Nearly a quarter of women with gestational diabetes history have undiagnosed prediabetes
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Nearly 25% of women included in a study of patients with a history of gestational diabetes had undiagnosed prediabetes, according to data published in Preventing Chronic Disease.
The researchers also found that more health visits in the prior year was associated with receiving diabetes screening, and that fewer screening opportunities may delay early detection, clinical management and prevention of diabetes.
“Although glucose intolerance resolves immediately after delivery in 90% of women with [gestational diabetes], their risk of developing type 2 diabetes mellitus is 35% to 60% within 5 to 10 years, which is a 5- to 7-fold increase in risk compared with women without a history of [gestational diabetes],” Bernice Man, MD, MS, of the University of Illinois at Chicago, and colleagues wrote. “... Approximately 50% of women with a history of [gestational diabetes] obtain diabetes screening, with rates ranging from 30% to 70%. Screening with the recommended [oral glucose tolerance test] is uncommon; most studies recognize or consider any marker of glucose measure as a screening test.”
To determine the diabetes screening rate, identify characteristics associated with screening, and calculate the proportion of women with histories of gestational diabetes who have undiagnosed diabetes and prediabetes, the researchers drew data from three cycles of the National Health and Nutrition Examination Survey. Using data from 2007-08, 2009-10, and 2011-12, they identified 284 women with a history of gestational diabetes who were eligible for diabetes screening.
Participants’ screening status was defined by self-reported accounts of having had a blood test for diabetes within the previous 3 years. Undiagnosed diabetes and prediabetes was determined by hemoglobin A1c measurement.
According to the researchers, 67% of the women reported undergoing screening for diabetes within the previous 3 years. Weighted, bivariate analyses concluded that women who had been screened differed from those who hadn’t in two categories — BMI (P = .01) and number of health visits in the prior year (P = .001). In addition, multivariate analysis showed that screening was associated with a greater number of health visits in the previous year (1 visit vs. 0 visits; AOR = 1.91; 95% CI, 0.71-5.18; 2-3 visits, AOR = 7.05; and 4 or more visits, AOR = 5.83). Of the women with a history of gestational diabetes, 24.4% (95% CI, 18.3-31.7) had undiagnosed prediabetes, and 6.5% (95% CI, 3.7-11.3) had undiagnosed diabetes.
“Women with [gestational diabetes] reporting higher health care usage were more likely to report diabetes screening. Limited engagement with the health care system likely reduces opportunities for screening,” Man and colleagues wrote. “An emphasis on increasing prediabetes screening may also delay progression to diabetes and improve diabetes detection for women with a history of [gestational diabetes]. Once diagnosed, efforts to promote lifestyle changes and increase metformin use may help delay or prevent diabetes and its complications.”
Disclosure: The researchers report no relevant financial disclosures.