Long Term Predictors of Post-Partum Glucose Metabolism in Women with Gestational Diabetes Mellitus

Abstract

Aims: The question asked by this study was whether β-cell function expressed by insulin secretion/sensitivity measured during pregnancy in women with gestational diabetes (GDM) predicts post-partum long-term derangement in glucose metabolism.

Methods: Seventy-four Caucasian women with previous GDM were retested through a 75 g-2-h-OGTT after 8 [6] years (median[interquartile range]) from index pregnancy, measuring at pregnancy and follow-up insulin sensitivity, insulin secretion (1-h-incremental-insulin-area/incremental-glucose-area: ΔAUC60_I/ΔAUC60_G) as well as the product of Stumvoll-first-phase – secretion x insulin sensitivity (insulin-secretion-sensitivity index (ISSI).

Results: At follow-up 47 women were normotelerant to glucose and 27 had altered glucose metabolism (AGM:10 with type 2 diabetes and 17 with IGT). Women progressed to AGM had at their index pregnancy higher mean 2-h-OGTT-glucose area (1.15±0.09vs. 1.09±0.09 mol l 2-h⁻¹;p=0.014), and lower ΔAUC60_I/ΔAUC60 (median [interquantile range]) (54.4 [51.7] vs. 73.4 [60] pmol mmol⁻¹) and ISSI (2 977 [766] vs. 3 708 [1 141]; p<0.05 for both), but similar insulin sensitivity index 2.9 [2.5]vs. 3.2 [2.2] ml min⁻¹ m⁻²;p=NS). Two-h-OGTT-glucose area, or decrease in ΔAUC60_I/ΔAUC60_G and ISSI were significantly associated with glucose tolerance impairment and with raised adjusted risk for AGM while insulin sensitivity at pregnancy did no predict AGM development.

Conclusions: In this group of women increased post-load plasma glucose and impaired β-cell function assessed during GDM pregnancy predict long-term post-partum AGM, while insulin sensitivity measured at the same time does not.

Key words

gestational diabetes mellitus - post-partum altered glucose metabolism - OGTT - insulin secretion - insulin sensitivity - insulin-secretion-sensitivity index

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