Abstract
Objective : To evaluate the prediction performance of 1st
trimester fasting plasma glucose (FPG) levels, as compared to
gestational diabetes (GDM), for type 2 diabetes mellitus (T2DM), in a
5-year follow-up after pregnancy.
Design: A retrospective analysis of prospectively collected
data
Setting: Mehuedet HMO, Israel
Population or sample: 69,001 parturients with FPG levels
measured at 1st-trimester and T2DM data up to 5 years after delivery.
Methods: T2DM diagnosis was stratified by FPG levels divided
into categories with 10 mg/dl increments. GDM was diagnosed using the
two-step strategy. Prediction performance for T2DM was determined using
ROC-AUC statistics with the utilization of the Youden index(YI) for the
calculation of the best FPG cut-off for T2DM prediction. Survival
analysis was applied to calculate hazard ratios(HRs) for T2DM prediction
with further stratification to maternal obesity status.
Main outcome measures: T2DM, as determined by the Israeli
National Diabetes Registry..
Results: The determined FPG cut-off for predicting the risk of
T2DM was 86.5mg/dl (sensitivity 53.3%, specificity 72.4%). This cutoff
demonstrated superior predictive performance when compared to GDM
diagnosis (0.615 vs. 0.586). Furthermore, all FPG level categories
exceeding 80 mg/dL were associated with an increased risk of developing
T2DM. FPG levels equal to or greater than 110 mg/dL exhibited even
stronger predictive performance for T2DM compared to GDM diagnosis (HR
4.92 and 3.92, respectively). When stratified by maternal obesity, FPG
levels displayed enhanced predictive capabilities for T2DM, particularly
among women without obesity.
Conclusions: 1st trimester FPG levels are associated with
increased risk for T2DM, at least as GDM.
Funding: None
Keywords : Type 2 diabetes mellitus; first trimester;
fasting glucose; Gestational diabetes mellitus; Prediction; Pregnancy