A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.

<h4>Introduction</h4>Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict...

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Autores principales:	Bernice Man, Alan Schwartz, Oksana Pugach, Yinglin Xia, Ben Gerber
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2af104f1bda04a9dad5da3ef85277304
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spelling	oai:doaj.org-article:2af104f1bda04a9dad5da3ef852773042021-12-02T20:07:03ZA clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.1932-620310.1371/journal.pone.0252501https://doaj.org/article/2af104f1bda04a9dad5da3ef852773042021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252501https://doaj.org/toc/1932-6203<h4>Introduction</h4>Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM.<h4>Methods</h4>The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model.<h4>Results</h4>Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m2 than BMI < 30kg/m2. The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM.<h4>Conclusions</h4>A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM.Bernice ManAlan SchwartzOksana PugachYinglin XiaBen GerberPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252501 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bernice Man Alan Schwartz Oksana Pugach Yinglin Xia Ben Gerber A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
description	<h4>Introduction</h4>Without treatment, prediabetic women with a history of gestational diabetes mellitus (GDM) are at greater risk for developing type 2 diabetes compared with women without a history of GDM. Both intensive lifestyle intervention and metformin can reduce risk. To predict risk and treatment response, we developed a risk prediction model specifically for women with prior GDM.<h4>Methods</h4>The Diabetes Prevention Program was a randomized controlled trial to evaluate the effectiveness of intensive lifestyle intervention, metformin (850mg twice daily), and placebo in preventing diabetes. Data from the Diabetes Prevention Program (DPP) was used to conduct a secondary analysis to evaluate 11 baseline clinical variables of 317 women with prediabetes and a self-reported history of GDM to develop a 3-year diabetes risk prediction model using Cox proportional hazards regression. Reduced models were explored and compared with the main model.<h4>Results</h4>Within three years, 82 (25.9%) women developed diabetes. In our parsimonious model using 4 of 11 clinical variables, higher fasting glucose and hemoglobin A1C were each associated with greater risk for diabetes (each hazard ratio approximately 1.4), and there was an interaction between treatment arm and BMI suggesting that metformin was more effective relative to no treatment for BMI ≥ 35kg/m2 than BMI < 30kg/m2. The model had fair discrimination (bias corrected C index = 0.68) and was not significantly different from our main model using 11 clinical variables. The estimated incidence of diabetes without treatment was 37.4%, compared to 20.0% with intensive lifestyle intervention or metformin treatment for women with a prior GDM.<h4>Conclusions</h4>A clinical prediction model was developed for individualized decision making for prediabetes treatment in women with prior GDM.
format	article
author	Bernice Man Alan Schwartz Oksana Pugach Yinglin Xia Ben Gerber
author_facet	Bernice Man Alan Schwartz Oksana Pugach Yinglin Xia Ben Gerber
author_sort	Bernice Man
title	A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
title_short	A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
title_full	A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
title_fullStr	A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
title_full_unstemmed	A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
title_sort	clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/2af104f1bda04a9dad5da3ef85277304
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A clinical diabetes risk prediction model for prediabetic women with prior gestational diabetes.

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