title: Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA1cin an Indian cohort.
abstract: To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India.
  
  
  
  All women (n = 989) from two obstetric units in New Delhi and Hyderabad with a history of gestational diabetes were invited to participate, of whom 366 (37%) agreed. Sociodemographic, medical and anthropometric data were collected and 75-g oral glucose tolerance test were carried out.
  
  
  
  Within 5 years (median 14 months) of the pregnancy in which they were diagnosed with gestational diabetes, 263 (72%) women were dysglycaemic, including 119 (32%) and 144 (40%) with Type 2 diabetes and prediabetes, respectively. A higher BMI [odds ratio 1.16 per 1-kg/m2greater BMI (95% CI 1.10, 1.28)], presence of acanthosis nigricans [odds ratio 3.10, 95% CI (1.64, 5.87)], postpartum screening interval [odds ratio 1.02 per 1 month greater screening interval 95% CI (1.01, 1.04)] and age [odds ratio 1.10 per 1-year older age 95% CI (1.04, 1.16)] had a higher likelihood of having dysglycaemia. The American Diabetes Association-recommended threshold HbA1cvalue of ≥ 48 mmol/mol (6.5%) had a sensitivity and specificity of 81.4 and 90.7%, respectively, for determining the presence of Type 2 diabetes postpartum.
  
  
  
  The high post-pregnancy conversion rates of gestational diabetes to diabetes reported in the present study reinforce the need for mandatory postpartum screening and identification of strategies for preventing progression to Type 2 diabetes. Use of the American Diabetes Association-recommended HbA1cthreshold for diabetes may lead to significant under-diagnosis.
authors.affiliation: Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Y
authors.initials: Y
authors.lastname: Gupta
authors.affiliation: Centre for Chronic Disease Control, Gurgaon, India.
authors.forename: D
authors.initials: D
authors.lastname: Kapoor
authors.affiliation: Endocrine Unit-Department of Medicine, Goa Medical College, Goa, India.
authors.forename: A
authors.initials: A
authors.lastname: Desai
authors.affiliation: Division of Epidemiology, George Institute for Global Health, Hyderabad, India.
authors.forename: D
authors.initials: D
authors.lastname: Praveen
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Centre for Fertility Management-MHRT, Hyderabad, India.
authors.forename: R
authors.initials: R
authors.lastname: Rozati
authors.affiliation: Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: N
authors.initials: N
authors.lastname: Bhatla
authors.affiliation: Centre for Chronic Disease Control, Gurgaon, India.
authors.forename: D
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: School of Medicine and Public Health, University of Newcastle and St Vincents Health Network, Sydney, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Reddy
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: N
authors.initials: N
authors.lastname: Tandon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D016640:Diabetes, Gestational / Q000097:blood / Q000208:ethnology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007194:India / Q000453:epidemiology; D049590:Postpartum Period; D011236:Prediabetic State / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human