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Meta-analysis: Screening interventions may delay type 2 diabetes in women with gestational diabetes
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Women with gestational diabetes — who are at increased risk for type 2 diabetes — may prevent or delay onset of disease with the use of dietary, lifestyle and pharmacological interventions.
“Women who have had gestational diabetes also have increased lipid concentrations and blood pressure, and type 2 diabetes is estimated to confer an equivalent risk of ageing 15 years,” the researchers wrote. “Early identification and treatment of these factors could also help to reduce premature cardiovascular and renal diseases in this group of individuals.”
Researchers pooled data from an electronic records database between Jan. 1, 1960 and Jan. 31, 2009. Twenty retrospective and prospective cohort studies including 675,455 women with type 2 diabetes were included in the analysis. Among these, 31,867 previously had gestational diabetes; there were 10,859 incident cases of type 2 diabetes.
Outcome measure was the development of type 2 diabetes at least six weeks following the end of pregnancy — defined as an oral glucose tolerance test, fasting plasma glucose concentration or both.
An increase in the risk for type 2 diabetes was found in women with gestational diabetes compared with women with a normoglycemic pregnancy (RR=7.43; 95% CI, 4.79-11.51).
When studies were grouped according to the number of type 2 diabetes cases, the researchers identified some heterogeneity in effect estimates. However, “no significant heterogeneity was evident from the subgroup analysis of the criteria used for the diagnosis of gestational diabetes and type 2 diabetes,” the researchers wrote.
In an accompanying editorial, Rhonda Bentley-Lewis wrote that data support the assertion that “gestational diabetes is a harbinger of type 2 diabetes in predisposed women who are faced with the metabolic challenges of pregnancy.” Bentley-Lewis stressed the need for targeted prevention efforts and the “need to address how progression from diabetes to type 2 diabetes can be halted so that evidence-based approaches to management can be developed.” – by Jennifer Southall
Bellamy L. Lancet. 2009;373:1773-1779.
Education is critical before women become pregnant, such as awareness that they are at risk for type 2 diabetes. Women should also be re-screened at their post-partum check-up and this message should be incorporated into education materials. In addition, OBGYNs may be another source to put forth programs, so diabetes educators should develop relationships with OBGYNs or high-risk physicians as well.
– Donna M. Rice, MBA, RN, CDE
Endocrine Today Editorial Board member