Subclinical abnormalities of glucose metabolism in Brazilian women with a history of gestational diabetes mellitus

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 83; no. 12; pp. 1152 - 1158
• Main Authors: Pimenta, Walkyria P., Calderon, Iracema M. P., Cruz, Ney S., Santos, Maria Luiza, Aragon, Flávio F., Padovani, Carlos Roberto
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Munksgaard International Publishers 01.12.2004; Taylor & Francis
• Subjects: Adult; Area Under Curve; Biological and medical sciences; Blood Glucose - metabolism; Body Constitution; Body Mass Index; Brazil; Case-Control Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - metabolism; Diabetes, Gestational - blood; Diabetes, Gestational - metabolism; Diabetes, Gestational - physiopathology; Fasting; Female; gestational diabetes mellitus; Glucose Clamp Technique; Glucose Intolerance - blood; Glucose Intolerance - epidemiology; Glucose Intolerance - metabolism; Glucose Tolerance Test; Glycated Hemoglobin A - analysis; Gynecology. Andrology. Obstetrics; Humans; Insulin - metabolism; Insulin Resistance; Insulin Secretion; insulin sensitivity; Medical sciences; Pregnancy; Risk Factors; South America; Brazil; America; Human; Pancreatic hormone; Secretion; Gynecology; Glucose; gestational diabetes mellitus; insulin secretion; History; Maternal diseases; Metabolism; Insulin; Obstetrics; Pregnancy; insulin sensitivity; Sensitivity; Adult; Female; Gestational diabetes
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1111/j.0001-6349.2004.00444.x

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.