Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study

Jiaxi Yang; Frank Qian; Jorge E. Chavarro; Sylvia H. Ley; Deirdre K. Tobias; Edwina Yeung; Stefanie N. Hinkle; Wei Bao; Mengying Li; Aiyi Liu; James L. Mills; Qi Sun; Walter C. Willett; Frank B. Hu; Cuilin Zhang

doi:10.1136/bmj-2022-070312

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Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study

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Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study

Jiaxi Yang, Frank Qian, Jorge E. Chavarro, Sylvia H. Ley, Deirdre K. Tobias, Edwina Yeung, Stefanie N. Hinkle, Wei Bao, Mengying Li, Aiyi Liu, …

BMJ (Online), Vol.378, pp.e070312-e070312

09/21/2022

DOI: 10.1136/bmj-2022-070312

PMCID: PMC9490550

PMID: 36130782

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Abstract

Objectives To evaluate the individual and combined associations of five modifiable risk factors with risk of type 2 diabetes among women with a history of gestational diabetes mellitus and examine whether these associations differ by obesity and genetic predisposition to type 2 diabetes. Design Prospective cohort study. Setting Nurses' Health Study II, US. Participants 4275 women with a history of gestational diabetes mellitus, with repeated measurements of weight and lifestyle factors and followed up between 1991 and 2009. Main outcome measure Self-reported, clinically diagnosed type 2 diabetes. Five modifiable risk factors were assessed, including not being overweight or obese (body mass index <25.0), high quality diet (top two fifthsof the modified Alternate Healthy Eating Index), regular exercise (=150 min/week of moderate intensity or =75 min/week of vigorous intensity), moderate alcohol consumption (5.0-14.9 g/day), and no current smoking. Genetic susceptibility for type 2 diabetes was characterised by a genetic risk score based on 59 single nucleotide polymorphisms associated with type 2 diabetes in a subset of participants (n=1372). Results Over a median 27.9 years of follow-up, 924 women developed type 2 diabetes. Compared with participants who did not have optimal levels of any of the risk factors for the development of type 2 diabetes, those who had optimal levels of all five factors had >90% lower risk of the disorder. Hazard ratios of type 2 diabetes for those with one, two, three, four, and five optimal levels of modifiable factors compared with none was 0.94 (95% confidence interval 0.59 to 1.49), 0.61 (0.38 to 0.96), 0.32 (0.20 to 0.51), 0.15 (0.09 to 0.26), and 0.08 (0.03 to 0.23), respectively (P trend<0.001). The inverse association of the number of optimal modifiable factors with risk of type 2 diabetes was seen even in participants who were overweight/obese or with higher genetic susceptibility (P trend<0.001). Among women with body mass index =25 (n=2227), the hazard ratio for achieving optimal levels of all the other four risk factors was 0.40 (95% confidence interval 0.18 to 0.91). Among women with higher genetic susceptibility, the hazard ratio of developing type 2 diabetes for having four optimal factors was 0.11 (0.04 to 0.29); in the group with optimal levels of all five factors, no type 2 diabetes events were observed. Co nclusions Among women with a history of gestational diabetes mellitus, each additional optimal modifiable factor was associated with an incrementally lower risk of type 2 diabetes. These associations were seen even among individuals who were overweight/obese or were at greater genetic susceptibility.

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Title: Subtitle: Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study
Creators: Jiaxi Yang - National University of Singapore
Frank Qian - Harvard University
Jorge E. Chavarro - Harvard University
Sylvia H. Ley - Tulane University
Deirdre K. Tobias - Harvard University
Edwina Yeung - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Stefanie N. Hinkle - University of Pennsylvania
Wei Bao - University of Science and Technology of China
Mengying Li - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Aiyi Liu - Eunice Kennedy Shriver National Institute of Child Health and Human Development
James L. Mills - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Qi Sun - Brigham and Women's Hospital
Walter C. Willett - Harvard University
Frank B. Hu - Harvard University
Cuilin Zhang - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Resource Type: Journal article
Publication Details: BMJ (Online), Vol.378, pp.e070312-e070312
DOI: 10.1136/bmj-2022-070312
PMID: 36130782
PMCID: PMC9490550
NLM abbreviation: BMJ
ISSN: 0959-535X
eISSN: 1756-1833
Publisher: Bmj Publishing Group
Number of pages: 11
Grant note: HHSN275201000020C / Intramural Research Programme of the Eunice Kennedy Shriver National Institute of Child Health and Human Development R21 HD091458; DK58845; CA50385; P30 DK46200; U01 CA176726; R01 CA67262; U01 HL145386; P30 DK046200 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA P20 GM109036 / National Institute of General Medical Sciences, NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS) American Diabetes Association
Language: English
Date published: 09/21/2022
Academic Unit: Epidemiology
Record Identifier: 9984364420302771

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