University of Oulu

Auvinen, A., Luiro, K., Jokelainen, J. et al. Type 1 and type 2 diabetes after gestational diabetes: a 23 year cohort study. Diabetologia 63, 2123–2128 (2020).

Type 1 and type 2 diabetes after gestational diabetes : a 23 year cohort study

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Author: Auvinen, Anna-Maaria1,2; Luiro, Kaisu3; Jokelainen, Jari4,5;
Organizations: 1Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
2PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland
3Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO 140 (Haartmaninkatu 2E), 00029, Helsinki, Finland
4Center for Life Course Health Research, University of Oulu, Oulu, Finland
5Unit of Primary Care, Oulu University Hospital, Oulu, Finland
6Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
7Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
8Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
9Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-10-29


Aims/hypothesis: The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study.

Methods: We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984–1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, ≥4.8 mmol/l; 1 h, ≥10.0 mmol/l; and 2 h, ≥8.7 mmol/l. Two follow-up questionnaires were sent (in 1995–1996 and 2012–2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7–28.8) years.

Results: Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]).

Conclusions/interpretation: All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.

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Series: Diabetologia
ISSN: 0012-186X
ISSN-E: 1432-0428
ISSN-L: 0012-186X
Volume: 63
Issue: 10
Pages: 2123 - 2128
DOI: 10.1007/s00125-020-05215-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Open access funding provided by University of Helsinki including Helsinki University Central Hospital. This study was supported by Sigrid Jusélius Foundation, Academy of Finland, and Helsinki and Oulu University Hospital Research Funds.
Copyright information: © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit