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HbA1c as a predictor of diabetes after gestational diabetes mellitus

Claesson, Rickard LU ; Ignell, Claes LU ; Shaat, Nael LU and Berntorp, Kerstin LU (2017) In Primary Care Diabetes 11(1). p.46-51
Abstract

Aim We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Methods Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. Results By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis,... (More)

Aim We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Methods Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. Results By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Conclusion Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Gestational diabetes, HbA1c, OGTT, Post-partum diabetes, Prediction
in
Primary Care Diabetes
volume
11
issue
1
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85007579601
  • wos:000392679200006
ISSN
1751-9918
DOI
10.1016/j.pcd.2016.09.002
language
English
LU publication?
yes
id
48969c11-aee8-4e91-8432-6c75b151a780
date added to LUP
2017-01-13 12:51:21
date last changed
2018-01-21 04:18:38
@article{48969c11-aee8-4e91-8432-6c75b151a780,
  abstract     = {<p>Aim We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). Methods Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. Results By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36 mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39 mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36 mmol/mol) were associated with a 5.5-fold increased risk of diabetes. Conclusion Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM.</p>},
  author       = {Claesson, Rickard and Ignell, Claes and Shaat, Nael and Berntorp, Kerstin},
  issn         = {1751-9918},
  keyword      = {Gestational diabetes,HbA1c,OGTT,Post-partum diabetes,Prediction},
  language     = {eng},
  month        = {02},
  number       = {1},
  pages        = {46--51},
  publisher    = {Elsevier},
  series       = {Primary Care Diabetes},
  title        = {HbA1c as a predictor of diabetes after gestational diabetes mellitus},
  url          = {http://dx.doi.org/10.1016/j.pcd.2016.09.002},
  volume       = {11},
  year         = {2017},
}