Gestational Glucose Intolerance and Risk of Future Diabetes

Author:

Selen Daryl J.1234,Thaweethai Tanayott235,Schulte Carolin C.M.56,Hsu Sarah127,He Wei8,James Kaitlyn9,Kaimal Anjali39,Meigs James B.2378,Powe Camille E.12379ORCID

Affiliation:

1. 1Diabetes Unit, Massachusetts General Hospital, Boston, MA

2. 2Department of Medicine, Massachusetts General Hospital, Boston, MA

3. 3Harvard Medical School, Boston, MA

4. 4Division of Endocrinology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI

5. 5Biostatistics Center, Division of Clinical Research, Massachusetts General Hospital, Boston, MA

6. 6Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA

7. 7Broad Institute of MIT and Harvard, Boston, MA

8. 8Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA

9. 9Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA

Abstract

OBJECTIVE Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks’ gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance. RESULTS Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54–2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09–2.16], P = 0.01; one, aHR 2.97 [2.07–4.27], P < 0.001; GDM, aHR 8.26 [6.49–10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively. CONCLUSIONS GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.

Funder

Massachusetts General Hospital

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference40 articles.

1. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services . National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States, 2020. Accessed 26 April 2022. Available from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

2. Hypertension and diabetes in non-pregnant women of reproductive age in the United States;Azeez;Prev Chronic Dis,2019

3. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement;Davidson;JAMA,2021

4. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2022;American Diabetes Association Professional Practice Committee;Diabetes Care,2022

5. ACOG practice bulletin no. 190: gestational diabetes mellitus;Obstet Gynecol,2018

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