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Diabetologia

, Volume 56, Issue 12, pp 2753–2760 | Cite as

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

  • Anny H. XiangEmail author
  • Miwa Takayanagi
  • Mary Helen Black
  • Enrique Trigo
  • Jean M. Lawrence
  • Richard M. Watanabe
  • Thomas A. Buchanan
Article

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.

Keywords

Beta cell function Gestational diabetes mellitus Longitudinal change Insulin sensitivity 

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

Notes

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Anny H. Xiang
    • 1
    Email author
  • Miwa Takayanagi
    • 1
  • Mary Helen Black
    • 1
  • Enrique Trigo
    • 2
  • Jean M. Lawrence
    • 1
  • Richard M. Watanabe
    • 3
  • Thomas A. Buchanan
    • 2
  1. 1.Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  2. 2.Department of Medicine, Keck School of Medicinethe University of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Preventive Medicine, Keck School of Medicinethe University of Southern CaliforniaLos AngelesUSA

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