Factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus: decision‐curve analysis. Issue 8 (23rd May 2018)

• Record Type: Journal Article
• Authors: Kondo, M.; Nagao, Y.; Mahbub, M. H.; Tanabe, T.; Tanizawa, Y.
• Is Part Of: Diabetic medicine. Volume 35:Issue 8(2018)
• Page Start: 1111
• Page End: 1117
• Publication Date: 2018-05-23
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13657
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To identify factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus, using decision‐curve analysis. Methods: A retrospective cohort study was performed. The participants were 123 Japanese women with gestational diabetes who underwent 75‐g oral glucose tolerance tests at 8–12 weeks after delivery. They were divided into a glucose intolerance and a normal glucose tolerance group based on postpartum oral glucose tolerance test results. Analysis of the pregnancy oral glucose tolerance test results showed predictive factors for postpartum glucose intolerance. We also evaluated the clinical usefulness of the prediction model based on decision‐curve analysis. Results: Of 123 women, 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance. Multivariable logistic regression analysis showed insulinogenic index/fasting immunoreactive insulin and summation of glucose levels, assessed during pregnancy oral glucose tolerance tests (total glucose), to be independent risk factors for postpartum glucose intolerance. Evaluating the regression models, the best discrimination (area under the curve 0.725) was obtained using the basic model (i.e. age, family history of diabetes, BMI ≥25 kg/m 2 and use of insulin during pregnancy) plus insulinogenic index/fasting immunoreactive insulin <1.1. Decision‐curve analysis showed that combining insulinogenic index/fasting immunoreactive insulin <1.1 with basic clinical information resulted in superior net benefits for prediction of postpartum glucose intolerance. Conclusions: Insulinogenic index/fasting immunoreactive insulin calculated using oral glucose tolerance test results during pregnancy is potentially useful for predicting early postpartum glucose intolerance in Japanese women with gestational diabetes. What's new?: Of 123 Japanese women with gestational diabetes mellitus (GDM), 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance at 8–12 weeks after delivery. Insulinogenic index/fasting immunoreactive insulin (IRI) and summation of glucose levels during pregnancy, assessed by 75‐g oral glucose tolerance test, were independent risk factors for early postpartum glucose intolerance even after adjustment for known risk factors (age, family history of diabetes, BMI >25 kg/m 2 and use of insulin during pregnancy). On decision‐curve analysis, insulinogenic index/fasting IRI <1.1 correlated well with early postpartum glucose intolerance among threshold probabilities, especially in the range of 30–40%.