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Longitudinal changes in insulin sensitivity and beta cell function between women with and without a history of gestational diabetes mellitus

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Abstract

Aims/hypothesis

The aim of the study was to compare longitudinal changes in insulin sensitivity (SI) and beta cell function between women with and without a history of gestational diabetes mellitus (GDM).

Methods

The prospective follow-up cohort included 235 parous non-diabetic Mexican–American women, 93 with and 142 without a history of GDM. The participants underwent dual-energy x-ray absorptiometry, OGTTs and IVGTTs at baseline and at a median of 4.1 years follow-up. The baseline values and rates of change of metabolic measures were compared between groups.

Results

At baseline, women with prior GDM (mean age 36.3 years) had similar values of SI but higher percentages of body fat and trunk fat (p ≤ 0.02), a lower acute insulin response and poorer beta cell compensation (disposition index [DI]) (p < 0.0001) than women without GDM (mean age 37.9 years). During the follow-up, women with GDM had a faster decline in SI (p = 0.02) and DI (p = 0.02) than their counterparts without GDM, with no significant differences in changes of weight or fat (p > 0.50). Adjustment for baseline age, adiposity, calorie intake, physical activity, age at first pregnancy, additional pregnancies and changes in adiposity during follow-up increased the between-group differences in the rates of change of SI and DI (p ≤ 0.003).

Conclusions/interpretation

Mexican–American women with recent GDM had a faster deterioration in insulin sensitivity and beta cell compensation than their parous counterparts without GDM. The differences were not explained by differences in adiposity, suggesting more deleterious effects of existing fat and/or reduced beta cell robustness in women with GDM.

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Abbreviations

30´ΔInsulin:

Difference in plasma insulin level between the 30 min and fasting time points of the OGTT

ΔGlucose AUC:

Incremental AUC for the 2 h OGTT glucose curve

AIR:

Acute insulin response

DEXA:

Dual-energy x-ray absorptiometry

DHHS:

Department of Health and Human Services

DI:

Disposition index

GDM:

Gestational diabetes mellitus

GEE:

Generalised estimating equation

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

IQR:

Interquartile range

SI :

Insulin sensitivity

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Acknowledgements

We thank the participants who took part in the BetaGene study and in particular those who returned to participate in the BetaGene-II study. We also acknowledge the efforts of our recruiting and technical staff, the support of the University of Southern California General Clinical Research Center (M01-RR-00043), the SC CTSI (UL1-RR-031986) and their respective staff, and Kaiser Permanente Southern California Direct Community Benefit funds.

Funding

This work was supported by National Institutes of Health grants DK-061628 and UL1-TR000130; by Clinical Research Grant 7-09-CT-09 from the American Diabetes Association Research Award.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

AHX, RMW and TAB contributed to study conception and design; AHX, MT, ET, JML, RMW and TAB contributed to data acquisition; AHX, MT and MHB contributed to analysis and interpretation of data; AHX drafted the manuscript; MT, MHB, ET, JML, RMW and TAB reviewed and revised the manuscript critically for important intellectual content; all approved the version to be published.

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Authors and Affiliations

  1. Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 5th Floor, Pasadena, CA, 91101, USA

    Anny H. Xiang, Miwa Takayanagi, Mary Helen Black & Jean M. Lawrence

  2. Department of Medicine, Keck School of Medicine, the University of Southern California, Los Angeles, CA, USA

    Enrique Trigo & Thomas A. Buchanan

  3. Department of Preventive Medicine, Keck School of Medicine, the University of Southern California, Los Angeles, CA, USA

    Richard M. Watanabe

Authors
  1. Anny H. Xiang
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  2. Miwa Takayanagi
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  3. Mary Helen Black
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  4. Enrique Trigo
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  5. Jean M. Lawrence
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  6. Richard M. Watanabe
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  7. Thomas A. Buchanan
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Corresponding author

Correspondence to Anny H. Xiang.

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Xiang, A.H., Takayanagi, M., Black, M.H. et al. Longitudinal changes in insulin sensitivity and beta cell function between women with and without a history of gestational diabetes mellitus. Diabetologia 56, 2753–2760 (2013). https://doi.org/10.1007/s00125-013-3048-0

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  • DOI: https://doi.org/10.1007/s00125-013-3048-0

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