The Inter- and Intragenerational Impact of Gestational Diabetes on the Epidemic of Type 2 Diabetes

Objectives. We investigated the contribution of gestational diabetes mellitus (GDM) to the historic epidemic of type 2 diabetes mellitus (T2DM) in Saskatchewan. Methods. We constructed a population-level simulation model of the inter- and intragenerational interaction of GDM and T2DM for the period 1956 to 2006. The model was stratified by gender, ethnicity, and age; parameterized with primary and secondary data; and calibrated to match historic time series. Risk of diabetes was sigmoidally trended to capture exogenous factors. Results. Best-fit calibrations suggested GDM may be responsible for 19% to 30% of the cases of T2DM among Saskatchewan First Nations people, but only for approximately 6% of cases among other persons living in Saskatchewan. The estimated contribution of GDM to the growth in T2DM was highly sensitive to assumptions concerning the post-GDM risk of developing T2DM. Conclusions. GDM may be an important driver for the T2DM epidemic in many subpopulations. Because GDM is a readily identifiable, preventable, and treatable condition, investments in prevention, rapid diagnosis, and evidence-based treatment of GDM in at-risk populations may offer substantial benefit in lowering the T2DM burden over many generations. Model-informed data collection can aid in assessing intervention tradeoffs. (Am J Public Health. 2011;101:173-179. doi:10.2105/AJPH.2009.186890)