A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes

INTRODUCTION: Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment...

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Autores principales: Man, Bernice, Schwartz, Alan, Pugach, Oksana, Xia, Yinglin, Gerber, Ben
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232404/
https://www.ncbi.nlm.nih.gov/pubmed/34170930
http://dx.doi.org/10.1371/journal.pone.0252501
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author Man, Bernice
Schwartz, Alan
Pugach, Oksana
Xia, Yinglin
Gerber, Ben
author_facet Man, Bernice
Schwartz, Alan
Pugach, Oksana
Xia, Yinglin
Gerber, Ben
author_sort Man, Bernice
collection PubMed
description INTRODUCTION: Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM. METHODS: The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model. RESULTS: Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m(2) than BMI < 30kg/m(2). The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM. CONCLUSIONS: A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM.
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spelling pubmed-82324042021-07-07 A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes Man, Bernice Schwartz, Alan Pugach, Oksana Xia, Yinglin Gerber, Ben PLoS One Research Article INTRODUCTION: Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM. METHODS: The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model. RESULTS: Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m(2) than BMI < 30kg/m(2). The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM. CONCLUSIONS: A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM. Public Library of Science 2021-06-25 /pmc/articles/PMC8232404/ /pubmed/34170930 http://dx.doi.org/10.1371/journal.pone.0252501 Text en © 2021 Man et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Man, Bernice
Schwartz, Alan
Pugach, Oksana
Xia, Yinglin
Gerber, Ben
A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
title A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
title_full A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
title_fullStr A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
title_full_unstemmed A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
title_short A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
title_sort clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232404/
https://www.ncbi.nlm.nih.gov/pubmed/34170930
http://dx.doi.org/10.1371/journal.pone.0252501
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