ABSTRACT
Las mujeres con diabetes mellitus gestacional (DMG) previa presentan mayor riesgo de desarrollar diabetes mellitus (DM). En estas mujeres, se recomienda realizar una reclasificación metabólica después del parto. El objetivo de este estudio fue valorar el rendimiento de la hemoglobina A1c para la evaluación postparto en mujeres con DMG reciente y evaluar la concordancia en el diagnóstico de las distintas formas de alteración de la tolerancia a la glucosa con el test de tolerancia con sobrecarga oral de 75g de glucosa (TTOG 75g), método recomendado actualmente para dicha reclasificación. Material y métodos56 mujeres con DMG reciente fueron reclasificadas tras el parto en nuestro centro según los criterios de la Asociación Americana de Diabetes (ADA). Se analizó la concordancia en el diagnóstico entre la hemoglobina A1c y el TTOG 75g y se evaluó el rendimiento de la hemoglobina A1c para el diagnóstico de DM y para la detección de cualquier forma de alteración de tolerancia a la glucosa. Resultados Se diagnosticó DM en 7 mujeres y otras formas de alteración de la tolerancia a la glucosa en 25. El índice kappa de concordancia en el diagnóstico fue de 0,22. Una hemoglobina A1c ≥ 5,7% presentó una sensibilidad de 47% y una especificidad de 71% para identificar cualquier forma de alteración de la tolerancia a la glucosa. Una hemoglobina A1c ≥ 6,5 presentó una sensibilidad de 29% y una especificidad de 100% para el diagnóstico de DM. El área bajo la curva ROC para la detección de cualquier forma de alteración de la tolerancia a la glucosa fue 0,57 y para el diagnóstico de DM de 0,81.ConclusionesLa hemoglobina A1c, empleando los puntos de corte de la ADA, no es apropiada para la reclasificación metabólica de mujeres con antecedente reciente de DMG (AU)
Women with gestational diabetes mellitus (GDM) have an increased risk for developing diabetes mellitus (DM). Their postpartum metabolic classification using a 75g oral glucose tolerance test (75g OGTT) is recommended. The purpose of this study was to assess the value of hemoglobin A1c for postpartum evaluation in women with recent gestational diabetes mellitus. Patients and methods Fifty-six women with recent GDM underwent a 75g OGTT at our center to assess postpartum changes in carbohydrate metabolism and were classified using diagnostic criteria of the American Diabetes Association (ADA). Receiver operating characteristic (ROC) curves analysis was used to assess the diagnostic performance of hemoglobin A1c, and kappa index was used to evaluate diagnostic agreement between hemoglobin A1c and 75g OGTT. Results DM was diagnosed in 7 women, and other categories of increased risk for DM in 25 women. Kappa index for diagnosis agreement was 0,22. Hemoglobin A1c ≥ 5.7% had 47% sensitivity and 71% specificity for identifying any change in carbohydrate metabolism. A hemoglobin A1c value ≥ 6.5 had 29% sensitivity and 100% specificity for diagnosis of DM. Area under the ROC curve was 0.57 for identifying any change in carbohydrate metabolism and 0.81 for diagnosis of DM. Conclusion Using ADA cutoff values, hemoglobin A1c is not appropriate for postpartum glucose tolerance evaluation in women with recent gestational diabetes mellitus (AU)
Subject(s)
Humans , Female , Diabetes, Gestational/physiopathology , Diabetes Mellitus/diagnosis , Glycated Hemoglobin/analysis , Glucose Metabolism Disorders/diagnosis , Glucose Tolerance Test , Glycemic Index , Prospective StudiesABSTRACT
INTRODUCTION: Women with gestational diabetes mellitus (GDM) have an increased risk for developing diabetes mellitus (DM). Their postpartum metabolic classification using a 75g oral glucose tolerance test (75g OGTT) is recommended. The purpose of this study was to assess the value of hemoglobin A1c for postpartum evaluation in women with recent gestational diabetes mellitus. PATIENTS AND METHODS: Fifty-six women with recent GDM underwent a 75g OGTT at our center to assess postpartum changes in carbohydrate metabolism and were classified using diagnostic criteria of the American Diabetes Association (ADA). Receiver operating characteristic (ROC) curves analysis was used to assess the diagnostic performance of hemoglobin A1c, and kappa index was used to evaluate diagnostic agreement between hemoglobin A1c and 75g OGTT. RESULTS: DM was diagnosed in 7 women, and other categories of increased risk for DM in 25 women. Kappa index for diagnosis agreement was 0,22. Hemoglobin A1c ≥ 5.7% had 47% sensitivity and 71% specificity for identifying any change in carbohydrate metabolism. A hemoglobin A1c value ≥ 6.5 had 29% sensitivity and 100% specificity for diagnosis of DM. Area under the ROC curve was 0.57 for identifying any change in carbohydrate metabolism and 0.81 for diagnosis of DM. CONCLUSION: Using ADA cutoff values, hemoglobin A1c is not appropriate for postpartum glucose tolerance evaluation in women with recent gestational diabetes mellitus.
