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Diabetes mellitus after GDM.

J B O'Sullivan1

  • 1Diabetes and Arthritis Foundation, Boston, Massachusetts.

Diabetes
|December 1, 1991
PubMed
Summary
This summary is machine-generated.

Diagnosing gestational diabetes mellitus (GDM) uses varied criteria, impacting comparisons of diabetes mellitus (DM) and impaired glucose tolerance (IGT) risk in former GDM patients. Gestational blood glucose levels are key predictors.

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Area of Science:

  • Endocrinology and Metabolism
  • Reproductive Medicine
  • Epidemiology

Background:

  • Gestational diabetes mellitus (GDM) diagnosis lacks standardized criteria, complicating comparisons of long-term diabetes mellitus (DM) and impaired glucose tolerance (IGT) incidence in affected women.
  • Existing diagnostic standards, such as O'Sullivan and Mahan criteria and World Health Organization (WHO) criteria, yield varying prevalence rates for GDM.
  • Inconsistent diagnostic definitions for GDM, particularly regarding overt diabetes and post-pregnancy glucose tolerance, contribute to significant differences in reported subsequent DM incidence.

Purpose of the Study:

  • To analyze the impact of varying diagnostic criteria on the incidence rates of DM and IGT in former GDM patients.
  • To highlight the sources of variability in interstudy comparisons of diabetes risk following GDM.
  • To assess the predictive value of gestational blood glucose levels for future diabetes risk.

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Main Methods:

  • Review of 12 international studies on diabetes incidence among former GDM patients.
  • Application of different diagnostic criteria (O'Sullivan and Mahan, WHO, National Diabetes Data Group) to assess prevalence and incidence rates.
  • Comparative analysis of diabetes risk in GDM patients versus control subjects using WHO DM criteria in different geographical locations (Copenhagen, Boston).
  • Utilized actuarial methods to evaluate the impact of observation periods on incidence rates.

Main Results:

  • Wide-ranging incidence rates for combined DM and IGT (19-87%) and DM alone (6-62%) were observed across studies.
  • Application of WHO DM criteria showed excess diabetes risk in former GDM patients: 18% in Copenhagen and 30.9% in Boston.
  • Actuarial methods indicated a potential 50% increase in Boston incidence rates, highlighting the influence of observation duration.
  • Gestational blood glucose levels demonstrated consistent predictive value for subsequent diabetes risk across studies.

Conclusions:

  • Variability in diagnostic criteria and methodologies significantly impacts the reported incidence of DM and IGT in former GDM patients, hindering interstudy comparisons.
  • Despite variability, elevated gestational blood glucose levels remain a strong predictor of future diabetes risk.
  • Standardization of diagnostic criteria and consistent follow-up methodologies are crucial for accurate assessment of long-term risks associated with GDM.