產後糖尿病篩檢比例可能並不高

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　October 6, 2009 — 根據一項發表於9月9日糖尿病照護期刊的回溯性世代研究結果，產後糖尿病篩檢率可能並不高。
　　
　　加拿大愛德蒙頓艾伯特大學的Sarah Kwong醫師與其同事們寫到，妊娠糖尿病（GDM）強烈地預測之後發生第二型糖尿病、可能持續到分娩後的異常葡萄糖耐受性，導致空腹血糖異常（IFG）、葡萄糖耐受性異常（IGT），甚至是第二型糖尿病。這項研究的主要目的在於評估產後篩檢的遵從性，以找出與遵從性不佳的因子，以及比較FPG與75公克OGTT在偵測產後葡萄糖耐受性不佳的敏感度。
　　
　　這項研究收納了包括1,066位至妊娠糖尿病診所就診的妊娠糖尿病患者，其中97位被排除；結果顯示，僅有438位（48%）接受產後篩檢。相較於接受篩檢的女性，未接受篩檢的女性比較可能順利生產（1.10相較於0.87），且比較不可能需要胰島素處理她們的妊娠糖尿病。
　　
　　在那些產後接受治療的女性中，89位（21%）的結果異常，僅有25位（28%）的空腹血糖結果異常。非高加索女性或是過去有妊娠糖尿病的女性、懷孕時血紅素A1c值或是口服葡萄糖耐受性檢測值較高，或是以胰島素治療比較可能有異常的產後糖尿病篩檢結果。
　　
　　研究作者們寫到，產後糖尿病篩檢的比例並不高，且FPG相較於OGTT作為篩檢工具缺乏敏感度。雖然企圖改善遵從性，但在我們的族群中，仍然僅有不到50%接受產後葡萄糖耐受性檢驗，且只有順產機率較高及未使用胰島素顯著地與未遵從檢驗有關，考慮到產後高血糖的發生率增加，以及缺乏找出未遵從產後篩檢的可靠預測因子，應該針對這些高風險群以OGTT進行全面篩檢。
　　
　　研究作者們表示已無相關資金上的往來。

Rate of Postpartum Diabetes Screening May Be Low

By Laurie Barclay, MD
Medscape Medical News

October 6, 2009 — The rate of postpartum diabetes screening is low, according to the results of a retrospective cohort study reported online ahead of print in the September 9 issue of Diabetes Care.

"Gestational diabetes (GDM) strongly predicts future development of type 2 diabetes and abnormal glucose tolerance can persist postpartum leading to impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes," write Sarah Kwong, MD, from the University of Alberta in Edmonton, Canada, and colleagues. "Compared with an oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) has greater reproducibility but may lack sensitivity to identify women with IGT or type 2 diabetes. The main study objectives were to assess adherence with postpartum testing, to identify factors associated with non-adherence, and to compare the sensitivity of FPG versus a 75g OGTT in detecting postpartum glucose intolerance."

The study cohort consisted of 1006 women with gestational diabetes who were attending a pregnancy diabetes clinic, of whom 97 were excluded. Only 438 women (48%) underwent postpartum screening. Compared with women who were screened, women who did not undergo screening were more likely to have higher parity (1.10 vs 0.87) and were less likely to need insulin for management of their gestational diabetes.

Among women who were tested postpartum, 89 (21%) had an abnormal result, only 25 (28%) of whom had an abnormal fasting plasma glucose result. Women who were non-Caucasian or who had previous gestational diabetes, higher hemoglobin A1c or oral glucose tolerance test values during pregnancy, or treatment with insulin were most likely to have abnormal postpartum diabetes screening results.

"The rate of postpartum diabetes screening is low and FPG lacks sensitivity as a screening test in comparison with OGTT," the study authors write. "Despite attempts to improve adherence, less than 50% of our cohort underwent postpartum testing for glucose intolerance, and only higher parity and lack of insulin use were significantly associated with non-adherence to testing....Given the rising incidence of post-gestational hyperglycemia and a lack of reliable predictors to identify non-adherence to post partum testing, universal screening with an OGTT should be applied to this high risk population."

The study authors have disclosed no relevant financial relationships.

Diabetes Care. Published online September 9, 2009.