Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women
| Autor: | Enrique Trigo, Siri L. Kjos, Jerry P. Palmer, Anny H. Xiang, Thomas A. Buchanan, W P Lee, E A Bergner, Ruth K. Peters, I Nader |
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| Rok vydání: | 1998 |
| Předmět: |
Adult
Blood Glucose medicine.medical_specialty endocrine system diseases Endocrinology Diabetes and Metabolism medicine.medical_treatment Type 2 diabetes Body Mass Index Impaired glucose tolerance Cohort Studies Insulin resistance Pregnancy Risk Factors Diabetes mellitus Internal medicine Glucose Intolerance Internal Medicine medicine Humans Insulin Longitudinal Studies Glucose tolerance test medicine.diagnostic_test Obstetrics business.industry Postpartum Period nutritional and metabolic diseases Hispanic or Latino Glucose Tolerance Test medicine.disease Gestational diabetes Diabetes Gestational Endocrinology Diabetes Mellitus Type 2 Female business Forecasting |
| Zdroj: | Diabetes. 47(8) |
| ISSN: | 0012-1797 |
| Popis: | We examined antepartum clinical characteristics along with measures of glucose tolerance, insulin sensitivity, pancreatic β-cell function, and body composition in Latino women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes or impaired glucose tolerance (IGT) within 6 months after delivery. A total of 122 islet cell antibody-negative women underwent oral and intravenous glucose tolerance tests (OGTT; IVGTT), hyperinsulinemic-euglycemic clamps, and measurement of body fat between 29 and 36 weeks' gestation and returned between 1 and 6 months postpartum for a 75-g OGTT. Logistic regression analysis was used to examine the relationship between antepartum variables and glucose tolerance status postpartum. At postpartum testing, 40% of the cohort had normal glucose tolerance, 50% had IGT, and 10% had diabetes by American Diabetes Association criteria. Independent antepartum predictors of postpartum diabetes were the 30-min incremental insulin:glucose ratio during a 75-g OGTT (P = 0.0002) and the total area under the diagnostic 100-g glucose tolerance curve (P = 0.003). Independent predictors of postpartum IGT were a low firstphase IVGTT insulin response (P = 0.0001), a diagnosis of GDM before 22 weeks' gestation (P = 0.003), and weight gain between prepregnancy and the postpartum examination (P = 0.03). All subjects had low insulin sensitivity during late pregnancy, but neither glucose clamp nor minimal model measures of insulin sensitivity in the 3rd trimester were associated with the risk of IGT or diabetes within 6 months' postpartum. These results highlight the importance of pancreatic β-cell dysfunction, detectable under conditions of marked insulin resistance in late pregnancy, to predict abnormalities of glucose tolerance soon after delivery in pregnancies complicated by GDM. Moreover, the association of postpar-turn IGT with weight gain and an early gestational age at diagnosis of GDM suggests a role for chronic insulin resistance in mediating hyperglycemia outside the 3rd trimester in women with such a β-cell defect. |
| Databáze: | OpenAIRE |
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