The low-risk perception of developing type 2 diabetes among women with a previous history of gestational diabetes: a qualitative study

Women with a history of gestational diabetes mellitus (GDM) have a high chance of developing type 2 diabetes mellitus (T2DM) following the index pregnancy, however, little is known of women's perception of this risk. The objectives were to (1) determine women's perception of risk of future development of T2DM following a GDM pregnancy and (2) describe the prevalence of undetected dysglycaemia in a Canadian population. The study was designed as a 9–11 year follow-up study of women previously enrolled in a randomized controlled trial of tight versus minimal intervention for GDM. Women's perception of future risk of diabetes was determined by questionnaire. Fasting lipid profile, height and weight were performed on all participants. Oral glucose tolerance tests were performed on all women without prior history of diabetes mellitus type 2 (DM2). The study was conducted at Ottawa Hospital General Campus and Children's Hospital of Eastern Ontario, in Ottawa, Canada. Eighty-nine of 299 (30%) of the original cohort were recruited. Eighty-eight women completed the questionnaire and 77 women without known diabetes underwent two hour glucose tolerance testing. Twenty-three (30%) felt their risk was no different than other women or did not know, 27 (35%) felt risk was increased a little and 27 (35%) felt risk was increased a lot. Only 52% (40/77) had normal glucose tolerance. Of all, 25/88 (28%) patients had diabetes (11 previously diagnosed and 14 diagnosed within the study). Of those newly diagnosed with DM2, four (29%) were diagnosed by fasting glucose, six (42%) by two hour glucose tolerance test (GTT) alone and four (29%) by both. Twenty-four of the women (27%) had impaired glucose tolerance (IGT). Of those with IGT, 12 (57%) had a fasting food glucose < 5.6 mmol/L. In the high-risk perception group with newly diagnosed diabetes, two were overweight, seven were obese, four had a family history of DM2, and all had a waist circumference >88 cm. In conclusion the perception of being at high risk for T2DM did not prevent women from having undetected T2DM. Many factors are likely to contribute to this, including the reliance on screening tests (i.e. fasting glucose) rather than a two hour GTT to detect diabetes. Further studies on effective public and health-care provider education and intervention are needed to identify this high-risk population.

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1386-P: Long-Term Weight Change after Pregnancy and Type 2 Diabetes Risk in Women with a History of Gestational Diabetes

Diabetes ◽

10.2337/db20-1386-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1386-P

Author(s):

SYLVIA E. BADON ◽

FEI XU ◽

CHARLES QUESENBERRY ◽

ASSIAMIRA FERRARA ◽

MONIQUE M. HEDDERSON

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Weight Change ◽

Diabetes Risk ◽

History Of

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myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes: A prospective, randomized, placebo-controlled study

Diabetes Care ◽

10.2337/dc12-1371 ◽

2013 ◽

Vol 36 (4) ◽

pp. 854-857 ◽

Cited By ~ 75

Author(s):

R. D'Anna ◽

A. Scilipoti ◽

D. Giordano ◽

C. Caruso ◽

M. L. Cannata ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Family History ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Controlled Study ◽

History Of

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Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study

Journal of Clinical Medicine ◽

10.3390/jcm10040843 ◽

2021 ◽

Vol 10 (4) ◽

pp. 843

Author(s):

Anne Timm ◽

Karoline Kragelund Nielsen ◽

Ulla Christensen ◽

Helle Terkildsen Maindal

Keyword(s):

Type 2 Diabetes ◽

Qualitative Study ◽

Gestational Diabetes ◽

Healthcare Professionals ◽

Care Pathway ◽

Adverse Outcomes ◽

Treatment Pathway ◽

Healthy Behaviors ◽

The Cross

Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: (1) “professional identities”, which were identified across healthcare professionals and shaped care practices; (2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after pregnancy; and (3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes.

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Visit-to-visit blood pressure variability in patients with type 2 diabetes with and without previous history of cardiovascular disease

Journal of Hypertension ◽

10.1097/hjh.0000000000002443 ◽

2020 ◽

Vol 38 (9) ◽

pp. 1737-1744

Author(s):

Maria Grazia Radaelli ◽

Stefano Ciardullo ◽

Silvia Perra ◽

Rosa Cannistraci ◽

Eleonora Bianconi ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Blood Pressure Variability ◽

Previous History ◽

History Of

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Lactation Duration and Long-term Risk for Incident Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus

Diabetes Care ◽

10.2337/dc19-2237 ◽

2020 ◽

Vol 43 (4) ◽

pp. 793-798 ◽

Cited By ~ 8

Author(s):

Sylvia H. Ley ◽

Jorge E. Chavarro ◽

Mengying Li ◽

Wei Bao ◽

Stefanie N. Hinkle ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Incident Type ◽

Incident Type 2 Diabetes ◽

History Of ◽

Lactation Duration

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Genetic factors and risk of type 2 diabetes among women with a history of gestational diabetes: findings from two independent populations

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000850 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000850 ◽

Cited By ~ 2

Author(s):

Mengying Li ◽

Mohammad L Rahman ◽

Jing Wu ◽

Ming Ding ◽

Jorge E Chavarro ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

White Women ◽

Healthy Eating Index ◽

Dietary Quality ◽

Genome Wide Association Studies ◽

Genetic Determinants ◽

Increased Risk ◽

History Of

ObjectiveWomen with a history of gestational diabetes mellitus (GDM) have an exceptionally high risk for type 2 diabetes (T2D). Yet, little is known about genetic determinants for T2D in this population. We examined the association of a genetic risk score (GRS) with risk of T2D in two independent populations of women with a history of GDM and how this association might be modified by non-genetic determinants for T2D.Research design and methodsThis cohort study included 2434 white women with a history of GDM from the Nurses’ Health Study II (NHSII, n=1884) and the Danish National Birth Cohort (DNBC, n=550). A GRS for T2D was calculated using 59 candidate single nucleotide polymorphisms for T2D identified from genome-wide association studies in European populations. An alternate healthy eating index (AHEI) score was derived to reflect dietary quality after the pregnancy affected by GDM.ResultsWomen on average were followed for 21 years in NHSII and 13 years in DNBC, during which 446 (23.7%) and 155 (28.2%) developed T2D, respectively. The GRS was generally positively associated with T2D risk in both cohorts. In the pooled analysis, the relative risks (RRs) for increasing quartiles of GRS were 1.00, 0.97, 1.25 and 1.19 (p trend=0.02). In both cohorts, the association appeared to be stronger among women with poorer (AHEI <median) than better dietary quality (AHEI ≥median), although the interaction was not significant. For example, in NHSII, the RRs across increasing quartiles of GRS were 1.00, 0.99, 1.51 and 1.29 (p trend=0.06) among women with poorer dietary quality and 1.00, 0.83, 0.81 and 0.94 (p trend=0.79) among women with better dietary quality (p interaction=0.11).ConclusionsAmong white women with a history of GDM, higher GRS for T2D was associated with an increased risk of T2D.

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