Subtypes of gestational diabetes and future risk of pre-diabetes or diabetes.
GCT, glucose challenge test
GDM, gestational diabetes mellitus
HOMA-IR, Homeostasis Model Assessment of insulin resistance
IGI/HOMA-IR, insulinogenic index divided by HOMA-IR
ISSI-2, Insulin Secretion-Sensitivity Index-2
OGTT, oral glucose challenge test
beta-cell function
gestational diabetes
heterogeneity
postpartum
subtypes
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
28
06
2021
revised:
22
07
2021
accepted:
29
07
2021
entrez:
8
11
2021
pubmed:
9
11
2021
medline:
9
11
2021
Statut:
epublish
Résumé
Recent studies have suggested that gestational diabetes (GDM) is a heterogeneous condition with distinct subtypes determined by whether the predominant metabolic abnormality is impaired insulin sensitivity or deficient insulin secretion. However, it is not known if the elevated future risk of pre-diabetes/diabetes associated with GDM varies according to these subtypes. Thus, we sought to evaluate maternal metabolic function in the 1st year postpartum in relation to GDM subtypes. In this prospective cohort study conducted in Toronto, Canada, 613 women underwent GDM screening by oral glucose tolerance test (OGTT) in pregnancy, followed by repeat OGTT at both 3-months and 12-months postpartum between 09/2003 and 03/2016. The antepartum OGTT identified 3 groups of women: GDM with predominant sensitivity defect (GDM-sensitivity), GDM with predominant secretion defect (GDM-secretion), and non-GDM. Antepartum findings persisted after pregnancy, with lower insulin sensitivity in GDM-sensitivity (Matsuda index; HOMA-IR) and lower insulin secretion in GDM-secretion (Stumvoll first-phase; insulinogenic index (IGI)) at both 3-months and 12-months (all Beta-cell dysfunction, glycemia and incident pre-diabetes/diabetes do not vary between GDM subtypes in the 1st year postpartum. Canadian Institutes of Health Research; Diabetes Canada.
Sections du résumé
BACKGROUND
BACKGROUND
Recent studies have suggested that gestational diabetes (GDM) is a heterogeneous condition with distinct subtypes determined by whether the predominant metabolic abnormality is impaired insulin sensitivity or deficient insulin secretion. However, it is not known if the elevated future risk of pre-diabetes/diabetes associated with GDM varies according to these subtypes. Thus, we sought to evaluate maternal metabolic function in the 1st year postpartum in relation to GDM subtypes.
METHODS
METHODS
In this prospective cohort study conducted in Toronto, Canada, 613 women underwent GDM screening by oral glucose tolerance test (OGTT) in pregnancy, followed by repeat OGTT at both 3-months and 12-months postpartum between 09/2003 and 03/2016. The antepartum OGTT identified 3 groups of women: GDM with predominant sensitivity defect (GDM-sensitivity), GDM with predominant secretion defect (GDM-secretion), and non-GDM.
FINDINGS
RESULTS
Antepartum findings persisted after pregnancy, with lower insulin sensitivity in GDM-sensitivity (Matsuda index; HOMA-IR) and lower insulin secretion in GDM-secretion (Stumvoll first-phase; insulinogenic index (IGI)) at both 3-months and 12-months (all
INTERPRETATION
CONCLUSIONS
Beta-cell dysfunction, glycemia and incident pre-diabetes/diabetes do not vary between GDM subtypes in the 1st year postpartum.
FUNDING
BACKGROUND
Canadian Institutes of Health Research; Diabetes Canada.
Identifiants
pubmed: 34746711
doi: 10.1016/j.eclinm.2021.101087
pii: S2589-5370(21)00367-9
pmc: PMC8548926
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101087Informations de copyright
© 2021 The Author(s).
Déclaration de conflit d'intérêts
RR reports grants from Boehringer Ingelheim, grants and personal fees from Novo Nordisk, personal fees from Sanofi, personal fees from Eli Lilly, outside the submitted work. RR holds the Boehringer Ingelheim Chair in Beta-cell Preservation, Function and Regeneration at Mount Sinai Hospital and his research program is supported by the Sun Life Financial Program to Prevent Diabetes in Women. BZ reports personal fees from Eli Lilly, personal fees from NovoNordisk Advisory Board, personal fees from Merck, personal fees from Boehringer Ingelheim, outside the submitted work. CY, AJH, PWC, and MS have nothing to disclose.
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