한국인 임산부에서 임신성 당뇨병 선별검사의 필요성

정규병,장학철,조남한,Metzger, Boyd E. 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.3

한국인 임신부에서 임신성당뇨병의 유병률은 2-3%로 보고되고 있고, 이는 다른 인종 임산부의 임신성당뇨병 유병률에 비하여 드물지 않다. 또 임신성당뇨병 임신부에서 관찰되는 산과적 합병증과 주산기이환률도 차이가 없다. 임신성당뇨병으로 인한 합병증은 임신성당뇨병의 관리정도와 발견한 시기에 따라 좌우되므로, 임신성당뇨병의 단기 및 장기 합병증을 예방하려면 적절한 시기에 임신성당뇨병을 진단해야 하고, 적극적인 임신성당뇨병 관리가 필요하다. 임신성당뇨병 선별검사는 임산부가 내원한 당일에 1시간 정도면 시행할 수 있고, 검사과정도 간편하기 때문에, 비교적 쉽게 할 수 잇는 검사이다. 일반적으로 임신성당뇨병은 임신중에 특별한 증상을 일으키는 것이 아니고, 위험인자가 있는 임산부에서만 발생하는 것이 아니기 때문에, 모든 임산부를 대상으로 임신성당뇨병 선별검사를 시행하는 것이 바람직하겠다. Gestational diabets mellitus(GDM) is one of the most common metabolic disorders complicating pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean section, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Women with GDM are at higher risk for non-insulin dependent diabetes mellitus later in life and have a predisposition to dyslipidemia and cardiovascular disease. GDM may also have long-term implications for the offspring. The offspring of mothers with pregestational and gestatioal diabets have veen reported to have a higher frequency of obesity in childhood, impaired glucose tolerance or non-insulin dependent diabetes in adolescence or later, and if poorly controlled, may be at risk of impairment of intellectual and neurobehavioral development. The reported prevalence of GDM in Korean women is 2-3%, which is very similar to that in the Caucasian and African-American women in North America. The prequencies of obstetrical complications and adverse perinatal outcomes observed in Korea women with GDM are also similar to that in other reports. Therfore, identifying with GDM is very important in Korean women. The Second and Third International Workshop-Conference on Gestational Diabetes Mellitus and the American College of Obstetricians and Gynecologists recommend screening with a 50 g oral glucose challenge followed 1 hour later by a plasma glucose measurement. The 1-h, 50-g oral gucose challenge test can be perforemed without regard to time or amount of last meal. The test procedure is simple and convenient for patients and doctors. Selective screening based on clinical or historic risk factors has been reported ineffective to identify the women with GDM. Universal screening with 135 mg/dl as a thershold offeres a cost-effective protocol to edentify women with GDM in the Korean population.

실행 요약: 당뇨병의 진단과 관리에서 검사실적 분석에 대한 지침과 권고안

David B. Sacks,Mark Arnold,George L. Bakris,David E. Bruns,Andrea Rita Horvath,M. Sue Kirkman,Ake Lernmark,Boyd E. Metzger,David M. Nathan 대한진단검사의학회 2011 Laboratory Medicine Online Vol.1 No.4

Background: Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. Approach: An expert committee compiled evidencebased recommendations for the use of laboratory analysis in patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. A draft of the guidelines was posted on the Internet, and the document was modified in response to comments. The guidelines were reviewed by the joint Evidence-Based Laboratory Medicine Committee of the AACC and the National Academy of Clinical Biochemistry and were accepted after revisions by the Professional Practice Committee and subsequent approval by the Executive Committee of the American Diabetes Association. Content: In addition to the long-standing criteria based on measurement of venous plasma glucose, diabetes can be diagnosed by demonstrating increased hemoglobin A1c (HbA1c) concentrations in the blood. Monitoring of glycemic control is performed by the patients measuring their own plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing,and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. Summary: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.

Visceral fatness and insulin sensitivity in women with a previous history of gestational diabetes mellitus.

Lim, Soo,Choi, Sung Hee,Park, Young Joo,Park, Kyong Soo,Lee, Hong Kyu,Jang, Hak C,Cho, Nam H,Metzger, Boyd E American Diabetes Association 2007 Diabetes care Vol.30 No.2

<P>OBJECTIVE: The purpose of this study was to investigate the insulin sensitivity and visceral fatness in women with previous gestational diabetes mellitus (GDM), who are prone to develop type 2 diabetes. RESEARCH DESIGN AND METHODS: A 75-g oral glucose tolerance test (OGTT) performed 1 year postpartum identified 21 GAD(-) women with previous GDM and impaired glucose tolerance (GDM-IGT). Sixty age- and BMI-matched women with normal glucose tolerance (GDM-NGT) were selected by 1:3 matching to the GDM-IGT group. Another 18 women with normal glucose metabolism during a previous pregnancy and no family history of diabetes were recruited as the normal control group. Age and BMI matching was performed using a range of +/-1.0 years and +/-1.0 kg/m(2), respectively. Total body fat was measured by tetrapolar bioelectrical impedance, and visceral fat was determined using a single cut of a computed tomography scan. Insulin sensitivity was determined by the minimal model technique using the frequently sampled intravenous glucose tolerance test. RESULTS: One year postpartum, visceral fat was greater in the GDM-IGT group than in the age- and BMI-matched GDM-NGT or normal control groups. The insulin sensitivity index was lower in the GDM-IGT group than in the GDM-NGT or normal control groups. beta-Cell function, as measured by the acute insulin response to glucose, was also lower in GDM-IGT. CONCLUSIONS: High body fat content, especially visceral fat content, and a low insulin response to glucose seem to contribute simultaneously to the development of impaired glucose metabolism in Korean women with previous GDM.</P>

Metabolic syndrome independently predicts future diabetes in women with a history of gestational diabetes mellitus

Cho, Nam H.,Ahn, Chang Ho,Moon, Joon Ho,Kwak, Soo Heon,Choi, Sung Hee,Lim, Soo,Park, Kyong Soo,Metzger, Boyd E.,Jang, Hak C. Wolters Kluwer Health 2016 Medicine Vol.95 No.35

<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Metabolic syndrome (MetS) is an established predisposing condition for type 2 diabetes mellitus (T2DM). However, it is not thoroughly evaluated whether MetS increases the risk of T2DM in women with a previous history of gestational diabetes mellitus (GDM) who already at high risk of T2DM compared with the general population. We investigated the impact of MetS on the development of postpartum diabetes in women with a history of GDM.</P><P>This was a multicenter, prospective cohort study of women diagnosed with GDM. The follow-up evaluations, including the oral glucose tolerance test, were completed at 6 weeks postpartum and annually thereafter. MetS was diagnosed at the initial postpartum evaluation according to the revised criteria of the National Cholesterol Education Program-Adult Treatment Panel III. The risk of developing type 2 diabetes (T2DM) in the follow-up period was analyzed based on the presence of MetS, and the adjusted risk was calculated using a Cox proportional hazards model.</P><P>A total of 412 women without diabetes at the initial postpartum evaluation participated in the annual follow-up for median 3.8 years. MetS was prevalent in 66 (19.2%) women at the initial postpartum evaluation. The incidences of diabetes in women with and without MetS were 825 and 227 per 10,000 person-years, respectively (<I>P</I> < 0.001). The presence of MetS was an independent risk factor for T2DM, with a hazard ratio (HR) of 2.23 (95% confidence interval 1.04–5.08) in multivariate analysis after adjustment for clinical and metabolic parameters. When we considered MetS and impaired fasting glucose (IFG) separately, women with MetS, IFG, or both had an increased risk of T2DM, with HRs of 4.17, 4.36, and 6.98, respectively.</P><P>The presence of MetS during the early postpartum period is an independent risk factor for the development of T2DM in women with a previous history of GDM.</P></▼2>