ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes
MetadataShow full item record
This item's downloads: 300 (view details)
Noctor, E,Crowe, C,Carmody, LA,Avalos, GM,Kirwan, B,Infanti, JJ,O'Dea, A,Gillespie, P,Newell, J,McGuire, B,O'Neill, C,O'Shea, PM,Dunne, FP (2013) 'ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes'. European Journal Of Endocrinology, 169 :681-687.
Objective: Previous gestational diabetes (GDM) is associated with a significant lifetime risk of type 2 diabetes. In this study, we assessed the performance of HbA1c and fasting plasma glucose (FPG) measurements against that of 75 g oral glucose tolerance testing (OGTT) for the follow- up screening of women with previous GDM.Methods: Two hundred and sixty-six women with previous GDM underwent the follow- up testing (mean of 2.6 years (S.D. 1.0) post- index pregnancy) using HbA1c (100%), and 75 g OGTT (89%) or FPG (11%). American Diabetes Association (ADA) criteria for abnormal glucose tolerance were used.Design, cohort study, and results: The ADA HbA1c high-risk cut-off of 39 mmol/mol yielded sensitivity of 45% (95% CI 32, 59), specificity of 84% (95% CI 78, 88), negative predictive value (NPV) of 87% (95% CI 82, 91) and positive predictive value ( PPV) of 39% (95% CI 27, 52) for detecting abnormal glucose tolerance. ADA high-risk criterion for FPG of 5.6 mmol/ l showed sensitivity of 80% ( 95% CI 66, 89), specificity of 100% (95% CI 98, 100), NPVof 96% (95% CI 92, 98) and PPVof 100% (95% CI 91, 100). Combining HbA1c >= 39 mmol/ mol with FPG >= 5.6 mmol/ l yielded sensitivity of90%(95% CI 78, 96), specificity of 84% (95% CI 78, 88), NPV of 97% (95% CI 94, 99) and PPVof 56% (95% CI 45, 66).Conclusions: Combining test cut- offs of 5.6 mmol/l and HbA1c 39 mmol/mol identifies 90% of women with abnormal glucose tolerance post- GDM ( mean 2.6 years (S. D. 1.0) post- index pregnancy). Applying this follow-up strategy will reduce the number of OGTT tests required by 70%, will be more convenient forwomen and their practitioners, and is likely to lead to increased uptake of long-term retesting by these women whose risk for type 2 diabetes is substantially increased.
This item is available under the Attribution-NonCommercial-NoDerivs 3.0 Ireland. No item may be reproduced for commercial purposes. Please refer to the publisher's URL where this is made available, or to notes contained in the item itself. Other terms may apply.
The following license files are associated with this item: