- 作者：Luis Garc¨ªa de Guadiana Romualdo ; Mercedes Gonz¨¢lez Morales ; M. Dolores Albaladejo Ot¨®n ; Elena Mart¨ªn Garc¨ªa ; M. del Carmen Mart¨ªn-Ondarza Gonz¨¢lez ; Jorge Nuevo Garc¨ªa ; Enrique Jim¨¦nez Santos
- 关键词：Hemoglobina A1c ; Diabetes mellitus gestacional ; Diabetes mellitus ; Tolerancia disminuida a la glucosa ; Glucemia alterada en ayunas
- 刊名：Endocrinolog¨ªa y Nutrici¨®n
- 出版年：2012
- 出版时间：June-July, 2012
- 年：2012
- 卷：59
- 期：6
- 页码：362-366
- 全文大小：265 K
Introduction
Women with gestational diabetes mellitus (GDM) have an increased risk for developing diabetes mellitus (DM). Their postpartum metabolic classification using a 75 g oral glucose tolerance test (75 g OGTT) is recommended. The purpose of this study was to assess the value of hemoglobin A1c for postpartum evaluation in women with recent gestational diabetes mellitus.
Patients and methods
Fifty-six women with recent GDM underwent a 75 g OGTT at our center to assess postpartum changes in carbohydrate metabolism and were classified using diagnostic criteria of the American Diabetes Association (ADA). Receiver operating characteristic (ROC) curves analysis was used to assess the diagnostic performance of hemoglobin A1c, and kappa index was used to evaluate diagnostic agreement between hemoglobin A1c and 75 g OGTT.
Results
DM was diagnosed in 7 women, and other categories of increased risk for DM in 25 women. Kappa index for diagnosis agreement was 0,22. Hemoglobin A1c ¡Ý 5.7 % had 47 % sensitivity and 71 % specificity for identifying any change in carbohydrate metabolism. A hemoglobin A1c value ¡Ý 6.5 had 29 % sensitivity and 100 % specificity for diagnosis of DM. Area under the ROC curve was 0.57 for identifying any change in carbohydrate metabolism and 0.81 for diagnosis of DM.
Conclusion
Using ADA cutoff values, hemoglobin A1c is not appropriate for postpartum glucose tolerance evaluation in women with recent gestational diabetes mellitus.