Postnatal testing following gestational diabetes: time to replace the oral glucose tolerance test?

Venkataraman, Hema; Sattar, Naveed; Saravanan, Ponnusamy

doi:10.1016/s2213-8587(15)00232-6

Cited by 25 publications

(18 citation statements)

References 11 publications

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“…This highlights the need for postpartum screening in these women. Global data indicates that postpartum screening is between 24% and 58% [51], whereas, in South Africa, less than 30% attend the recommended 6 weeks postpartum OGTT [24]. Several barriers from both the health system and patient perspectives hinder the 6-week postpartum screening.…”

Section: Discussionmentioning

confidence: 99%

Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa

2019

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BackgroundGlobal data indicate that women with a history of hyperglycemia first detected in pregnancy (HFDP) are at up to 7 times risk of progressing to type 2 diabetes mellitus (T2DM) compared with their counterparts who have pregnancies that are not complicated by hyperglycemia. However, there are no data from the sub-Saharan African region, which has the highest projected rise in diabetes prevalence globally. The aim of this study was to determine the proportion of women who progress to T2DM and associated risk factors 5 to 6 years after HFDP in Cape Town, South Africa.Methods and findingsAll women with HFDP, at a major referral hospital in Cape Town, were followed up 5 to 6 years later using a cross-sectional study. Each participant had a 75 g oral glucose tolerance test; anthropometric measurements and a survey were administered. A total of 220 participants were followed up. At this time, their mean age was 37.2 years (SD 6.0). Forty-eight percent (95% CI 41.2–54.4) progressed to T2DM, 5.5% (95% CI 3.1–9.4) had impaired fasting glucose, and 10.5% (95% CI 7.0–15.3) had impaired glucose tolerance. Of the participants who progressed to T2DM, 47% were unaware of their diabetes status. When HFDP was categorized post hoc according to WHO 2013 guidelines, progression in the diabetes in pregnancy (DIP) group was 81% (95% CI 70.2–89.0) and 31.3% (95% CI 24.4–39.3) in the gestational diabetes mellitus (GDM) category. Factors associated with risk of progression to T2DM were; at follow-up: waist circumference (odds ratios [OR] 1.1, 95% CI 1.0–1.1, p = 0.007), hip circumference (OR 0.9, 95% CI 0.8–1.0, p = 0.001), and BMI (OR 1.1, 95% CI 1.0–1.3, p = 0.001), and at baseline: insulin (OR 25.8, 95% CI 3.9–171.4, p = 0.001) and oral hypoglycaemic treatment during HFDP (OR 4.1, 95% CI 1.3–12.9, p = 0.018), fasting (OR 2.7, 95% CI 1.5–4.8, p = 0.001), and oral glucose tolerance test 2-hour glucose concentration at HFDP diagnosis (OR 4.3, 95% CI 2.4–7.7, p < 0.001). Our findings have limitations in that we did not include a control group of women without a history of HFDP.ConclusionsThe progression to T2DM in women with previous HFDP found in this study highlights the need for interventions to delay or prevent progression to T2DM after HFDP. In addition, interventions to prevent HFDP may also contribute to reducing the risk of T2DM.

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Section: Discussionmentioning

confidence: 99%

Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa

2019

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“…200 Previously, oral glucose tolerance testing was advocated to screen for DM in such patients, but screening by fasting glucose or glycated haemoglobin may be preferable. 201 2.5.3.2 Non-obstetric conditions PCOS affects 5% of all women in their fertile years. PCOS has been associated with an increased risk for future development of CVD, but larger studies have produced conflicting results.…”

Section: Obstetric Conditionsmentioning

confidence: 99%

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Piepoli¹,

Hoes²,

et al. 2016

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“…Wcześniej u takich pacjentek zalecano doustny test tolerancji glukozy jako badanie przesiewowe w kierunku DM, natomiast obecnie w ramach badań przesiewowych preferuje się pomiar glikemii na czczo lub hemoglobiny glikowanej [201].…”

Section: Stany Położniczeunclassified

2016 European Guidelines on cardiovascular disease prevention in clinical practice

Piepoli

Hoes²,

Agewall³

et al. 2016

Kardiol Pol

Self Cite

161

186

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Postnatal testing following gestational diabetes: time to replace the oral glucose tolerance test?

Cited by 25 publications

References 11 publications

Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa

Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa

2016 European Guidelines on cardiovascular disease prevention in clinical practice

2016 European Guidelines on cardiovascular disease prevention in clinical practice

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