Diabetes detection in women with gestational diabetes and polycystic ovarian syndrome

Hanna, Fahmy; Wu, Pensee; Heald, Adrian; Fryer, Anthony

Abstract

Gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) represent two of the highest risk factors for development of type 2 diabetes mellitus in young women. As these increasingly common conditions generally affect younger women, early detection of dysglycemia is key if preventative measures are to be effective. While international guidance recommends screening for type 2 diabetes, current screening strategies suffer from significant challenges.First, guidance lacks consensus in defining which tests to use and frequency of monitoring, thereby sending mixed messages to healthcare professionals.Second, conformity to guidance is poor, with only a minority of women having tests at the recommended frequency (where specified). Approaches to improve conformity have focused on healthcare related factors (largely technology driven reminder systems), but patient factors such as convenience and clear messaging around risk have been neglected.Third, and most critically, current screening strategies are too generic and rely on tests that become abnormal far too late in the trajectory towards dysglycemia to offer opportunities for effective preventative measures. Risk factors show wide interindividual variation, and insulin sensitivity and β cell function are often abnormal during pre-diabetes stage, well before frank diabetes.New, consistent, targeted screening strategies are required that incorporate early, prevention focused testing and personalised risk stratification. [Abstract copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.]

Citation

Hanna, F., Wu, P., Heald, A., & Fryer, A. (2023). Diabetes detection in women with gestational diabetes and polycystic ovarian syndrome. BMJ, 382, Article e071675. https://doi.org/10.1136/bmj-2022-071675

• Journal Article Type: Review
• Acceptance Date: Mar 23, 2023
• Online Publication Date: Jul 4, 2023
• Publication Date: 2023
• Deposit Date: Jul 6, 2023
• Publicly Available Date: Aug 1, 2023
• Journal: BMJ (Clinical research ed.)
• Print ISSN: 0959-8138
• Electronic ISSN: 0959-8138
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 382
• Article Number: e071675
• DOI: https://doi.org/10.1136/bmj-2022-071675
• Keywords: Diabetes, Gestational - diagnosis - etiology, Prediabetic State - complications, Female, Risk Factors, Diabetes Mellitus, Type 2 - diagnosis - epidemiology - prevention & control, Pregnancy, Polycystic Ovary Syndrome - complications - diagnosis, Humans