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

English version

Autoři: Tawanda Chivese ^aff001; Shane A. Norris ^aff002; Naomi S. Levitt ^aff001
Působiště autorů: Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa ^aff001; SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ^aff002
Vyšlo v časopise: 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. PLoS Med 16(9): e32767. doi:10.1371/journal.pmed.1002865
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002865

Souhrn

Background

Global 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 findings

All 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.

Conclusions

The 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.

Klíčová slova:

Medicine and health sciences – Endocrinology – Endocrine disorders – Metabolic disorders – Hyperglycemia – Women's health – Maternal health – Pregnancy – Obstetrics and gynecology – Pharmacology – Pharmacologic-based diagnostics – Oral glucose suppression test – Diagnostic medicine – Glucose tolerance tests – Body weight – Body Mass Index – People and places – Geographical locations – Africa – South Africa – Biology and life sciences – Physiology – Physiological parameters

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