Longitudinal patterns of cardiometabolic risk factors, gestational diabetes, and diabetes

Project: Research project

Project Details

Description

Clinical Significance: Type 2 diabetes mellitus (T2DM) is a common, costly, and morbid condition
affecting over 13% of adults in the United States. The prevalence of T2DM has doubled since 1980, and there has been a resurgence in DM-related complications, including increases in age-adjusted mortality rates. Prevalence of T2DM and DM-related complications differs significantly by race/ethnicity with higher rates of both among non-Hispanic Blacks (NHB) and Hispanic adults compared with non-Hispanic whites (NHW). In addition to higher rates in racial/ethnic minorities, T2DM is more common in other disadvantaged populations (e.g. low socioeconomic status [SES]). Cumulative exposures to preventable, modifiable risk factors across the life course are largely responsible for T2DM risk, and ample evidence supports that T2DM can be prevented.
Therefore, prevention of T2DM is critical, beginning as early as the prenatal period, to curb the
intergenerational spread of metabolic risk. In particular, pregnancy is a unique metabolic stressor and thus, a critical period to address and understand a woman and offspring’s lifetime risk of T2DM.
A large body of evidence has identified and highlights the presence of glucose intolerance in pregnancy or gestational DM (GDM) as a unique sex-specific risk factor in women for future risk of T2DM and DM-related complications. GDM commonly affects up to 10% of pregnancies in the US with disproportionately higher rates in NHB and Hispanic and lower SES women. GDM is associated with a 7-fold greater risk of incident T2DM as well as increased risk of developing hypertension, early subclinical atherosclerosis, and premature cardiovascular disease (CVD). However, prior reports identifying risks are based predominantly on retrospective study designs or limited pre-pregnancy data from established pregnancy cohorts. Therefore, it remains unclear whether a history of GDM increases cardiometabolic risk independent of prior and subsequent DM RF (i.e. is the GDM pregnancy unmasking known risk or is it an independent risk factor of future DM and CVD). Gestation is also increasingly recognized as a critical period for developmental programming of offspring
metabolic risk. For example, maternal GDM has been associated with offspring metabolic health (adiposity, blood pressure, lipids, and insulin resistance) as well as CVD and premature all-cause mortality.
In collaboration with AllianceChicago (Alliance), a nationwide network of over 60 community health
centers for disadvantaged populations across 19 states with a national data warehouse and electronic health records, our group (Co-I: O’Brien) has previously collected on >50,000 adult primary care patients at risk for T2DM. Women comprise a large majority of the patient population with prenatal care being a leading driver of seeking care. Therefore, these data represent the largest national system of primary care clinics with broad geographic and racial/ethnic diversity for pregnancy-related data.22-24 The proposed study will leverage readily available data to understand the patterns of cardiometabolic risk factors pre-, peri-, and post-partum and their association with critical intermediate cardiometabolic risk factors (e.g. obesity, hypertension, and diabetes) by examining longitudinal trajectories (i.e. patterns of change over time) of these factors among a communitybased, high-risk group of women. The proposed investigation involves an interdisciplinary team of experts who offer innovative methodologies and statistical approaches in health services research that w
StatusActive
Effective start/end date8/1/207/31/21

Funding

  • University of Chicago (AWD047431-02-PR (SUB00000333)//5P30DK092949-10)
  • National Institute of Diabetes and Digestive and Kidney Diseases (AWD047431-02-PR (SUB00000333)//5P30DK092949-10)

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