Journal List > Perspect Nurs Sci > v.13(1) > 1060417

Choi and Chung: Patterns of Diagnosis and Risk Factors for Type 2 Diabetes in Women with a History of Gestational Diabetes Mellitus

Abstract

Purpose:

This study aimed to identify patterns of diagnosis and to explore risk factors for type 2 diabetes beyond the postpartum period in women with a previous history of gestational diabetes, and to identify differences in such risk factors between early and late-onset (aged <45 and≥45). Methods: Using epidemiological data from the Korean Genome and Epidemiology Study, a retrospective analysis of 175 women with various timings of type 2 diabetes diagnosis was performed. Results: The average age (42.6±10.6) at type 2 diabetes diagnosis was earlier than the general population, and obesity was prevalent with marked weight gains around 35 years old. Longer duration of breastfeeding was observed in women with late-onset of type 2 diabetes. Conclusion: For prevention of type 2 diabetes, early intervention is required, and modifiable factors such as weight control and breastfeeding should be taken into consideration for intervention strategies.

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Figure 1.
Cumulative percentage of type 2 diabetes by age at diagnosis and intervals from childbirth to diagnosis (N=175)
pns-13-17f1.tif
Table 1.
Demographics of Respondents (N=175)
Variables Categories n (%) or M±SD
Age (year)   50.77±8.49
40~49 94 (53.7)
50~59 47 (26.9)
60~70 34 (19.4)
Marital status Married/cohabitation 157 (91.3)
Divorced/widowed/single 15 (8.7)
Education level <High school graduate 117 (67.6)
≥High school graduate 56 (32.4)
Job status Have 50 (28.7)
None/housewife 124 (71.3)
Monthly income (10,000 won) <300 88 (54.3)
≥300 74 (45.7)

Missing data were excluded.

Table 2.
Pregnancy and Postpartum, Medical and Family History, Anthropometry, and Lifestyle Characteristics (N=175)
Variables Characteristics Categories n (%) M±SD
Obstetric characteristics Total no. of pregnancy   3.86±1.92  
Age at first pregnancy (year) ≤24 60 (34.7) 26.01±3.60
25~29 85 (49.1)  
≥30 28 (16.2)  
Spontaneous abortion Yes 39 (22.3)  
No 136 (77.7)  
Total no. of childbirth ≤2 118 (67.4) 3.86±1.92
≥3 57 (32.6)  
Age at first childbirth (year) ≤24 49 (28.0) 26.80±3.79
25~29 88 (50.3)  
30~34 30 (17.1)  
35~39 8 (4.6)  
Age at last childbirth (year) ≤29 59 (37.1) 31.53±4.63
  30~34 62 (39.0)  
  35~39 29 (18.2)  
  ≥40 9 (5.7)  
Spacing of childbirth (year) (n=156)     3.65±2.59
Hx. of gestational hypertension Yes 35 (20.1)  
No 139 (79.9)  
Hx. of high birth weight infant Yes 50 (28.6)  
No 125 (71.4)  
Breastfeeding Yes 132 (75.4)  
No. of babies breastfed ≤2 91 (68.9) 2.23±0.95
≥3 41 (31.1)  
Duration (month) <12 31 (23.8) 24.52±19.31
12~23 35 (26.9)  
≥24 64 (49.2)  
Oral contraceptive Used 36 (20.8)  
Not used 137 (79.2)  
Medical and family history Hypertension Yes 59 (33.7)  
Age at diagnosis   48.59±7.88
Hyperlipidemia Yes 32 (18.4)  
Family with diabetes mellitus Yes 86 (49.4)  
Mother 44 (51.2)  
Father 20 (23.3)  
Sibling 30 (34.9)  
Family with hypertension Yes 46 (26.3)  
Mother 28 (60.9)  
Father 18 (39.1)  
Anthropometry Current Body mass index (BMI) <23 55 (31.5) 24.92±3.28
23≤BMI<25 44 (25.1)  
≥25 76 (43.4)  
Waist circumference (cm) <85 109 (62.6)  
≥85 65 (37.4)  
Past BMI At 18~20 yr old   21.04±2.50
At 35 yr old   24.15±3.32
Weight change (kg) 18~20 to 35 years old   7.61±7.71
35 to 50 years old   3.34±8.91
Lifestyle characteristics Smoking Current 3 (1.7)  
Past 3 (1.7)  
No 168 (96.6)  
Drinking alcohol Current 51 (20.7)  
Past 4 (2.3)  
No 120 (68.6)  
Exercise ≥150 (min/week) 75 (42.9)  
<150 (min/week) 28 (16.0)  
No 72 (41.1)  
Diet Over calories 102 (59.3)  
Under calories 70 (40.7)  

Missing data were excluded

High birth weight is defined as more than 4 kilograms;

In case of 'yes', multiple choice is possible.

Table 3.
Age at Diagnosis and Interval from Childbirth to Type 2 Diabetes Diagnosis (N=175)
Age at diagnosis
Age (year) 26~29 30~34 35~39 40~44 45~49 50~59 ≥60 Total
n (%) or M±SD 15 (8.6) 27 (15.4) 29 (16.6) 40 (22.9) 18 (10.3) 30 (17.1) 16 (9.1) 42.62±10.62
Cumulative % 8.6 24 40.6 63.4 73.7 90.9 100 (Min: 26~Max: 69)
Interval from first childbirth to diagnosis
Years 0~4 5~9 10~14 15~19 20~24 25~29 ≥30 Total
n (%) or M±SD 33 (18.9) 28 (16.0) 30 (17.1) 25 (14.3) 19 (10.9) 12 (6.9) 28 (16.0) 15.82±11.15
Cumulative % 18.9 34.9 52.0 66.3 77.1 84.0 100 (Min: 0~Max: 43)
Interval from last childbirth to diagnosis
Years <0 0 1~4 5~9 10~14 15~19 ≥20 Total
n (%) or M±SD 17 (10.7) 22 (13.8) 20 (12.6) 21 (13.2) 19 (11.9) 18 (11.3) 42 (26.4) 11.30±11.25
Cumulative % 10.7 24.5 37.1 50.3 62.3 73.6 100 (Min: -7~Max: 36)

Women who gave a birth only one child (n=15) and missing datum (n=1) were excluded.

Table 4.
Comparison of Women's Characteristics among Three Groups by DM Diagnosis Age and Current Age (N=175)
Variables Categories G1 (n=51) G2 (n=60) G3 (n=64) G1 and G2 G2 and G3
n (%) or M±SD n (%) or M±SD n (%) or M±SD p p
Age (year)   41.59±1.63 50.40±5.52 58.44±6.36 <.01 <.01
40~49 51 (100.0) 36 (60.0) 7 (10.9)    
50~59 - 20 (33.3) 27 (42.2)    
60~70 - 4 (6.7) 30 (46.9)    
Total no. of pregnancy   3.41±1.40 3.62±1.81 4.45±2.22 .86 .03
Age at first pregnancy (year) ≤24 12 (24.0) 17 (28.2) 31 (48.4) .63 .04
25~29 28 (56.0) 34 (57.6) 23 (35.9)    
≥30 10 (20.0) 8 (13.6) 10 (15.6)    
Total no. of childbirth   2.24±0.68 2.13±0.60 2.61±1.05 .28 <.01
≤2 34 (66.7) 49 (81.7) 35 (54.7) .07 <.01
≥3 17 (33.3) 11 (18.3) 29 (45.3)    
Age at first child birth (year) 27.92±3.89 27.02±3.74 25.70±3.49 .09 .08
Hx. of gestational hypertension Yes 11 (21.6) 16 (27.1) 8 (12.5) .50 .04
No 40 (78.4) 43 (72.9) 56 (87.5)    
Total no. of babies breastfed ≤2 27 (77.1) 49 (81.7) 35 (54.7) .76 .01
≥3 8 (22.9) 11 (18.3) 29 (45.3)    
Total duration of breastfeeding (month) <12 12 (34.3) 12 (27.3) 7 (13.7) .71 <.01
12~23 13 (37.1) 16 (36.4) 6 (11.8)    
≥24 10 (28.6) 16 (36.4) 38 (74.5)    
Hypertension Yes 8 (15.7) 19 (31.7) 32 (50.0) .05 .04
No 43 (84.3) 41 (68.3) 32 (50.0)    
Age at diagnosis of hypertension 39.38±3.50 45.53±6.81 52.72±6.41 .02 <.01
Family with DM Yes 25 (49.0) 35 (59.3) 26 (40.6) .28 .04
No 26 (51.0) 24 (40.7) 38 (59.4)    
Family with HTN Yes 15 (29.4) 19 (31.7) 12 (18.8) .80 .10
No 36 (70.6) 41 (68.3) 52 (81.3)    
Weight change (kg) Age 35~50 - 0.29±5.68 4.67±9.77 - .06

Group 1: current age<45 and age at diabetes diagnosis<45, Group 2: current age≥45 and age at diabetes diagnosis<45, Group 3: current age≥45 and age at diabetes diagnosis≥45;

x2or Fisher's exact or Mann-Whitney U test;

Missing data were excluded.

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