Perspect Nurs Sci.  2016 Apr;13(1):17-28. 10.16952/pns.2016.13.1.17.

Patterns of Diagnosis and Risk Factors for Type 2 Diabetes in Women with a History of Gestational Diabetes Mellitus

  • 1College of Nursing, Seoul National University, Seoul, Korea.


This study aimed to identify patterns of diagnosis and to explore risk factors for type 2 diabetes beyond the postpartum period in women with a previous history of gestational diabetes, and to identify differences in such risk factors between early and late-onset (aged <45 and≥45).
Using epidemiological data from the Korean Genome and Epidemiology Study, a retrospective analysis of 175 women with various timings of type 2 diabetes diagnosis was performed.
The average age (42.6±10.6) at type 2 diabetes diagnosis was earlier than the general population, and obesity was prevalent with marked weight gains around 35 years old. Longer duration of breastfeeding was observed in women with late-onset of type 2 diabetes.
For prevention of type 2 diabetes, early intervention is required, and modifiable factors such as weight control and breastfeeding should be taken into consideration for intervention strategies.


Diabetes gestational; Diabetes mellitus type 2; Risk factors; Retrospective studies; Prevention and control

MeSH Terms

Breast Feeding
Diabetes, Gestational*
Early Intervention (Education)
Postpartum Period
Retrospective Studies
Risk Factors*
Weight Gain


  • Figure 1. Cumulative percentage of type 2 diabetes by age at diagnosis and intervals from childbirth to diagnosis (N=175)


1.American Diabetes Association Inc. Standards of medical care in diabetes-2013. Diabetes Care. 2013. 36(Suppl 1):S11–66.
2.Jiwani A., Marseille E., Lohse N., Damm P., Hod M., Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012. 25(6):600–10.
3.Lim NK. Gestational diabetes mellitus in Korea using Korean Health Insurance Database, 2010-2011. Public Health Wkly Rep. 2013. 6(21):411–5.
4.Korean National Health Insurance Service. Gestational diabetes mellitus in Korea using Korean Health Insurance Database [Internet]. Wonju: Korea National Health Insurance Service; [cited 2014 Oct 9]. Available from:.
5.Metzger B., Gabbe S., Persson B., Buchanan T., Catalano P., Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010. 33(3):676–82.
6.Buchanan TA., Xiang AH., Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol. 2012. 8(11):639–49.
7.Boney CM., Verma A., Tucker R., Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatr [Internet]. 2005. Mar;. 115(3):290–6. Available from:.
8.Bellamy L., Casas J-P., Hingorani AD., Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009. 373(9677):1773–9.
9.Lee H., Jang HC., Park HK., Metzger BE., Cho NH. Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus. Diabetes Res Clin Pract. 2008. 81(1):124–9.
10.Feig DS., Zinman B., Wang X., Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008. 179(3):229–34.
11.Mehta Z., Cull C., STratton I., Yudkin J. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). Diabetes Care. 1999. 22(7):1125–36.
12.Baptiste-Roberts K., Barone BB., Gary TL., Golden SH., Wilson LM., Bass EB, et al. Risk factors for type 2 diabetes among women with gestational diabetes: a systematic review. Am J Med. 2009. 122(3):207–14.
13.Metzger BE., Buchanan TA., Coustan DR., De Leiva A., Dunger DB., Hadden DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007. 30(Suppl 2):S251–60.
14.Ratner RE., Christophi CA., Metzger BE., Dabelea D., Bennett PH., Pi-Sunyer X, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008. 93(12):4774–9.
15.Nielsen KK., Kapur A., Damm P., de Courten M., Bygbjerg IC. From screening to postpartum follow-up-the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth. 2014. 14:41.
16.Jang HC. Gestational diabetes in Korea: incidence and risk factors of diabetes in women with previous gestational diabetes. Diabetes Metab J. 2011. 35(1):1–7.
17.Kim YL., Cho YW., Park SW., Lee SK., Ahn IS., Na BW, et al. Antepartum characteristics predicting persistent postpartum glucose lntolerance in the patients with gestational diabetes mellitus (GDM). J Korean Diabetes Assoc. 2000. 24(1):46–59.
18.Jang HC., Yim C-H., Han KO., Yoon H-K., Han I-K., Kim M-Y, et al. Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum. Diabetes Res Clin Pract. 2003. 61(2):117–24.
Article [Internet]. Cheongju: Korean Centers for Disease Control and Prevention; [updated 2016 Jan 20; cited 2014 Feb 7]. Available from:.
20.Korean Academy of Medical Sciences. Evidence-based recommendations for type 2 diabetes in primary care [Internet]. Seoul: Korean Medical Guideline Information Center; [cited 2014]. Available from:.
21.Misra A., Chowbey P., Makkar B., Vikram N., Wasir J., Chadha D, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009. 57(2):163–70. [Internet]. Seoul: Korean Diabetes Association. Available from:. [Internet]. Atlanta: Centers for Disease Control and Prevention(CDC); [updated 2015 Dec 1]. Available from:.
24.Ha KH., Kim DJ. Trends in the diabetes epidemic in Korea. Endocrinol Metab. 2015. 30(2):142–6.
25.Kim C., Newton KM., Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002. 25(10):1862–8.
26.Girgis CM., Gunton JE., Cheung NW. The influence of ethnicity on the development of type 2 diabetes mellitus in women with gestational diabetes: a prospective study and review of the literature. ISRN Endocrinol. 2012. 2012:
27.Ziegler A-G., Wallner M., Kaiser I., Rossbauer M., Harsunen MH., Lachmann L, et al. Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus. Diabetes. 2012. 61(12):3167–71.
28.Stuebe AM., Rich-Edwards JW., Willett WC., Manson JE., Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005. 294(20):2601–10.
29.Kjos SL., Henry O., Lee RM., Buchanan TA., Mishell Jr DR. The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol. 1993. 82(3):451–5.
30.Gunderson EP. Breastfeeding after gestational diabetes pregnancy subsequent obesity and type 2 diabetes in women and their offspring. Diabetes Care. 2007. 30(Suppl 2):S161–8.
31.Taylor JS., Kacmar JE., Nothnagle M., Lawrence RA. A systematic review of the literature associating breastfeeding with type 2 diabetes and gestational diabetes. J Am Coll Nutr. 2005. 24(5):320–6.
Full Text Links
  • PNS
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: