Homeostatic model assessment of beta cell function predicting abnormal oral glucose tolerance testing in pregnancy: a systematic review and meta-analysis

Abstract

Background: Gestational diabetes mellitus (GDM) complicates 1–14% of pregnancies and relates to increased risk of adverse obstetric outcomes. Currently GDM is diagnosed using an oral glucose tolerance test (OGTT), which is burdensome and time intensive.

Objective: To compare current literature on whether the homeostatic model assessment beta cell function (HOMA-β) is an accurate predictor of an abnormal OGTT in pregnant women.

Methods: Pubmed, Cochrane and Embase were searched. Included studies evaluated pregnant women at risk for GDM using the homeostatic model assessment of beta cell function (HOMA-β) for the assessment of beta cell function and the OGTT. Studies with animals, non-pregnant women, women with type 2 diabetes and post-partum diabetes were excluded. The QUADAS-2 criteria were used to assess the methodological quality of studies.

Results: A total of 12 studies were included, reporting on 7292 women. Seven studies showed a difference in beta cell function between women with impaired glucose tolerance compared to healthy pregnant women. HOMA-β is significantly lower in impaired glucose tolerance (p < 0.001).

Conclusions: Although HOMA-β is lower in women with abnormal OGTT in pregnancy, given the high degree of heterogeneity of studies, we do not propagate HOMA-β as a sole diagnostic tool replacing OGTT to diagnose GDM.

Chinese abstract

背景：妊娠期糖尿病（GDM）在妊娠期的发生率为1-14%, 并增加不良产科结局的风险。目前GDM通过繁琐和耗时的口服葡萄糖耐量试验（OGTT）诊断。

目的：比较研究β细胞功能稳态模型（HOMA-β）是否能准确预测孕妇OGTT异常的最新文献。

方法：检索PubMed、Cochrane和Embase。包括使用β细胞功能稳态模型（HOMA-β）及OGTT评估孕妇GDM风险的研究。排除动物、非孕妇、2型糖尿病和产后糖尿病患者的研究。QUADAS-2标准用来评估研究的方法学质量。

结果：共纳入12项研究, 包括7292名女性。七项研究显示糖耐量受损孕妇与健康孕妇β细胞功能的差异。HOMA-β在糖耐量受损孕妇中显著降低(p < 0.001)。

结论：虽然HOMA-β在OGTT异常孕妇中较低, 考虑研究的异质性程度高, 我们不宣传HOMA-β取代OGTT作为GDM的唯一诊断工具。

Keywords:

• Gestational diabetes
• beta cell function
• insulin secreting cells
• homeostatic model assessment
• HOMA
• prediction
• insulin resistance

Disclosure statement

No potential conflict of interest was reported by the authors.