Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: While the oral glucose tolerance test (OGTT) is the gold standard for diagnosing gestational diabetes mellitus (GDM), hemoglobin A1c (A1C), glycated albumin (GA), and fructosamine (Fruc) have the potential to conveniently classify pregnant women as having or not having GDM because two or more measurements are not necessary, unlike with OGTT. Compared with A1C, GA or Fruc, which reflects more recent glycemic indices, may more accurately detect GDM. This meta-analysis compared the diagnostic ability of GDM between GA or Fruc and A1C. METHOD: Comprehensive literature searches were performed for studies published up to Sep.11, 2023. Selected studies were limited to those that attempted to identify GDM using both GA and/or Fruc and A1C to compare these indicators. Two authors extracted the data. Disagreements were resolved by a third author. Study quality was assessed by a revised tool for quality assessment of diagnostic accuracy in studies (QUADUS-2). The dataset consisting of true-positives, false-positives, false-negatives, and true-negatives was pooled with a bivariate between-study model and hierarchical summary receiver operating characteristic model. Pooled relative sensitivity and specificity based on a random-effects model were calculated to compare the diagnostic ability of A1C and GA and/or Fruc for GDM. RESULT: There were 20 eligible studies. Pooled positive and negative likelihood ratios with 95% confidence intervals (CI) were 5.11 (2.30-11.37) and 0.53 (0.40-0.71), respectively, if GA or Fruc was used and 3.75 (2.61-11.39) and 0.53 (0.42-0.66), respectively, if A1C was used. Relative sensitivity and specificity (95% CI) for GA or Fruc compared with A1C was 1.00 (0.94-1.07) and 0.99 (0.97-1.01), respectively. CONCLUSION: The insufficiently low value of the negative likelihood ratio did not support the single use of GA/Fruc or A1C in screening for GDM suggesting the necessity of combining other risk factors with glycemic indicators. Although there was no statistically significant difference in diagnostic ability between GA or Fruc and A1C, the value of the positive likelihood ratio indicated that GA or Fruc was somewhat more useful than A1C as a rule-in test for the diagnosis of GDM. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023461975.

DOI： 10.1186/s13643-025-02894-0

PubMed

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Language：Japanese   Publisher：Japan Academy of Midwifery  

<b>Purpose</b>

This study aimed to investigate how women without recurrent gestational diabetes mellitus (GDM) lived their daily lives after being diagnosed with GDM in the past.

<b>Methods</b>

A qualitative descriptive study was conducted, consisting of semi-structured interviews with five women who did not have a recurrence of GDM. A verbatim transcript was prepared from the data obtained, and the parts of the transcript that were related to the daily life after the diagnosis of GDM were extracted, coded, and subcategories and categories were formed.

<b>Results</b>

Women without GDM recurrence were surprised at their diagnosis and reflected on their lives, while at the same time worrying about the effects of hyperglycemia on their fetus. They also talked about the reality of the mental and physical burden caused by the restrictions on daily life, requested by the medical staff, that they found troublesome and painful, which started along with the diagnosis. However, some women gained positive experience by managing their blood glucose through dietary changes with the support of their family members. By continuing their lifestyle at the time of GDM out of concern for recurrence and the effects on their fetus it prevented the recurrence of GDM. In addition, the cooperation of family members was necessary to maintain this lifestyle, and the participants expressed their continued concern that they would develop diabetes in the future.

<b>Conclusion</b>

Women without GDM recurrence continued with the lifestyle behaviors they had acquired during GDM with the support of their families both during and after GDM treatment. In addition, after pregnancy, these women remained mindful of preventing a recurrence of GDM in order to protect their children, from the harmful effects of hyperglycemia on the fetus. By maintaining their daily lifestyle changes they were able to prevent a recurrence of GDM.

DOI： 10.3418/jjam.jjam-2023-0021

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

J-GLOBAL

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: To determine the incidence of remission and 1-year relapse from remission and associated factors in patients with type 2 diabetes. MATERIALS AND METHODS: A total of 48 320 Japanese patients with type 2 diabetes aged ≥18 years, with glycated haemoglobin (HbA1c) levels ≥48 mmol/mol (6.5%) and/or glucose-lowering drug prescription, were identified from databases of specialist clinics from 1989 and followed until September 2022. Remission was defined as HbA1c <48 mmol/mol at least 3 months after cessation of a glucose-lowering drug. Relapse was defined as failure to maintain remission for 1 year. Factors associated with remission and relapse were evaluated by logistic regression analysis. RESULTS: The overall incidence of remissions per 1000 person-years was 10.5, and for those with HbA1c levels of 48 to 53 mmol/mol (6.5% to 6.9%), those taking no glucose-lowering drugs at baseline, and those with a ≥10% body mass index (BMI) reduction in 1 year, it was 27.8, 21.7 and 48.2, respectively. Shorter duration, lower baseline HbA1c, higher baseline BMI, higher BMI reduction at 1 year, and no glucose-lowering drugs at baseline were significantly associated with remission. Among 3677 persons with remission, approximately two-thirds (2490) relapsed within 1 year. Longer duration, lower BMI at baseline, and lower BMI reduction at 1 year were significantly associated with relapse. CONCLUSIONS: The results showed that the incidence of remission and predictors of relapse, especially baseline BMI, might differ greatly between East Asian and Western populations. Furthermore, the relationships of BMI reduction with remission and relapse may be greater in East Asian than in Western populations, implying ethnic differences in returning from overt hyperglycaemia to nearly normal glucose levels.

DOI： 10.1111/dom.15100

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: To determine the association between the magnitude of weight loss and incidence of remission according to baseline characteristics in patients with diabetes in clinical settings. METHODS: In total, 39 676 Japanese patients with type 2 diabetes aged ≥18 years with glycated haemoglobin (HbA1c) ≥6.5% and/or glucose-lowering drug prescription were identified from databases of specialists' clinics from 1989 and followed until September 2022. Remission was diagnosed as maintaining HbA1c <6.5% at least 3 months after cessation of a glucose-lowering drug. Factors associated with remission were evaluated by logistic regression analysis according to weight change in 1 year (i.e. ≥10%, 7.0-9.9%, 3.0-6.9% reduction, <3% change and ≥3.0% increase). RESULTS: During the study period, 3454 remissions occurred. The rates of remission were higher in the group with the greatest reduction of body mass index (BMI) in any category examined (i.e. baseline BMI, HbA1c, duration of diabetes and treatment). The incidences of remission per 1000 person-years were about 25 and 50, respectively, for those with BMI ≥22.5 and reductions in BMI of 7.0-9.9% and ≥10% in 1 year. Remissions per 1000 person-years were 99.2 and 91.8, respectively, for those with baseline HbA1c of 6.5-6.9 and a 10% BMI reduction and those not taking glucose-lowering drugs accompanied by a 10% BMI reduction. CONCLUSIONS: Modest weight losses of 3.0-7.9% were significantly associated with remission, but a minimum of 10% weight loss would be required in addition to an early diagnosis to achieve a 10% remission rate in clinical settings. Our results implied that remission may be expected with a relatively lower BMI in an Asian population compared with that was reported in Western populations if accompanied by weight loss.

DOI： 10.1111/dom.15206

PubMed

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

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Language：Japanese   Publisher：(一社)日本糖尿病・妊娠学会  

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Language：Japanese   Publisher：新潟周産母子研究会  

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