Jiaxi Yang postdoctoral fellow, Frank Qian resident physician, Jorge E Chavarro professor, Sylvia H Ley assistant professor, Deirdre K Tobias assistant professor, Edwina Yeung senior investigator et al
Yang J, Qian F, Chavarro J E, Ley S H, Tobias D K, Yeung E et al.
Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study
BMJ 2022; 378 :e070312
doi:10.1136/bmj-2022-070312
Re: Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study
Dear Editor
There are some difficulties of lifestyle modifications to reduce the risk of type 2 diabetes mellitus (T2DM). Yang et al. reported the effective risk reduction of T2DM by lowering five modifiable risk factors, such as keeping body mass index under 25.0, high quality diet, regular exercise, moderate alcohol consumption and no current smoking, among women with prior gestational diabetes (GDM), even women with genetic susceptibility for T2DM (1). The results were derived form a long-term cohort study over a median 27.9 years of follow-up. I present some information on the risk of T2DM among women with prior GDM, stratified by natives or not.
Dyck et al. conducted a retrospective cohort study to determine the risk of T2DM among Saskatchewan First Nations (FN) and non-FN women with prior GDM (2). The adjusted odds ratios (ORs) (95% CI) of prior GDM for T2DM within the FN and non-FN cohorts were 7.05 (5.82-8.54) and 9.64 (8.62-10.77), respectively. In addition, the cumulative survival rate in women within the FN cohort was lower than that in women within the non-FN cohort, regardless of GDM. I suppose that socioeconomic factors, including medical resources, would contribute to the higher mortality risk among FN women than that among non-FN women, although T2DM risk was lower in FN women with GDM. A comparative study of lifestyles in women within FN and non-FN cohort is needed.
Hummelen et al. also conducted a retrospective cohort study to identify the incidence of T2DM among FN women with prior GDM in northwest Ontario (3). The cumulative incidence of T2DM among women with prior GDM at 2 years was 18% (42/237) and 39% (76/194) at 6 years. Compared to these data, Dyck et al. reported the cumulative incidence of T2DM among FN women with prior GDM was about 82% after the follow-up of 30 years, and it was linearly increased after the follow-up of 10 years (2). Severity of GDM and the history of GDM medication may also contributed to the risk of subsequent T2DM, and these factors should be checked in combination with modifiable risk factors, genetic susceptibility, and ethnic characteristics.
References
1. Yang J, Qian F, Chavarro JE, et al. Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study. BMJ 2022;378:e070312.
2. Dyck RF, Pahwa P, Karunanayake C, et al. The contribution of gestational diabetes to diabetes risk among First Nations and non-First Nations women in Saskatchewan: Results from the DIP: ORRIIGENSS Project. Can J Diabetes 2023;47:509-18.
3. Hummelen R, Sodhi S, Poirier J, et al. Progression from gestational diabetes mellitus to type 2 diabetes mellitus among First Nations women in Northwest Ontario: A retrospective cohort study. Can J Diabetes 2023 May 15. doi: 10.1016/j.jcjd.2023.05.003.
Competing interests: No competing interests