妊娠糖尿病的诊断标准和临床实践的影响之间的一致和分歧:一项追溯观察性研究
Alpesh Goyal1, Rahul Gupta1, Avantika Gupta2
1Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, India.
Diabetes & metabolic syndrome
|February 20, 2025
概括
11个妊娠糖尿病诊断标准显示出显著的分歧,影响了流行率估计. 2013年CDA标准显示与IADPSG参考标准达成最高一致.
科学领域:
- 产科和妇科 产科和妇科
- 内分泌学 在内分泌学.
- 临床诊断 临床诊断 临床诊断
背景情况:
- 孕期糖尿病 (GDM) 诊断依赖于全球范围内的各种标准.
- 诊断标准的差异可能导致GDM患病率和管理的变化.
研究的目的:
- 评估妊娠糖尿病 (GDM) 的十一个不同的诊断标准之间的一致性和分歧.
- 为了比较常用的临床标准与国际糖尿病和怀孕研究小组协会 (IADPSG) 标准的表现.
主要方法:
- 353名孕妇口服葡萄糖耐受性测试 (OGTT) 结果的回顾性审查.
- 使用11个标准进行GDM诊断的比较:IADPSG,DIPSI,WHO 1999,CDA 2003/2013,NICE 2015,JSOG 1984,ADIPS 1998,ADA 2004,NZSSD 2004,和EASD 1996.使用的标准是
- 通过使用科恩的卡帕系数 (k) 评估一致性,使用百分比 (d) 评估不一致性,以IADPSG作为参考.
主要成果:
- GDM患病率有很大的差异,从7.4% (CDA 2003) 到23.8% (IADPSG) 之间.
- 在55个对比的对比中,52.7%的对象表示中度一致,29.1%的对象表示良好,18.2%的对象表示非常良好.
- 2013年CDA标准与IADPSG的一致性最高 (k=0.811),而1999年DIPSI/WHO的一致性最低 (k=0.456).
结论:
- 由于不同的诊断标准,GDM患病率存在明显的差异.
- 标准之间存在重大分歧,需要仔细解释GDM患病率数据.
- 追溯性质和非连续的招聘可能会引入选择偏见.
相关概念视频
Diabetes Mellitus: Type 2 and Gestational
2.1K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.1K
Pathophysiology of Diabetes
843
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
843
Diabetes: Symptoms, Diagnosis, and Complications
497
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
497
Diabetes Mellitus: Overview and Type I Subtype
2.4K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
2.4K
Diabetes: Management and Pharmacotherapy
227
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
227
Diagnostic and Statistical Manual of Mental Disorders (DSM)
35
The Diagnostic and Statistical Manual of Mental Disorders (DSM) serves as the primary classification system for mental health disorders, providing standardized diagnostic criteria for clinicians and researchers. First published by the American Psychiatric Association (APA) in 1952, the DSM has undergone several revisions to reflect evolving psychiatric understanding. The fifth edition, DSM-5, released in 2013, introduced key updates that expanded diagnostic categories and modified diagnostic...
35


