A recent study published in Diabetes Care reveals that a one-hour oral glucose tolerance test (OGTT) is more effective than the traditional two-hour test in predicting the risk of developing diabetes, particularly for women with a history of gestational diabetes.
Postpartum Glucose Testing Compliance Remains Low
New mothers often prioritize their baby’s needs over their own health, leading to low compliance with postpartum glucose testing, especially among those who had gestational diabetes. This group faces a significantly heightened risk of developing type 2 diabetes later in life. Dr. Ravi Retnakaran, professor at the University of Toronto, emphasizes that postpartum glucose testing within six months of delivery is crucial for identifying women at risk. Despite this, only about half of women with gestational diabetes return for testing.
Challenges in Testing and Diagnosis
Pregnancy acts as a “stress test” for the body, potentially revealing insulin production limitations that could lead to diabetes. Dr. Retnakaran points out that many women are unsure about which healthcare provider should order their postpartum test, complicating the situation. This issue is widespread across multiple regions, including Canada, the U.S., China, Australia, and Europe.
The International Diabetes Federation has recommended the one-hour glucose test as a more practical and sensitive alternative to the two-hour OGTT. The one-hour test eliminates the need for fasting and the lengthy waiting period, making it more feasible for new mothers to comply.
Study Design and Results
The study aimed to compare the predictive power of the one-hour and two-hour tests. A cohort of 369 women was tested at three, one, three, and five years postpartum. The analysis, using Cox proportional hazard regression models, revealed that the one-hour test identified 60 women diagnosed with diabetes at the three-month mark, and additionally flagged 96 more women who would later develop diabetes.
Over the five-year period, the one-hour test emerged as the strongest predictor of future diabetes risk, with a 16.1% change in the concordance index (CCI). In comparison, the two-hour test showed a 14.9% change. This suggests that the one-hour test could enhance the accuracy of postpartum diabetes risk assessments, providing earlier intervention opportunities.
Conclusion
The findings suggest that the one-hour glucose test offers a more reliable method for identifying women at risk of diabetes after gestational diabetes, potentially improving long-term health outcomes. Dr. Retnakaran also emphasizes the importance of weight loss as a critical intervention in reducing diabetes risk, noting that new medications have made weight management more achievable than ever before.
This study highlights the potential of the one-hour glucose test to revolutionize diabetes screening practices, particularly for postpartum women, and calls for wider adoption of this shorter, more efficient test.
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