title: The inter- and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes.
abstract: OBJECTIVE
  We investigated the contribution of gestational diabetes mellitus (GDM) to the historic epidemic of type 2 diabetes mellitus (T2DM) in Saskatchewan.
  
  
  METHODS
  We constructed a population-level simulation model of the inter- and intragenerational interaction of GDM and T2DM for the period 1956 to 2006. The model was stratified by gender, ethnicity, and age; parameterized with primary and secondary data; and calibrated to match historic time series. Risk of diabetes was sigmoidally trended to capture exogenous factors.
  
  
  RESULTS
  Best-fit calibrations suggested GDM may be responsible for 19% to 30% of the cases of T2DM among Saskatchewan First Nations people, but only for approximately 6% of cases among other persons living in Saskatchewan. The estimated contribution of GDM to the growth in T2DM was highly sensitive to assumptions concerning the post-GDM risk of developing T2DM.
  
  
  CONCLUSIONS
  GDM may be an important driver for the T2DM epidemic in many subpopulations. Because GDM is a readily identifiable, preventable, and treatable condition, investments in prevention, rapid diagnosis, and evidence-based treatment of GDM in at-risk populations may offer substantial benefit in lowering the T2DM burden over many generations. Model-informed data collection can aid in assessing intervention tradeoffs.
authors.affiliation: Department of Computer Science, University of Saskatchewan, Saskatoon, SK, Canada. nathaniel.osgood@usask.ca
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Osgood
authors.forename: Roland F
authors.initials: RF
authors.lastname: Dyck
authors.forename: Winfried K
authors.initials: WK
authors.lastname: Grassmann
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D016640:Diabetes, Gestational / Q000208:ethnology*; D005192:Family Health; D005260:Female; D006801:Humans; D007198:Indians, North American; D016901:Intergenerational Relations; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012525:Saskatchewan / Q000453:epidemiology