Gestational diabetes mellitus – prevalence in southern Sweden and risk factors for subsequent diabetes

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

Bibtex

@phdthesis{e5a004fecc6b4ba88f81b6e2a1c5df3d,
title = "Gestational diabetes mellitus – prevalence in southern Sweden and risk factors for subsequent diabetes",
abstract = "Background: Gestational diabetes mellitus (GDM) is associated with risks during pregnancy, during delivery, and in later life with a substantial risk of subsequent diabetes. The worldwide prevalence of GDM is increasing, but varies with differences in diagnostic methods and population characteristics. Results: Capillary glucose concentrations were found to be higher than venous glucose concentrations during oral glucose tolerance test (OGTT) after pregnancy (n = 55). Equivalence values for capillary glucose concentrations tended to be higher than those proposed by the WHO, but diagnostic disagreements mainly occurred close to the diagnostic cut-off limits. In southern Sweden, defining GDM as a 2-h capillary plasma glucose concentration of ≥ 10.0 mmol/L during a universal 75-g OGTT, there was a 35{\%} increase in GDM prevalence (p < 0.001) from 2003 (1.9{\%}) to 2012 (2.6{\%}) when assessed in a log-linear Poisson model during a period with stable diagnostic procedures. 1–2 years after pregnancy with GDM (n = 456), the increased frequency of diabetes in non-European women (17{\%} vs. 4{\%} in European women, p < 0.001) was associated with increased insulin resistance―related to higher body mass index (BMI) in Arab women, and higher insulin resistance relative to BMI in Asian women. In logistic regression analysis, diabetes 5 years after GDM was associated with higher BMI at follow-up, non-European ethnicity, and higher OGTT 2-h glucose concentration in pregnancy (p < 0.0001). A prediction model based on these variables resulting in 86{\%} correct classifications (n = 200), with an area under the receiver-operating characteristic curve of 0.91 (95{\%} CI 0.86–0.95), was used in a function-sheet line diagram illustrating the individual effect of weight on diabetes risk. Conclusions: Interconversion of results from capillary sampling and venous sampling is associated with uncertainty, but it may be suitable when translating results on a group basis. The prevalence of GDM in southern Sweden was 2.6{\%} in 2012, with an upward trend. In women with GDM, insulin resistance was associated with subsequent diabetes, predicted by BMI, non-European ethnicity, and glucose tolerance during pregnancy.",
keywords = "prognosis, insulin resistance, insulin secretion, ethnic groups, sampling, diabetes, cohort studies, prevalence, oral glucose tolerance test, Gestational diabetes",
author = "Claes Ignell",
note = "Defence details Date: 2015-10-16 Time: 09:00 Place: CRC Lecture Hall at the Clinical Research Centre, Sk{\aa}ne University Hospital Malm{\"o} External reviewer(s) Name: Damm, Peter Title: Professor Affiliation: Department of Obstetrics, University of Copenhagen, Denmark ---",
year = "2015",
language = "English",
isbn = "978‐91‐7619‐162‐0",
series = "Lund University Faculty of Medicine Doctoral Dissertation Series",
publisher = "Department of Clinical Sciences, Lund University",
school = "Genomics, Diabetes and Endocrinology",

}