Title The prevalence of abnormal glucose tolerance up to 5 years after an index pregnancy

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The prevalence of abnormal glucose tolerance up to 5 years
after an index pregnancy complicated by gestational diabetes
Title
defined using International Association of Diabetes and
Pregnancy Study Groups criteria
Author(s) Noctor, Eoin
Publication
2015-09-25
Date
Item record http://hdl.handle.net/10379/5307
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The prevalence of abnormal glucose tolerance up to 5 years
after an index pregnancy complicated by gestational diabetes
defined using International Association of Diabetes and
Pregnancy Study Groups criteria

Single Volume

Eoin Gerard Noctor
MB BCh BAO MRCPI

In fulfilment of the requirements for the MD degree

Supervisor – Professor Fidelma Dunne
School of Medicine
Discipline of Medicine

National University of Ireland, Galway

September 2015
Introduction

  ii
Introduction
Publications and presentation arising from this work

Publications

Type 2 diabetes after gestational diabetes- the influence of changing
diagnostic criteria (Review)
E Noctor, F Dunne
World Journal of Diabetes 2015 Mar 15;6(2):234-44.
PMID 25789105

Short- and long-term effects of gestational diabetes mellitus on healthcare
cost: a cross-sectional comparative study in the ATLANTIC DIP cohort.
Danyliv A, Gillespie P, O'Neill C, Noctor E, O'Dea A, Tierney M, McGuire
B, Glynn LG, Dunne F.
Diabetic Medicine 2015 Apr;32(4):467-76.
PMID: 25529506

ATLANTIC-DIP: prevalence of metabolic syndrome and insulin resistance
in women with previous gestational diabetes mellitus by International
Association of Diabetes in Pregnancy Study Groups criteria.
Noctor E, Crowe C, Carmody LA, Kirwan B, O'Dea A, Glynn LG,
McGuire BE, O'Shea PM, Dunne FP.
Acta Diabetologica
 2015
 Feb
 52
 (1)
 153-­‐60
 2015

PMID: 25002067

ATLANTIC DIP: simplifying the follow-up of women with previous
gestational diabetes.
Noctor E, Crowe C, Carmody LA, Avalos GM, Kirwan B, Infanti JJ, O'Dea
A, Gillespie P, Newell J, McGuire B, O'Neill C, O'Shea PM, Dunne FP;
ATLANTIC DIP investigators.
European Journal of Endocrinology 2013 Oct 3;169(5):681-7
PMID: 24092597

  iii
Introduction
An evaluation of Croí MyAction community lifestyle modification
programme compared to standard care to reduce progression to
diabetes/pre-diabetes in women with prior gestational diabetes mellitus
(GDM): study protocol for a randomised controlled trial.
Infanti JJ, Dunne FP, O'Dea A, Gillespie P, Gibson I, Glynn LG, Noctor E,
Newell J, McGuire BE.
Trials. 2013 May 2;14:121.
PMID: 23782471

Submitted

ATLANTIC-DIP- Prevalence of abnormal glucose tolerance up to 5 years
post gestational diabetes mellitus with use of International Association of
Diabetes and Pregnancy Study Groups criteria
E Noctor, C Crowe, LA Carmody, J. Saunders, B Kirwan, JJ Infanti, A
O’Dea, P Gillespie, Liam G Glynn, Brian McGuire, Ciaran O’Neill, PM
O’Shea, FP Dunne for the ATLANTIC DIP investigators

  iv
Introduction
Presentations

ATLANTIC-DIP- Comparison of fasting plasma glucose and HbA1c for
follow-up of women with previous gestational diabetes
E Noctor, C Crowe, LA Carmody, B Wickham, P O’Shea, F Dunne Poster
Presentation, Irish Endocrine Society 37th Annual Meeting Irish Journal of
Medical Science September 2012 181 S9

ATLANTIC-DIP-The prevalence of pre-diabetes/diabetes up to 5 years post
partum in women with previous gestational diabetes along the Atlantic
coast
E Noctor, C Crowe, LA Carmody, B Wickham, G Avalos, G Gaffney, P
O’Shea, F Dunne
Poster presentation at 48th EASD Annual Meeting, Berlin October 2012

ATLANTIC-DIP-The prevalence of abnormal glucose tolerance up to 5
years post-gestational diabetes in a West of Ireland population
E Noctor, C Crowe, LA Carmody, B Wickham, G Avalos, G Gaffney, P
O’Shea, F Dunne
Poster Presentation, American Diabetes Association 72nd Annual Scientific
Sessions
Diabetes June 2012 61 (Supplement 1)

The prevalence of metabolic syndrome up to 5 years post-partum in patients
with a history of gestational diabetes mellitus
E Noctor, C Crowe, LA Carmody, B Wickham, G Avalos, G Gaffney, P
O’Shea, F Dunne
Oral Presentation 36th Annual Irish Endocrine Society Meeting 2011
Irish Journal of Medical Science 180 S13

ATLANTIC DIP: The prevalence of pre-diabetes/type 2 diabetes in an Irish
population with gestational diabetes mellitus 1-5 years post index
pregnancy

  v
Introduction
E Noctor, C Crowe, LA Carmody, B Wickham, G Avalos, G Gaffney, P
O’Shea, F Dunne
Oral Presentation 36th Annual Irish Endocrine Society Meeting 2011
Irish Journal of Medical Science 180 S13

Validation of a diabetes risk score in identifying patients at risk of
progression to abnormal glucose tolerance post partum
E Noctor, C Crowe, LA Carmody, B Wickham, G Avalos, G Gaffney, P
O’Shea, F Dunne
Poster Presentation 36th Annual Irish Endocrine Society Meeting 2011
Irish Journal of Medical Science 180 S13

The prevalence of metabolic syndrome and insulin resistance post
gestational diabetes in the West of Ireland
E Noctor, C Crowe, LA Carmody, B Wickham, G Avalos, G Gaffney, P
O’Shea, F Dunne
(Publish Only) American Diabetes Association 72nd Annual Scientific
Sessions
Diabetes June 2012 61 (Supplement 1)

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Introduction
Summary of contents

Introduction

Gestational diabetes (GDM) is associated with an increased future risk of
type 2 diabetes, but the risk among women diagnosed with the International
Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria is
unknown. Therefore, we wished to determine the prevalence of abnormal
glucose tolerance, metabolic syndrome, and insulin resistance in women
with previous IADPSG-defined GDM.

Methods

We invited women with previous IADPSG-defined GDM up to 5 years
post-partum for retesting with OGTT and HbA1c. A control group known to
have normal glucose tolerance (NGT) at the same time also attended.
Results were analysed using descriptive statistics, logistic regression, linear
regression, decision tree analysis, and multidimensional scaling methods.

Results

270 women with previous GDM and 388 women with NGT in pregnancy
attended (mean of 2.6 and 3.3 years follow-up respectively). 25.9% percent
of women with previous GDM and 3.6% of women with previous NGT had
AGT. Fasting and 2-hour glucose on pregnancy OGTT, gestational week
diagnosed, family history, and BMI, were associated with AGT at retesting.
The predictive power of the models was suboptimal. 25.3% percent of
women with previous GDM and 6.6% with previous NGT had metabolic
syndrome, while the prevalence of insulin resistance (HOMA2-IR>1.8) was
33.6% in women with previous GDM vs. 9.1% in those with NGT.
Combining HbA1c ≥ 39 mmol/mol with FPG of ≥ 5.6 mmol/L yielded a
sensitivity of 90% and specificity of 84% for detection of AGT.

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Introduction

Conclusions

IADPSG criteria for GDM identify a cohort at significant risk of metabolic
disturbance up to 5 years post-partum. Identification of women at highest
risk using routine clinical variables is not a useful strategy. Follow-up
should be as frequent as for those meeting older GDM criteria. Combining
HbA1c and FPG to detect AGT may be useful for longer-term follow-up.

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Introduction

Acknowledgements

I would like to acknowledge the support and mentoring received throughout
from my supervisor, Professor Fidelma Dunne
I would also like to thank the members of the graduate research committee,
Professor Tim O’Brien and Dr Frances Finucane from National University
of Ireland Galway
I would also like to thank the ATLANTIC – DIP investigators;

University Hospital Galway Dr Geraldine Gaffney, Dr Paula M O’Shea,
Ms Louise Carmody, Ms Breege Wickham, Ms Breda Kirwan

Portiuncula Hospital Ballinasloe, Co. Galway Dr Maeve Durkan

Castlebar General Hospital, Co Mayo Dr Murtada Mohammed

Letterkenny General Hospital Dr Nandini Ravikumar, Ms Therese
Gallacher

Sligo General Hospital Dr Cathy McHugh

I would like to also thank all the laboratory staff of University Hospital
Galway, Portiuncula Hospital, Ballinasloe, Castlebar General Hospital, Co
Mayo, and Letterkenny General Hospital, Co. Donegal, and Gloria Avalos
and Jon Sedar for statistical advice
I would especially like to thank all the women who gave up their time to
participate in this study

Finally, I would like to thank my wife Mo, and our children, Charlotte and
Tom, for the many, many hours that they gave up to allow me to finish this
work.

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