記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：一般社団法人 日本助産学会  

<b>目 的</b>

妊娠糖尿病（GDM）を再発しなかった女性が，かつてGDMと診断されてからどのような日常生活を過ごしたのかを明らかにする。

<b>対象と方法</b>

研究デザインは質的記述的研究である。GDMを再発しなかった女性5名を対象に半構造化インタビューを行った。得られたデータから逐語録を作成し，かつてGDMと診断されてからの日常生活に関連する内容が語られている部分を抽出し，コード化し，サブカテゴリ・カテゴリを形成した。

<b>結 果</b>

GDMを再発しなかった女性は，かつてGDMの【診断に驚き，これまでの生活をふりかえる】と同時に【高血糖が胎児に及ぼす影響を心配する】経験をしていた。そして，診断と共に開始される【医療者から求められた生活の制限が面倒で苦痛と感じる】ことで，心と体に負担となっていた実態が語られた。一方で，【家族の存在に支えられる】ことで，【食事を制限して血糖を管理するコツをつかむ】前向きな経験も語られた。また，GDM治療後も【再発や胎児への影響を心配してGDM時の生活を続ける】ことでGDMの再発を防ぎ，【再発しなかった日常生活を続けようと思う】ことに繋がっていた。そして，【GDM時に得られた家族の協力を継続する】ことは，その日常生活の維持に必要な事柄として語られており，【自分が将来糖尿病を発症することを心配する】思いを現在も持ち続けていることが語られた。

<b>結 論</b>

GDMを再発しなかった女性は，GDM中もGDM治療後も家族の協力を支えとしながらGDMのときに取得した日常生活を継続していた。また，妊娠後は，胎児への影響を考え，子どもを守るためにGDMが再発しないことを常に意識しており，その生活はGDMの再発予防となっていた。GDMを再発しなかったことを支えとする一方で，将来の糖尿病発症を懸念することが，GDM中の日常生活を継続することに繋がったと推測された。

DOI： 10.3418/jjam.jjam-2023-0021

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

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記述言語：日本語   出版者・発行元：新潟周産母子研究会  

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