Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study
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 G…
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Early abnormal glucose metabolism, defined as a fasting glucose threshold of 110 mg/dL or an A1C of 5.9%, may identify individuals at higher risk of adverse pregnancy and neonatal outcomes, more likely to need insulin treatment, and at high risk of a later GDM diagnosis.
“Early abnormal glucose metabolism, defi ned as a fasting glucose threshold of 110 mg/dL (6.1 mmol/L) or an A1C of 5.9% (41 mmol/mol), may identify individuals who are at higher risk of adverse pregnancy and neonatal outcomes (preeclampsia, macrosomia, shoulder dystocia, and perinatal death), are more likely to need insulin treatment, and are at high risk of a later GDM diagnosis (189 -194).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [193]
Cites
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ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus
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2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s002 · Cited by 4,792 · see citing works
2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s002 · Cited by 3,116 · see citing works
2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Gaglia, J. L., Hilliard, M. E., Johnson, E. L., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s002 · Cited by 2,086 · see citing works
- Authors
- Yefet, E., Jeda, E., Tzur, A., & Nachum, Z.
- Affiliations
- Bar-Ilan University (IL)
- Emek Medical Center (IL)
- Technion – Israel Institute of Technology (IL)
- Corresponding author
- Yefet, Enav
- Venue
- Journal of Diabetes
- Publisher
- Wiley
- Published
- 2019-10-30
- Volume
- 12
- Issue
- 3
- Pages
- 205-214
- ISSN
- 1753-0393 (ISSN-L)
- 1753-0407
- OpenAlex
- W2972815859
- Cited by
- 21
- References
- 4
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 1
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, gestational diabetes mellitus, pregestational diabetes, undiagnosed diabetes, HbA1c, glucose challenge test, oral glucose tolerance test, diagnostic biomarkers
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Gestational Age, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Pregnancy, Retrospective Studies, ROC Curve, Biomarkers, Multivariate Analysis, Logistic Models, Diabetes, Gestational
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