Risk analysis of postpartum type 2 diabetes in patients with family history of diabetes and gestational diabetes mellitus / 中国医师杂志

ABSTRACT

Objective:To analyze the risk factors of postpartum type 2 diabetes (T2DM) in patients with family history of diabetes mellitus with gestational diabetes mellitus (GDM).Methods:From January 2017 to January 2019, 275 patients with GDM and family history of diabetes were selected. According to the occurrence of postpartum T2DM, the patients were divided into postpartum normal group (207 cases) and postpartum disease group (68 cases). The clinical data of the two groups were compared, and the independent risk factors of postpartum T2DM were analyzed by logistic regression, and a line chart prediction model was constructed. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive ability of the model. X-tile software was used to obtain the integral truncation value of the line graph model, and survival curve was drawn and internal verification was carried out.Results:Of 275 GDM patients, 68 had T2DM after delivery, with a incidence rate of 24.73%. There were significant differences between the two groups in age, body mass index (BMI) before pregnancy, weight gain during pregnancy, fasting blood glucose during pregnancy and glycosylated hemoglobin during pregnancy (all P<0.05). There was no significant difference in pregnancy outcome between the two groups ( P>0.05). Age≥30 years, high pre-pregnancy BMI, weight gain≥6 kg during pregnancy, fasting blood glucose>5.8 mmol/L during pregnancy, and glycosylated hemoglobin>5.2% during pregnancy were independent risk factors for postpartum T2DM in GDM patients with diabetes family history (all P<0.05). The nomogram model predicted that the C-index value of postpartum T2DM was 0.912 (95% CI 0.854-0.960), and the area under the ROC curve was 0.799 (95% CI 0.742-0.856), with good discrimination; The calibration curve indicated that the accuracy of the model was good. According to the integral cutoff value of the line chart model, the probability of postpartum T2DM in GDM patients with family history of diabetes was divided into three groups low (≤67.24 points), medium (>67.24 points and ≤129.82 points) and high-risk groups. The incidence rate of postpartum T2DM were 13.71%, 29.29% and 59.62%, respectively, with statistical significance (all P<0.05). Conclusions:Age≥30 years old, high pre-pregnancy BMI, pregnancy weight gain≥6 kg, pregnancy fasting blood glucose>5.8 mmol/L and pregnancy glycosylated hemoglobin>5.2% were independent risk factors for postpartum T2DM in GDM patients with family history of diabetes.