Glycated albumin in screening the abnormal glucose metabolism in postpartum women with previous gestational diabetes mellitus

Abstract

Objective To investigate the optimal cut- off point of glycated albumin for abnormal glucose metabolism and diabetes postpartum with previous gestational diabetes mellitus (GDM). Methods 75 g oral glucose tolerance test (OGTT) was underwent at 6-8 weeks after delivery in 241 GDM patients from Apr 2012 to Oct 2014. Diagnosis of GDM was based on International Association of Diabetic Pregnancy Study Group criteria. The clinical and biochemical characteristics were compared among normal glucose tolerance(NGT group), impaired glucose regulation(IGR group) and diabetes mellitus(DM group). Comparisons between three groups were performed using analysis of variance test (ANOVA) or Kruskal Wallis test. Chi square test was used in comparisons between proportions. The optimal cut- off point of glycated albumin(GA) for abnormal glucose metabolism(IGR+ DM) and diabetes were obtained by drawing receiver operating characteristic (ROC) curve. Results (1)We found that the rates of NGT (n=128), IGR (n= 66) and DM (n=47) were 53.1%, 27.4% and 19.5%, respectively.(2)GA was negatively correlated with weight, including pre-pregnancy weight(r=- 0.226, P<0.05) and weight at follow- up time (r=- 0.198, P<0.05). However, GA was positively correlated with blood glucose, including fasting blood glucose(r=0.582,P<0.001) and postprandial glucose(r=0.479,P<0.001). (3)GA was significant differences among three groups(F=34.1, P<0.001).Comparing with NGT, the GA/HbA1c rate significantly increased in DM group (2.2±0.7 vs 1.8±0.9, t=3.015, P<0.05). (4) The cut- off point of GA for abnormal glucose metabolism(IGR+ DM) postpartum was 12.70%. The sensitivity, specificity and area under the curve(AUC) were 62.8%, 66.4% and 0.685, respectively. The cut- off point of GA for postpartum diabetes was 13.03%. The sensitivity, specificity and area under the curve(AUC) were 66.7%, 72.0% and 0.769, respectively. Conclusion Nearly half of GDM patients remained abnormal glucose level at 6-8 weeks after delivery. OGTT test was strongly recommended in women whose level of GA was more than 12.7%, especially more than 13.03% at 6-8 weeks after delivery to determine the glucose metabolism status. Key words: Diabetes mellitus,gestational; Glycated albumin; Postpartum glucose metabolism