Type 2 diabetes risk lower for women with diabetes history, optimal risk factor levels
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Women with a history of gestational diabetes can lower their risk for developing type 2 diabetes by optimizing modifiable risk factors for the disease, such as weight, diet, physical activity and tobacco and alcohol use.
“Compared with the general population, women with a history of gestational diabetes mellitus face up to a 10-fold higher risk of progressing to type 2 diabetes. Gestational diabetes mellitus unmasks underlying cardiometabolic dysregulation or susceptibility at an early age, offering an opportunity for early intervention to prevent subsequent progression to type 2 diabetes,” Jiaxi Yang, PhD, a postdoctoral research fellow from the department of obstetrics and gynecology at the National University of Singapore and the department of epidemiology at Harvard T.H. Chan School of Public Health, and colleagues wrote. “While several individual diet and lifestyle factors have been related to risk of type 2 diabetes among these high-risk women, the combined associations of modifiable risk factors on long-term risk of the disorder are less well understood.”
The prospective cohort study, published in The BMJ, included data from 4,275 women with a history of gestational diabetes with repeated measurements of weight and lifestyle factors who were followed from 1991 to 2009. Researchers evaluated five modifiable risk factors, including a BMI less than 25 kg/m2, high quality diet, regular exercise of at least 150 minutes per week at moderate intensity or at least 75 minutes per week at vigorous intensity, moderate alcohol consumption of 5 g to 14.9 g per day and no current smoking.
Researchers categorized genetic susceptibility for type 2 diabetes through a genetic risk score based on 59 single nucleotide polymorphisms linked to type 2 diabetes in 1,372 participants in this study.
Throughout a median of 27.9 years of follow-up, 924 women developed type 2 diabetes. Participants with optimal levels of all five modifiable risk factors had a more than 90% lower risk for type 2 diabetes compared with those without optimal levels.
Compared with no modifiable risk factors, participants with one of these risk factors had an HR of 0.94 for type 2 diabetes, those with two had an HR of 0.61, those with three had an HR of 0.32, those with four had an HR of 0.15 and those with five had an HR of 0.08 (P < .001 for all).
Researchers observed the inverse association of the number of optimal modifiable factors with risk for type 2 diabetes even among those with overweight or obesity or with higher genetic susceptibility (P < .001 for all). The 2,227 women with a BMI of 25 kg/m2 or more had an HR of 0.4 for achieving optimal levels of all other modifiable risk factors. Compared with women with one or no optimized modifiable risk factors, women with higher genetic susceptibility had an HR of 0.11 for developing type 2 diabetes when they had optimal levels of four modifiable risk factors.
Researchers observed no type 2 diabetes events among women with optimal levels of all five modifiable risk factors.
“Our genetic risk score only used 59 single nucleotide polymorphisms that have been previously shown to be associated with type 2 diabetes, and the use of a larger number of single nucleotide polymorphisms might enable future studies to stratify analysis into finer categories of genetic risk,” the researchers wrote.
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