Influence of gestational diabetes on the long-term control of glucose tolerance

Aims/hypothesis Gestational diabetes (GDM) carries a high risk of subsequent diabetes. We asked what impact prior GDM has on beta cell function and insulin action in women who maintain normal glucose tolerance (NGT) for a long time. Methods Ninety-one women with NGT (aged 41 ± 8 years, mean±SD) were...

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Bibliographic Details
Published in:Diabetologia 2007-11, Vol.50 (11), p.2234-2238
Main Authors: Seghieri, G, Tesi, F, Anichini, R, De Bellis, A, Barsotti, E, Mari, A, Ferrannini, E
Format: Article
Language:English
Subjects:
Adult
Beta cell function
Beta cells
Biological and medical sciences
Blood Glucose - metabolism
Cohort Studies
Diabetes mellitus
Diabetes Mellitus - epidemiology
Diabetes, Gestational - blood
Diabetes. Impaired glucose tolerance
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Fasting
Female
Follow-Up Studies
Gestational diabetes
Glucose
Glucose tolerance
Glucose Tolerance Test
Humans
Insulin
Insulin Resistance
Insulin secretion
Insulin-Secreting Cells - physiology
Internal medicine
Kinetics
Mathematical models
Medical sciences
Peptides
Plasma
Pregnancy
Pregnancy Trimester, Third
Reference Values
Secretion
Treatment Outcome
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Summary:Aims/hypothesis Gestational diabetes (GDM) carries a high risk of subsequent diabetes. We asked what impact prior GDM has on beta cell function and insulin action in women who maintain normal glucose tolerance (NGT) for a long time. Methods Ninety-one women with NGT (aged 41 ± 8 years, mean±SD) were studied (by mathematical modelling of the C-peptide response to an OGTT) 7 [6] years (median [interquartile range]) after the index pregnancy, during which 52 had GDM (pGDM) and 39 had NGT (pNGT). In all women an OGTT had also been performed at 29 ± 3 weeks of the index pregnancy. Results Women with pGDM were matched with women with pNGT for age, familial diabetes, time and weight gain since index pregnancy, parity, BMI (25.4 ± 3.9 vs 26.8 ± 6.4 kg/m²), and fasting (4.64 ± 0.56 vs 4.97 ± 0.46 mmol/l) and 2 h plasma glucose levels (5.91 ± 1.14 vs 5.91 ± 1.21 mmol/l). Nonetheless, fasting (49 [29] vs 70 [45] pmol min-¹ m-², p < 0.001) and total insulin secretion (32 [17] vs 48 [21] nmol m-², p < 0.0001) and beta cell glucose sensitivity (slope of the insulin secretion/plasma glucose concentration-response function) (95 [71] vs 115 [79] pmol min-¹ m-² (mmol/l)-¹, p = 0.025) were reduced in the pGDM group compared with the pNGT group, while insulin sensitivity was preserved (424 [98] vs 398 [77] ml min-¹ m-²). At index pregnancy, women with pGDM and those with pNGT had similar age and BMI. However, both insulin sensitivity (359 [93] vs 417 [92] ml min-¹ m-², p = 0.0012) and the insulin/glucose incremental area ratio (an empirical index of beta cell function; 98 [74] vs 138 [122] pmol/mmol, p = 0.028) were reduced in women with pGDM. Conclusions Even in women who maintain normal insulin sensitivity, impaired beta cell function is carried over into the NGT status several years after a GDM pregnancy.
ISSN:0012-186X
1432-0428
DOI:10.1007/s00125-007-0802-1