Influencing factors of occurrence of type 2 diabetes in women with gestational diabetes mellitus within 2 years after delivery and prediction model construction

Objective To explore the influencing factors and prediction model construction of type 2 diabetes (T2DM) in women with gestational diabetes mellitus (GDM) within 2 years after delivery.

Methods A total of 359 patients who diagnosed as GDM in prenatal examination and delivered in Suzhou Ninth Hospital Affiliated to Soochow University were selected for a 2-year follow-up. According to whether T2DM occurred during the follow-up period, the patients were divided into T2DM group and non-T2DM group. Univariate analysis was performed on data of the two groups, and multivariate Logistic regression analysis was performed to establish the prediction model. The goodness of fit test and receiver operating characteristic (ROC) curve were used to analyze and evaluate the effectiveness of the model.

Results During the 2-year postpartum follow-up, 53 cases fell off, and 306 patients completed the follow-up. Among the 306 patients who completed the 2-year follow-up, 266 were not diagnosed with T2DM during the follow-up period (non-T2DM group), while 40 were diagnosed with T2DM (T2DM group). Statistically significant differences were observed between the T2DM andnon-T2DM groups in family history of diabetes, pre-pregnancy body mass index (BMI), 2-hour postprandial glucose level (OGTT-2hPG) for GDM diagnosis, the number of visits to prenatal classes during pregnancy, postpartum BMI, and postpartum visceral fat area (VFA) (P < 0.05). Multivariate Logistic regression analysis revealed that family history of diabetes, OGTT-2hPG, postpartum BMI, and postpartum VFA were influencing factors in the development of T2DM within 2 years postpartum among GDM patients (P < 0.05), while attending prenatal classes during pregnancy emerged as a protective factor (P < 0.05). The Hosmer-Lemeshow goodness-of-fit test indicated good fit of the prediction model (χ²=2.076, P=0.665). The area under the ROC curve for the model was 0.891 (95%CI, 0.828 to 0.954), with a cutoff value of 0.795 corresponding to the maximum Youden index, a sensitivity of 0.890 and a specificity of 0.847.

Conclusion The risk prediction model based on OGT-2hPG index during pregnancy, the number of pregnant women attending school during pregnancy, family history of diabetes, postpartum BMI, VFA index has a certain predictive value for the risk of T2DM in GDM patients within 2 years after delivery.