.identifier.issn	0742-3071	en_US
dc.identifier.uri	http://hdl.handle.net/10453/90342
dc.description.abstract	© 2016 Diabetes UK Aim: To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India. Methods: All women (n = 989) from two obstetric units in New Delhi and Hyderabad with a history of gestational diabetes were invited to participate, of whom 366 (37%) agreed. Sociodemographic, medical and anthropometric data were collected and 75-g oral glucose tolerance test were carried out. Results: Within 5 years (median 14 months) of the pregnancy in which they were diagnosed with gestational diabetes, 263 (72%) women were dysglycaemic, including 119 (32%) and 144 (40%) with Type 2 diabetes and prediabetes, respectively. A higher BMI [odds ratio 1.16 per 1-kg/m2 greater BMI (95% CI 1.10, 1.28)], presence of acanthosis nigricans [odds ratio 3.10, 95% CI (1.64, 5.87)], postpartum screening interval [odds ratio 1.02 per 1 month greater screening interval 95% CI (1.01, 1.04)] and age [odds ratio 1.10 per 1-year older age 95% CI (1.04, 1.16)] had a higher likelihood of having dysglycaemia. The American Diabetes Association-recommended threshold HbA1c value of ≥ 48 mmol/mol (6.5%) had a sensitivity and specificity of 81.4 and 90.7%, respectively, for determining the presence of Type 2 diabetes postpartum. Conclusion: The high post-pregnancy conversion rates of gestational diabetes to diabetes reported in the present study reinforce the need for mandatory postpartum screening and identification of strategies for preventing progression to Type 2 diabetes. Use of the American Diabetes Association-recommended HbA1c threshold for diabetes may lead to significant under-diagnosis.	en_US
dc.relation.ispartof	Diabetic Medicine	en_US
dc.relation.isbasedon	10.1111/dme.13102	en_US
dc.subject.classification	Endocrinology & Metabolism	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Diabetes, Gestational	en_US
dc.subject.mesh	Diabetes Mellitus, Type 2	en_US
dc.subject.mesh	Prediabetic State	en_US
dc.subject.mesh	Glucose Intolerance	en_US
dc.subject.mesh	Disease Progression	en_US
dc.subject.mesh	Glucose Tolerance Test	en_US
dc.subject.mesh	Prevalence	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Sensitivity and Specificity	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Follow-Up Studies	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Predictive Value of Tests	en_US
dc.subject.mesh	Postpartum Period	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	India	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Glycated Hemoglobin A	en_US
dc.title	Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA<inf>1c</inf> in an Indian cohort	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	34	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1701 Psychology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Faculty of Business/Management Discipline
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	34	en_US

Abstract:

© 2016 Diabetes UK Aim: To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India. Methods: All women (n = 989) from two obstetric units in New Delhi and Hyderabad with a history of gestational diabetes were invited to participate, of whom 366 (37%) agreed. Sociodemographic, medical and anthropometric data were collected and 75-g oral glucose tolerance test were carried out. Results: Within 5 years (median 14 months) of the pregnancy in which they were diagnosed with gestational diabetes, 263 (72%) women were dysglycaemic, including 119 (32%) and 144 (40%) with Type 2 diabetes and prediabetes, respectively. A higher BMI [odds ratio 1.16 per 1-kg/m2 greater BMI (95% CI 1.10, 1.28)], presence of acanthosis nigricans [odds ratio 3.10, 95% CI (1.64, 5.87)], postpartum screening interval [odds ratio 1.02 per 1 month greater screening interval 95% CI (1.01, 1.04)] and age [odds ratio 1.10 per 1-year older age 95% CI (1.04, 1.16)] had a higher likelihood of having dysglycaemia. The American Diabetes Association-recommended threshold HbA1c value of ≥ 48 mmol/mol (6.5%) had a sensitivity and specificity of 81.4 and 90.7%, respectively, for determining the presence of Type 2 diabetes postpartum. Conclusion: The high post-pregnancy conversion rates of gestational diabetes to diabetes reported in the present study reinforce the need for mandatory postpartum screening and identification of strategies for preventing progression to Type 2 diabetes. Use of the American Diabetes Association-recommended HbA1c threshold for diabetes may lead to significant under-diagnosis.

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http://hdl.handle.net/10453/90342