Is early postpartum HbA1c an appropriate risk predictor after pregnancy with gestational diabetes mellitus?

被引:31
作者
Goebl, Christian S. [1 ,2 ]
Bozkurt, Latife [2 ]
Yarragudi, Rajashri [2 ]
Tura, Andrea [3 ]
Pacini, Giovanni [3 ]
Kautzky-Willer, Alexandra [2 ]
机构
[1] Med Univ Vienna, Dept Gynecol & Obstet, Div Feto Maternal Med, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Internal Med 3, Div Endocrinol & Metab, Unit Gender Med, A-1090 Vienna, Austria
[3] CNR, Inst Biomed Engn, Metab Unit, Padua, Italy
基金
奥地利科学基金会;
关键词
HbA1c; Gestational diabetes mellitus; Oral glucose tolerance test; Postpartum risk stratification; Impaired fasting glucose; Impaired glucose tolerance; ORAL GLUCOSE-TOLERANCE; BETA-CELL FUNCTION; INSULIN SENSITIVITY; HEMOGLOBIN A(1C); IRON-DEFICIENCY; PLASMA-GLUCOSE; DIAGNOSIS; HBA(1C); WOMEN; A1C;
D O I
10.1007/s00592-014-0574-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Compared to the 2-h oral glucose tolerance test (OGTT), the assessment of HbA1c was proposed as a less time-consuming alternative to detect pathologies in carbohydrate metabolism. This report aims to assess the predictive accuracy of HbA1c to detect alterations in glucose disposition early after gestational diabetes mellitus (GDM) pregnancy. A detailed metabolic characterization was performed in 77 women with previous GDM (pGDM) and 41 controls 3-6 month after delivery: 3-h OGTT, frequently sampled intravenous glucose tolerance test. Follow-up examinations of pGDMs were performed up to 10 years. HbA1c (venous samples, HPLC) was assessed at baseline as well as during the follow-up period (475 patient contacts). Moderate associations were observed between HbA1c and measurements of plasma glucose during the OGTT at the baseline examination: The strongest correlation was found for FPG (r = 0.40, p < 0.001), decreasing after ingestion. No associations were detected between HbA1c and OGTT dynamics of insulin or C-peptide. Moreover, baseline HbA1c showed only modest correlation with insulin sensitivity (r = -0.25, p = 0.010) and disposition index (r = -0.26, p = 0.007). A linear model including fasting as well as post-load glucose levels was not improved by HbA1c. However, pGDM females with overt diabetes manifestation during the follow-up period showed more pronounced increasing HbA1c in contrast to females remaining normal glucose tolerant or developing prediabetes. It is suggested that the performance of HbA1c assessed early after delivery is inferior to the OGTT for the detection of early alterations in glucose metabolism. However, an increase in HbA1c levels could be used as an indicator of risk for diabetes manifestation.
引用
收藏
页码:715 / 722
页数:8
相关论文
共 39 条
  • [1] Contributions of β-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose
    Abdul-Ghani, MA
    Tripathy, D
    DeFronzo, RA
    [J]. DIABETES CARE, 2006, 29 (05) : 1130 - 1139
  • [2] Plasma Glucose Concentration and Prediction of Future Risk of Type 2 Diabetes
    Abdul-Ghani, Muhammad A.
    DeFronzo, Ralph A.
    [J]. DIABETES CARE, 2009, 32 : S194 - S198
  • [3] Importance of quantifying insulin secretion in relation to insulin sensitivity to accurately assess beta cell function in clinical studies
    Ahrén, B
    Pacini, G
    [J]. EUROPEAN JOURNAL OF ENDOCRINOLOGY, 2004, 150 (02) : 97 - 104
  • [4] Amer Diabet Assoc, 2011, DIABETES CARE, V34, pS11, DOI [10.2337/dc10-S062, 10.2337/dc14-S081, 10.2337/dc11-S011, 10.2337/dc13-S011, 10.2337/dc13-S067, 10.2337/dc12-s064, 10.2337/dc11-S062, 10.2337/dc10-S011, 10.2337/dc12-s011]
  • [5] Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis
    Bellamy, Leanne
    Casas, Juan-Pablo
    Hingorani, Aroon D.
    Williams, David
    [J]. LANCET, 2009, 373 (9677) : 1773 - 1779
  • [6] Pathogenetic Mechanisms and Cardiovascular Risk Differences between HbA1c and oral glucose tolerance test for the diagnosis of glucose tolerance
    Bianchi, Cristina
    Miccoli, Roberto
    Bonadonna, Riccardo C.
    Giorgino, Francesco
    Frontoni, Simona
    Faloia, Emanuela
    Marchesini, Giulio
    Dolci, Maria A.
    Cavalot, Franco
    Cavallo, Gisella M.
    Leonetti, Frida
    Del Prato, Stefano
    [J]. DIABETES CARE, 2012, 35 (12) : 2607 - 2612
  • [7] Fatty Liver Index Predicts Further Metabolic Deteriorations in Women with Previous Gestational Diabetes
    Bozkurt, Latife
    Goebl, Christian S.
    Tura, Andrea
    Chmelik, Marek
    Prikoszovich, Thomas
    Kosi, Lana
    Wagner, Oswald
    Roden, Michael
    Pacini, Giovanni
    Gastaldelli, Amalia
    Kautzky-Willer, Alexandra
    [J]. PLOS ONE, 2012, 7 (02):
  • [8] Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c
    Cohen, Robert M.
    Franco, Robert S.
    Khera, Paramjit K.
    Smith, Eric P.
    Lindsell, Christopher J.
    Ciraolo, Peter J.
    Palascak, Mary B.
    Joiner, Clinton H.
    [J]. BLOOD, 2008, 112 (10) : 4284 - 4291
  • [9] HbA1c for the Diagnosis of Diabetes and Prediabetes: Is It Time for a Mid-Course Correction?
    Cohen, Robert M.
    Haggerty, Shannon
    Herman, William H.
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2010, 95 (12) : 5203 - 5206
  • [10] Fonseca VA, 2009, DIABETES CARE, V32, P1, DOI [10.2337/dc09-9033, 10.2337/dc09-S301]