1245-P: GDM Patients and Prognostic Factors for Subsequent Type 2 Diabetes Mellitus—An Electronic Cohort Review

IF 6.2 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes Pub Date : 2024-07-19 DOI:10.2337/db24-1245-p

RYUNG S. KIM, LIHUA LI, CARMEN R. ISASI, ATHENA PHILIS-TSIMIKAS, JEE-YOUNG MOON, JUNXIU LIU, DIANA S. WOLFE, CAROL J. LEVY

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Abstract

Introduction: GDM affects 8-10% of pregnancies in the US and nearly 50% of these women have subsequent diabetes diagnosis. However, research on the prognostic factors of T2D incidence among women with GDM is scarce, due to the limited sample sizes. We aim 1) to construct a large electronic cohort of GDM and 2) to build a prognostic model for T2D incidence among patients with GDM. Methods: We extracted EMRs of patients diagnosed with GDM between 2016 and 2022 from two health systems in NYC: Montefiore (MMC) and Mt. Sinai. Only MMC patients were analyzed in this report. Prognostic factors during pregnancy included 32 baseline & pregnancy characteristics, 76 office visit variables, 418 lab tests, and prescription of 31 drugs. Time from GDM diagnosis to T2D was analyzed using proportional hazards models. Results: We collected EMRs of 6,014 GDM patients at MMC who were racially diverse with a median age of 32, BMI of 31.8 kg/m2. Among them, 355 (5.9%) later developed T2D, yielding a high T2D incidence rate (21.1 per 1,000 PY). There was an immediate heightened risk: T2D incidence proportions were 3.8% by 1 year after GDM diagnosis, and 11.9% by 5 years. The risk was elevated in Hispanic White (HR=2.3), Hispanic Non-White (HR=2.0), and Black (HR=2.3) compared to non-Hispanic White (p<0.00001). The risk was associated with higher BMI during pregnancy, insulin or oral-agent control compared to diet therapy, younger gestational age at GDM diagnosis, and Caesarean delivery. Lab findings associated with T2D risk included maternal glucose levels, erythrocyte MCH, monocytes, and ketone. T2D incidence was also associated with prescription of insulin therapy, oral treatment, aspirin, and iron supplements likely indicating underlying obstetric complications. Conclusions: A large electronic cohort of GDM patients identified potential prognostic factors of subsequent T2D. Future directions include calibration of 2 cohorts to establish the largest electronic cohort of GDM to date and building prognostic models for T2D risk. Disclosure R.S. Kim: None. L. Li: None. C.R. Isasi: None. A. Philis-Tsimikas: Advisory Panel; Dexcom, Inc., Lilly Diabetes, Novo Nordisk, Sanofi, Medtronic, Bayer Inc. J. Moon: None. J. Liu: None. D.S. Wolfe: None. C.J. Levy: Research Support; Dexcom, Inc. Consultant; Dexcom, Inc. Research Support; MannKind Corporation, T1D Exchange, Tandem Diabetes Care, Inc., Abbott, Insulet Corporation. Funding New York Regional Center for Diabetes Translation Research Pilot & Feasibility Project

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1245-P： GDM 患者及其继发 2 型糖尿病的预后因素--电子队列回顾

导言：在美国，8%-10%的孕妇会患上 GDM，其中近 50%的孕妇随后会被确诊为糖尿病。然而，由于样本量有限，有关 GDM 妇女 T2D 发病率预后因素的研究很少。我们的目标是：1）构建一个大型的 GDM 电子队列；2）建立一个 GDM 患者 T2D 发生率的预后模型。研究方法我们从纽约市的两个医疗系统中提取了 2016 年至 2022 年间诊断为 GDM 患者的 EMR：西奈山。本报告仅对 MMC 患者进行了分析。妊娠期预后因素包括 32 项基线&；妊娠特征、76 项门诊变量、418 项实验室检查和 31 种药物处方。使用比例危险模型分析了从 GDM 诊断到 T2D 的时间。结果：我们收集了 6,014 名 GDM 患者的 EMR，这些患者来自不同种族，中位年龄为 32 岁，体重指数为 31.8 kg/m2。其中有 355 人（5.9%）后来患上了 T2D，T2D 发病率很高（21.1‰）。风险立即增加：在确诊 GDM 后 1 年，T2D 的发病率为 3.8%，5 年后为 11.9%。与非西班牙裔白人相比，西班牙裔白人（HR=2.3）、西班牙裔非白人（HR=2.0）和黑人（HR=2.3）的风险更高（p<0.00001）。该风险与孕期体重指数（BMI）较高、胰岛素或口服药物控制（而非饮食疗法）、GDM 诊断时的妊娠年龄较小及剖腹产有关。与 T2D 风险相关的实验室检查结果包括母体血糖水平、红细胞 MCH、单核细胞和酮体。T2D发病率还与胰岛素治疗处方、口服治疗、阿司匹林和铁补充剂有关，这可能表明潜在的产科并发症。结论一个大型的 GDM 患者电子队列确定了随后 T2D 的潜在预后因素。未来的研究方向包括校准两个队列，以建立迄今为止最大的 GDM 电子队列，并建立 T2D 风险预后模型。披露 R.S. Kim：无。L. Li: 无。C.R. Isasi：无。A. Philis-Tsimikas：顾问团；Dexcom 公司、礼来糖尿病公司、诺和诺德公司、赛诺菲公司、美敦力公司、拜耳公司。J. Moon：无：J.Moon：无。J. Liu: None.D.S. Wolfe: None.C.J. Levy：研究支持；Dexcom, Inc.顾问；Dexcom, Inc.研究支持；MannKind 公司、T1D Exchange、Tandem 糖尿病护理公司、雅培公司、Insulet 公司。资助纽约地区糖尿病转化研究中心试点项目；可行性项目

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来源期刊

Diabetes 医学-内分泌学与代谢

CiteScore

12.50

自引率

2.60%

发文量

1968

审稿时长

1 months

期刊介绍： Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.