Gestational diabetes mellitus (GDM) is a condition where women develop diabetes during pregnancy. It affects more than 30,000 women per year in the UK. In most women, GDM goes away after giving birth but we know they are much more likely to develop diabetes and heart disease in the future, which can be as early as 5 years after the pregnancy. After giving birth, NICE recommends that women have a yearly health check (including a blood test) to test for diabetes. This is so that the above conditions and their associated complications can be identified early and managed more effectively. In practice, many women are not tested annually but we need to know how many women are being tested each year and whether this varies by factors such as age, geographical region, ethnicity, deprivation, and GP practice.
Women with GDM who go on to develop diabetes may also be more likely to develop complications from diabetes such as those affecting the eyes, kidneys, feet and heart but we don’t know how this compares to women with diabetes who did not have GDM. This project will allow us to examine how testing for diabetes in women with previous GDM differs by age, ethnicity, socioeconomic group, and geographical region and whether women with previous GDM have a greater risk of complications from diabetes. This in turn, will allow us to design better prevention programmes, interventions and care pathways that best serve the specific needs of these women.
Women with a history of GDM have increased risk of type 2 diabetes mellitus (T2DM) and cardiometabolic disorders. National Institute for Health and Care Excellence (NICE) guidelines state these women should be tested annually for T2DM; however, many women do not get tested. It is important to have better estimates of testing and whether this differs according to sociodemographic characteristics so that appropriate interventions or strategies can be implemented.
Objectives
To calculate the time trends in the testing for T2DM and other cardiovascular disease (CVD) risk factors (eg BMI, blood pressure) in those with a previous diagnosis of GDM and whether this differs by age, BMI, ethnicity, geographical region, and GP practice.
To assess the risk of developing micro and macrovascular complications from T2DM in women with a previous diagnosis of GDM compared to those without previous GDM and see whether this differs according to age, BMI, deprivation, ethnicity, and geographical region.
Study design and analysis
Cohort of women aged < 50 years with a history of GDM where we will assess the proportion of women who have had testing for type 2 diabetes and cardiometabolic risk factors according to calendar year, age, geographical region, ethnicity and level of social deprivation either per 1,000 person-years at risk or per 1,000 population. We will examine factors that are associated with being tested for T2DM and other CVD risk factors using logistic regression.
Retrospective cohort study of the risk of micro and macrovascular complications from T2DM in women with T2DM and previous GDM compared to age and GP matched women with T2DM (without a history of GDM). We will use Cox regression to examine the risk of diabetes complications by GDM adjusting for sociodemographic variables.
Blood glucose measurement (HbA1c, serum glucose, fasting glucose, glucose tolerance test, or fructosamine)
Lipid measurement (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or serum triglyceride level)
Body mass index (BMI)
Smoking
Blood pressure
Diagnosis of pre-diabetes and type 2 diabetes, according to the medical diagnostic codes, or a fasting plasma glucose, oral glucose tolerance test or hemoglobin A1c (HbA1c) value.
Microvascular complications of T2D including retinopathy, nephropathy, and neuropathy.
Macrovascular complications of T2DM including cardiovascular disease and peripheral vascular disease.
We will initially use clinical codes for gestational diabetes, type 2 diabetes, and complications from diabetes taken from here: https://www.phpc.cam.ac.uk/pcu/research/research-groups/crmh/cprd_cam/c… ) and develop or adopt codelists on these for Aurum.
shakila Thangaratinam - Chief Investigator - University of Birmingham
Francesca Crowe - Corresponding Applicant - University of Birmingham
Eleanor Massey - Collaborator - University of Birmingham
Jonathan Hazlehurst - Collaborator - University Hospitals Birmingham
Krishna Gokhale - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Nithya Sukumar - Collaborator - University of Warwick
Ponnusamy Saravanan - Collaborator - University of Warwick
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation