ECE2018 Poster Presentations: Diabetes, Obesity and Metabolism Diabetes (to include epidemiology, pathophysiology) (73 abstracts)
Oral glucose tolerance test in reclassification of gestational diabetes after delivery – results from portuguese national registry
Nelson Cunha 1 , Leonor Gomes 1, , Sandra Paiva 1 , Luisa Ruas 1 , Diana Oliveira 1, , Adriana Lages 1 , Mara Ventura 1 , Lúcia Fadiga 1 , Diana Catarino 1 , Maria Ceu Almeida 3 & Francisco Carrilho 1
1Serviço de Endocrinologia Diabetes e Metabolismo, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 2Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; 3Serviço de Obstetrícia, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Introduction: Gestational diabetes (DG) is associated with higher risk of diabetes mellitus (DM), and it’s recommended to perform an oral glucose tolerance test (OGTT) with 75 g after delivery to its reclassification. However, not all scientific societies recommend it.
Aim: To evaluate glucose tolerance with OGTT after delivery in women with DG and the risk factors to glucose intolerance in glycaemia at 120′.
Methods: Retrospective cohort study that included women with DG who performed OGTT after deliver between 2012 and 2015, from national register of diabetes and pregnancy of Portuguese Society of Diabetes. The WHO diagnostic criteria were considered.
Results: 7435 women were included: 92.2% (n=6857) had a normal response; 0.8% (n=60) presented DM criteria (43% (n=26) at 0’ and 57% (n=34) at 120′), 1.1% (n=84) had impaired fasting glucose (IFG) and 5.9% (n=434) had impaired glucose tolerance (IGT). Women with DM criteria at reclassification presented higher values at fasting glycaemia (FG) in 1st trimester (119.7±35.0 vs 97.3±7.1 mg/dl; P<0.001), at glycaemia at 60′ at OGTT in 2nd trimester (211.3±42.3 vs 175.5±30.1 mg/dl; P<0.001), daily dose of insulin (31.4±20.5 vs 21.7±16.9 U; P<0.001) and n° of injections (2.9±1.6 vs 2.2±1.3; P<0.001), and earlier diagnosis (16.4±8.4 vs 19.7±8.5weeks; P=0.004) and delivery (37.5±2.2 vs 38.4±1.6; P<0.001). Of 32 women with FG in 1st trimester ≥126 mg/dl, 34.4% had DM criteria, 18.8% IFG and 12.5% IGT at reclassification. At reclassification, women with DM criteria at 120′, were associated with IFG after delivery (OR=24.17; IC95% 11.32–51.60), insulin therapy (OR=7.40; IC95% 3.14–17.44), DG diagnosis at 60′ in 2nd trimester OGTT (OR=3.85; IC 95% 1.30–11.40), newborn large for gestational age (LGA) (OR=3.20; IC95% 1.59–6.46) and DG in previous pregnancy (OR=2.59; IC95% 1.36–4.95). Women with IGT were associated with these risk factors and also age ≥35years (OR=1.54; IC 95% 1.27–1.87).
Conclusion: The prevalence of glucose intolerance after delivery was 7.8%, with the majority of women (5.9%) being diagnosed with IGT, a condition with increased cardiovascular risk. DM was diagnosed in 0.8% of women, exclusively by glycaemia at 120′ in 57%. DM diagnosis at 120′ was associated with DG in previous pregnancy, DG diagnosis at 60′ in 2nd trimester OGTT, insulin therapy during pregnancy, newborn LGA and IFG after delivery. These data reinforces the importance of OGTT for correct reclassification of DG, with increased relevance in women with risk factors.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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