Longitudinal changes in insulin sensitivity and beta cell function between women with and without a history of gestational diabetes mellitus
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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).
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.
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).
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.
KeywordsBeta cell function Gestational diabetes mellitus Longitudinal change Insulin sensitivity
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
Acute insulin response
Dual-energy x-ray absorptiometry
Department of Health and Human Services
Gestational diabetes mellitus
Generalised estimating equation
Impaired fasting glucose
Impaired glucose tolerance
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.
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.
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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