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

Mi Jin Choi; Chae Weon Chung

doi:10.16952/pns.2016.13.1.17

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

Original Article

Perspectives in Nursing Science 2016;13(1):17-28.

Published online: 19 April 2016

DOI: https://doi.org/10.16952/pns.2016.13.1.17

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

Mi Jin Choi^1,, Chae Weon Chung²

¹Graduate Student, College of Nursing, Seoul National University, Seoul

²Professor, College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Choi, Mi Jin College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8463, Fax: +82-2-747-3948, E-mail: mj0610@snu.ac.kr

Received 25 February 2016 Revised 4 March 2016 Accepted 4 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Diabetes gestational, Diabetes mellitus type 2, Risk factors, Retrospective studies, Prevention and control

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Figure 1.

Cumulative percentage of type 2 diabetes by age at diagnosis and intervals from childbirth to diagnosis (N=175)

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)
Marital status^∗	Divorced/widowed/single	15 (8.7)
Education level^∗	＜High school graduate	117 (67.6)
Education level^∗	≥High school graduate	56 (32.4)
Job status^∗	Have	50 (28.7)
Job status^∗	None/housewife	124 (71.3)
Monthly income (10,000 won)^∗	＜300	88 (54.3)
Monthly income (10,000 won)^∗	≥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)
	Spontaneous abortion	No	136 (77.7)
	Total no. of childbirth	≤2	118 (67.4)	3.86±1.92
	Total no. of childbirth	≥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)
	Hx. of gestational hypertension^∗	No	139 (79.9)
	Hx. of high birth weight infant^†	Yes	50 (28.6)
	Hx. of high birth weight infant^†	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)
	Oral contraceptive^∗	Not used	137 (79.2)
Medical and family history	Hypertension	Yes	59 (33.7)
	Hypertension	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)
	Waist circumference (cm)^∗	≥85	65 (37.4)
	Past BMI	At 18~20 yr old		21.04±2.50
	Past BMI	At 35 yr old		24.15±3.32
	Weight change (kg)^∗	18~20 to 35 years old		7.61±7.71
	Weight change (kg)^∗	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)
	Diet^∗	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
Variables	Categories	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
Hx. of gestational hypertension^‡	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
Total no. of babies breastfed ^‡	≥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
Hypertension	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
Family with DM^‡	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
Family with HTN	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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