Authors: Walkyria P. Pimenta¹; Iracema M. P. Calderon²; Ney S. Cruz¹; Maria Luiza Santos¹; Flávio F. Aragon³; Carlos Roberto Padovani³

Source: Acta Obstetricia et Gynecologica Scandinavica, Volume 83, Number 12, December 2004 , pp. 1152-1158(7)

Publisher: Informa Healthcare

Abstract:

Background.

To evaluate insulin release and insulin sensitivity in women with prior gestational diabetes mellitus (GDM) to gain a better understanding of type 2 diabetes pathogenesis. Methods.

GDM women were individually matched for age, body mass index, and waist/hip ratio with those who were normal glucose tolerant in a previous pregnancy (NGT). All women presented with normal glucose tolerance. Twenty pairs were submitted to the oral glucose tolerance test (OGTT) with plasma glucose, insulin, and C-peptide determinations. Of the 20 pairs, 18 participated in hyperglycemic (10.0 mmol/l) clamp experiments with frequent plasma glucose and insulin determinations, allowing us to calculate first- and second-phase insulin release and the insulin sensitivity index. GDM and NGT women were compared using Student's t-test, the Mann–Whitney U-test, Friedman's non-parametric test, and the two proportion test for independent groups. Results.

GDM women showed higher glycosylated hemoglobin values; at OGTT, they showed late insulin peak with increased plasma insulin levels only during the second hour, and a similar plasma C-peptide response despite a higher plasma glucose curve; during hyperglycemic clamp procedures, they showed similar biphasic insulin release and insulin sensitivity index. Considering that a woman with previous GDM had a defect in insulin release and/or insulin sensitivity, if its magnitude was at least 25% lower than that of the matched NGT woman, 43.8% showed impairment of first-phase insulin release and 55.6% insulin resistance. Conclusions.

GDM women showed some degree of glucose intolerance. It is therefore necessary to follow them for a longer time.

Keywords: gestational diabetes mellitus; insulin secretion; insulin sensitivity

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.0001-6349.2004.00444.x

Affiliations: 1: Internal Medicine and 2: Obstetrics and Gynecology, Botucatu School of Medicine and 3: Biostatistics, Botucatu Institute of Biosciences, São Paulo State University, Brazil

Publication date: 2004-12-01

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