Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus
Camille E Powe, Catherine Allard, Marie-Claude Battista, Myriam Doyon, Luigi Bouchard, Jeffrey L Ecker, Patrice Perron, Jose C Florez, Ravi Thadhani, Marie-France Hivert, Camille E Powe, Catherine Allard, Marie-Claude Battista, Myriam Doyon, Luigi Bouchard, Jeffrey L Ecker, Patrice Perron, Jose C Florez, Ravi Thadhani, Marie-France Hivert
Abstract
Objective: To characterize physiologic subtypes of gestational diabetes mellitus (GDM).
Research design and methods: Insulin sensitivity and secretion were estimated in 809 women at 24-30 weeks' gestation, using oral glucose tolerance test-based indices. In women with GDM (8.3%), defects in insulin sensitivity or secretion were defined below the 25th percentile in women with normal glucose tolerance (NGT). GDM subtypes were defined based on the defect(s) present.
Results: Relative to women with NGT, women with predominant insulin sensitivity defects (51% of GDM) had higher BMI and fasting glucose, larger infants (birth weight z score 0.57 [-0.01 to 1.37] vs. 0.03 [-0.53 to 0.52], P = 0.001), and greater risk of GDM-associated adverse outcomes (57.6 vs. 28.2%, P = 0.003); differences were independent of BMI. Women with predominant insulin secretion defects (30% of GDM) had BMI, fasting glucose, infant birth weights, and risk of adverse outcomes similar to those in women with NGT.
Conclusions: Heterogeneity of physiologic processes underlying hyperglycemia exists among women with GDM. GDM with impaired insulin sensitivity confers a greater risk of adverse outcomes.
© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Source: PubMed