Enav Yefet1,2,3, Elad Jeda2, Ayellet Tzur2, Zohar Nachum2,4. 1. Department of Obstetrics & Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel. 2. Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel. 3. Faculty of Medicine in Galilee, Bar-Ilan University, Safed, Israel. 4. Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Abstract
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.
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.
Authors: Stefan Dugalic; Milos Petronijevic; Brankica Vasiljevic; Jovana Todorovic; Dejana Stanisavljevic; Aleksandra Jotic; Ljiljana Lukic; Tanja Milicic; Nebojsa Lalić; Katarina Lalic; Milica Stoiljkovic; Zorica Terzic-Supic; Tamara Stanisavljevic; Aleksandar Stefanovic; Katarina Stefanovic; Svetlana Vrzic-Petronijevic; Maja Macura; Igor Pantic; Pavle Piperac; Marija Jovanovic; Radmila Cerovic; Sinisa Djurasevic; Sandra Babic; Sonja Perkovic-Kepeci; Miroslava Gojnic Journal: Int J Environ Res Public Health Date: 2022-05-27 Impact factor: 4.614
Authors: Miroslava Gojnic; Jovana Todorovic; Dejana Stanisavljevic; Aleksandra Jotic; Ljiljana Lukic; Tanja Milicic; Nebojsa Lalic; Katarina Lalic; Milica Stoiljkovic; Tamara Stanisavljevic; Aleksandar Stefanovic; Katarina Stefanovic; Svetlana Vrzic-Petronijevic; Milos Petronijevic; Zorica Terzic-Supic; Maja Macura; Milan Perovic; Sandra Babic; Pavle Piperac; Marija Jovanovic; Bijana Parapid; Krisitna Doklestic; Radmila Cerovic; Sinisa Djurasevic; Stefan Dugalic Journal: Int J Environ Res Public Health Date: 2022-03-20 Impact factor: 3.390