High prevalence and significant ethnic differences in actionable HbA 1C after gestational diabetes mellitus in women living in Norway

Sharma, A., Nermoen, I., Qvigstad, E., Tran, A. T., Sommer, C., Sattar, N. , Gill, J. M.R. , Gulseth, H. L., Sollid, S. T. and Birkeland, K. I. (2022) High prevalence and significant ethnic differences in actionable HbA 1C after gestational diabetes mellitus in women living in Norway. BMC Medicine, 20, 318. (doi: 10.1186/s12916-022-02515-w) (PMID:36138475) (PMCID:PMC9502889)

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Abstract

Background: The type 2 diabetes risk after gestational diabetes mellitus (GDM) is twice as high in South Asian compared to European women. Current guidelines differ regarding which test to use as a screening-tool post-GDM. We aimed to identify ethnic differences in the prevalence rates and early predictors for actionable HbA1c (defined as prediabetes and diabetes) short time after GDM. Methods: This cross-sectional study, enrolling South Asian and Nordic women 1–3 years after a diagnosis of GDM, was undertaken at three hospitals in Norway. We performed a clinical and laboratory evaluation including an oral glucose tolerance test (OGTT). Medical records were used to retrieve data during pregnancy. Prediabetes was classified with HbA1c alone or combined with OGTT glucose measurements according to the WHO, WHO-IEC, and ADA criteria (fasting plasma glucose (FPG) 6.1–6.9 mmol/L, FPG 6.1–6.9 mmol/L and/or HbA1c 42-47 mmol/mol (6.0-6.4%), and FPG 5.6–6.9 mmol/L and/or HbA1c 39-47 mmol/mol (5.7-6.4%)). Ethnic differences in prevalence and predictors of glucose deterioration were assed by χ2 (Pearson) tests and logistic regression models. Results: We included 163 South Asian and 108 Nordic women. Actionable HbA1c levels were highly prevalent and more so among South Asian than Nordic women (WHO-IEC-HbA1c: 25.8% vs. 6.5% (p ≤ 0.001), ADA-HbA1c: 58.3% vs. 22.2% (p ≤ 0.001)). Although adding OGTT-data gave higher combined prevalence rates of prediabetes and diabetes (WHO: 65.6% vs. 47.2% (p ≤ 0.05), WHO-IEC: 70.6% vs. 47.2% (p ≤ 0.001), ADA: 87.8% vs. 65.7% (p ≤ 0.001)), the excess risk in the South Asian women was best captured by the HbA1c. Important predictors for glucose deterioration after GDM were: South Asian ethnicity, GDM before the index pregnancy, use of glucose-lowering drugs in pregnancy, higher age, and higher in-pregnancy fasting glucose levels. Conclusions: In women with GDM 1–3 year previously, we found high prevalence and significant ethnic differences in actionable ADA-HbA1c levels, with South Asian ethnicity, GDM before the index pregnancy, and the use of glucose-lowering drugs in pregnancy as the most important risk factors. This study reinforces the importance of annual screening—preferably with HbA1c measurements—to facilitate early intervention after GDM.

Item Type:Articles
Additional Information:This study was funded by the Research Council of Norway, grant number 273252.
Keywords:Gestational diabetes mellitus, glucose metabolism disorders, ethnic groups, prevention, overweight, glycated haemoglobin.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Gill, Professor Jason and Sattar, Professor Naveed
Authors: Sharma, A., Nermoen, I., Qvigstad, E., Tran, A. T., Sommer, C., Sattar, N., Gill, J. M.R., Gulseth, H. L., Sollid, S. T., and Birkeland, K. I.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:BMC Medicine
Publisher:BioMed Central
ISSN:1741-7015
ISSN (Online):1741-7015
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in BMC Medicine 20: 318
Publisher Policy:Reproduced under a Creative Commons License

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