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DC22-1390 GGI_and_DM_Supplemental_Materials_9-14-2022_FINAL.docx (324.59 kB)

Gestational Glucose Intolerance and Risk of Future Diabetes

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posted on 2022-12-06, 18:40 authored by Daryl J. Selen, Tanayott Thaweethai, Carolin C. M. Schulte, Sarah Hsu, Wei He, Kaitlyn James, Anjali Kaimal, James B. Meigs, Camille E. Powe

  

Objective: Pregnant individuals are universally screened for gestational diabetes. Gestational glucose intolerance (GGI, an abnormal initial gestational diabetes screening test without a gestational diabetes 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 gestational diabetes criteria. The primary outcome was incident diabetes. We used Cox proportional-hazard 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, 20,359 pregnancies had normal glucose tolerance, 2,943 had GGI, and 909 had gestational diabetes. 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 [95% confidence interval, CI] 2.01[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; gestational diabetes: aHR 8.26[6.49-10.51], p<0.001; each compared to normal glucose tolerance). The fraction of diabetes 10 years after delivery attributable to GGI and gestational diabetes was 8.5% and 28.1%, respectively.

Conclusion:  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.

 

Funding

Massachusetts General Hospital Claflin Distinguished Scholar Award Physician Scientist Development Award

U.S. Department of Health and Human Services > National Institutes of Health > National Institute of Diabetes and Digestive and Kidney Diseases T32DK007028 UM1DK078616

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