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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2015; 6(2): 234-244
Published online Mar 15, 2015. doi: 10.4239/wjd.v6.i2.234
Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria
Eoin Noctor, Fidelma P Dunne
Eoin Noctor, Steno Diabetes Center, DK-2820 Gentofte, Denmark
Fidelma P Dunne, Galway Diabetes Research Centre, National University of Ireland, Dublin 2, Ireland
Author contributions: Noctor E and Dunne FP contributed equally to this work; both reviewed the literature and approved the final manuscript.
Conflict-of-interest: Eoin Noctor reports no conflict of interest with regard this paper. He reports receipt of an unrestricted educational grant by Novo Nordisk Ireland in the last five years. Eoin Noctor is employed at Steno Diabetes Center, which is owned by Novo Nordisk A/S, and operates in the Danish health system.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eoin Noctor, Chief Physician, Steno Diabetes Center, Niels Steensens Vej 2-8, DK-2820 Gentofte, Denmark. eoge@steno.dk
Telephone: +45-30-755033
Received: August 27, 2014
Peer-review started: August 31, 2014
First decision: November 3, 2014
Revised: November 17, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: March 15, 2015
Processing time: 203 Days and 22.5 Hours
Abstract

A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies.

Keywords: Gestational diabetes; Pregnancy; Type 2 diabetes; Impaired glucose tolerance; Diagnostic oral glucose tolerance test criteria

Core tip: Gestational diabetes (GDM) is associated with a greatly increased future risk of type 2 diabetes, but there are many different GDM diagnostic criteria in clinical use. Criteria with lower glucose thresholds increase GDM prevalence, and therefore the number of women requiring follow-up to detect progression to diabetes. However, lower diagnostic thresholds are also likely to decrease the proportion that progress to diabetes. Heterogeneity across studies with regard to diagnostic criteria, demographics, and duration of follow-up, limit direct comparison. As the International Association of Diabetes in Pregnancy Study Groups criteria enter widespread use, follow-up of these women will be an important issue.