Abstract
While both individual- and neighborhood-level factors play a role in the progression from gestational diabetes mellitus (GDM) to type 2 diabetes mellitus (T2DM), few studies have simultaneously examined these two sets of factors. In this retrospective cohort study of 3567 women with a history of GDM, we used multilevel survival analysis to quantify T2DM risk associated with patient-level and neighborhood-level factors. During a mean follow-up of 2.2 years, 195 women (5.5%) developed T2DM. Statistically significant risk factors of T2DM progression included Black or Asian race, preeclampsia, family history of diabetes, and overweight or obesity. Importantly, residing in neighborhoods with a top tertile social deprivation index was also associated with increased risk (HR = 1.78, 95% CI: 1.01-3.14). In addition, after accounting for other factors, the residual clustering associated with neighborhoods conferred a 19% higher risk. Interventions addressing both individual- and neighborhood-level factors, including socioeconomic disparities, are critical to reducing the risk of T2DM in women with GDM.