Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study

Bardugo, A; Bendor, CD; Rotem, RS; Tsur, AM; Derazne, E; Gerstein, HC; Tzur, D; Pinhas-Hamiel, O; Cukierman-Yaffe, T; Raz, I; Hod, M; Tirosh, A; Lebenthal, Y; Afek, A; Chodick, G; Twig, G

doi:10.1016/s2213-8587(23)00062-1

Gestational diabetes & diabetes in pregnancy

Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study

Lancet Diabetes EndocrinolPublished 31 Mar 2023Population-based cohort study

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Authors' conclusion

Gestational glucose intolerance, including conditions not meeting gestational diabetes criteria of the two-step strategy, confers a high risk of type 2 diabetes in young adulthood. These conditions should be recognised as risk factors for type 2 diabetes, especially among women with abnormal fasting glucose concentrations during pregnancy.

Study context

Population: Israeli women evaluated in adolescence (age 16–20 years) before military service who later underwent two-step gestational diabetes screening, 2001–2019; Maccabi Healthcare Services
Participants: 177,241 women1,882,647 person-years

Exposure: Degrees of gestational glucose intolerance vs gestational normoglycaemia
Outcome: Incident T2D in the MHS diabetes registry
Follow-up: Median 10.8 (IQR 5.2-16.4) years

Methodological detailslinked national conscription database and Maccabi Healthcare Services (MHS) registry

Linked national conscription database and MHS registry

Main finding

As reported in the abstract

Incident T2D

Gestational normoglycaemia

2.6 per 10 000 person-years

CI 2.4–2.9

Abnormal glucose challenge test (GCT), normal oral glucose tolerance test (OGTT)

8.9 per 10 000 person-years

CI 7.4–10.6

One abnormal OGTT value

26.1 per 10 000 person-years

CI 22.4–30.1

GDM

71.9 per 10 000 person-years

CI 66.0–78.3

Each group vs gestational normoglycaemiaAdjusted hazard ratio (95% CI)P value

Abnormal GCT, normal OGTT

3.39(2.77–4.16)

P < 0.0001

One abnormal OGTT value

9.11(7.64–10.86)

P < 0.0001

GDM

24.84(21.78–28.34)

P < 0.0001

Women diagnosed with T2D: 1262

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk vs gestational normoglycaemia ←→ Higher risk vs gestational normoglycaemia →	aHR	P value
Incident T2D, isolated elevated fasting glucoseIsolated elevated fasting glucosevs Gestational normoglycaemia	0.050.21520	11.81 (95% CI 8.58–16.25)	P < 0.0001
Incident T2D, GDM with abnormal fasting glucoseGDM with abnormal fasting glucosevs Gestational normoglycaemia	0.050.21520	38.02 (CI 32.41–44.61)	P < 0.0001
	0.050.21520Adjusted hazard ratio (log scale)

Reference

Authors: Bardugo A, Bendor CD, Rotem RS, Tsur AM, Derazne E, Gerstein HC, et al.
All 16 authors
Bardugo A, Bendor CD, Rotem RS, Tsur AM, Derazne E, Gerstein HC, Tzur D, Pinhas-Hamiel O, Cukierman-Yaffe T, Raz I, Hod M, Tirosh A, Lebenthal Y, Afek A, Chodick G, Twig G
Journal: The Lancet Diabetes & Endocrinology
Published: 31 Mar 2023
DOI: 10.1016/s2213-8587(23)00062-1
PubMed: 37011646

Topic: Gestational diabetes & diabetes in pregnancy

Exposure definitions

Abnormal GCT, normal OGTT: abnormal 50 g GCT (≥140 mg/dL) with normal 100 g OGTT
One abnormal OGTT value: in the fasting state or 1 h, 2 h, or 3 h post-challenge
GDM: gestational diabetes by two-step strategy, Carpenter-Coustan thresholds

Key notes

Crude incidence rates
Hazard ratios (HRs) adjusted for sociodemographic characteristics, adolescent BMI and age at gestational screening

Original publication

Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study. Lancet Diabetes Endocrinol. Published 31 March 2023. doi:10.1016/s2213-8587(23)00062-1

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