Diabetologia

, Volume 60, Issue 7, pp 1344–1353

Women with prior gestational diabetes mellitus and prediabetes are characterised by a decreased incretin effect

  • Signe Foghsgaard
  • Louise Vedtofte
  • Camilla Andreasen
  • Emilie S. Andersen
  • Emilie Bahne
  • Jonatan I. Bagger
  • Jens A. Svare
  • Jens J. Holst
  • Tine D. Clausen
  • Elisabeth R. Mathiesen
  • Peter Damm
  • Filip K. Knop
  • Tina Vilsbøll
Article

DOI: 10.1007/s00125-017-4265-8

Cite this article as:
Foghsgaard, S., Vedtofte, L., Andreasen, C. et al. Diabetologia (2017) 60: 1344. doi:10.1007/s00125-017-4265-8

Abstract

Aims/hypothesis

We investigated whether a reduced incretin effect, as observed in patients with type 2 diabetes, can be detected in high-risk individuals, such as women with prior gestational diabetes mellitus (pGDM).

Methods

In this cross-sectional study, 102 women without diabetes with pGDM and 15 control participants without pGDM and with normal glucose tolerance (NGT) underwent a 4 h 75 g OGTT and an isoglycaemic i.v. glucose infusion (IIGI). Women with pGDM were classified as having NGT or prediabetes (impaired fasting glucose and/or impaired glucose tolerance). Insulin sensitivity was assessed using the Matsuda index and HOMA2-IR and the incretin effect was calculated from insulin responses during the study (100% × [AUCinsulin,OGTT − AUCinsulin,IIGI]/AUCinsulin,OGTT).

Results

Sixty-three of the 102 women with pGDM (62%) had prediabetes (median [interquartile range]: age, 38.3 [6.5] years; BMI, 32.1 [5.8] kg/m2) and 39 women (38%) had NGT (age, 39.5 [5.6] years; BMI, 31.0 [6.7] kg/m2). Control participants (n = 15) were not significantly different from the pGDM group with regards to age (39.2 [7.4] years) and BMI (28.8 [9.2] kg/m2). Compared with women with NGT and control participants, women with prediabetes had lower insulin sensitivity, as measured by the Matsuda index (3.0 [2.4] vs 5.0 [2.6] vs 1.5 [1.8], respectively; p < 0.001). The incretin effect was 55.3% [27.8], 73.8% [19.0] and 76.7% [24.6] in women with prediabetes, women with normal glucose tolerance and control participants, respectively (p < 0.01).

Conclusion/interpretation

Prediabetes was highly prevalent in women with pGDM, and alterations in the incretin effect were detected in this group before the development of type 2 diabetes.

Trial registration:

clinicaltrialsregister.eu 2012-001371-37-DK.

Keywords

Gestational diabetes mellitus Impaired glucose tolerance Incretin effect Isoglycaemic i.v. glucose infusion Oral glucose tolerance test Prediabetes Type 2 diabetes 

Abbreviations

FPG

Fasting plasma glucose

GCP

Good clinical practice

GDM

Gestational diabetes mellitus

GIGD

Gastrointestinal-mediated glucose disposal

GIP

Glucose-dependent insulinotropic polypeptide

GLP-1

Glucagon-like peptide-1

iAUC

Incremental AUC

IFG

Impaired fasting glucose

IGT

Impaired glucose tolerance

IIGI

Isoglycaemic i.v. glucose infusion

IQR

Interquartile range

ISR

Insulin secretory rate

NGT

Normal glucose tolerance

pGDM

Prior gestational diabetes mellitus

tAUC

Total AUC

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Signe Foghsgaard
    • 1
    • 2
    • 3
  • Louise Vedtofte
    • 1
  • Camilla Andreasen
    • 1
  • Emilie S. Andersen
    • 1
  • Emilie Bahne
    • 1
  • Jonatan I. Bagger
    • 1
  • Jens A. Svare
    • 4
  • Jens J. Holst
    • 2
  • Tine D. Clausen
    • 5
  • Elisabeth R. Mathiesen
    • 6
  • Peter Damm
    • 7
  • Filip K. Knop
    • 1
    • 2
    • 8
  • Tina Vilsbøll
    • 1
    • 8
  1. 1.Center for Diabetes ResearchGentofte Hospital, University of CopenhagenHellerupDenmark
  2. 2.NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
  3. 3.Danish Diabetes AcademyOdense University HospitalOdenseDenmark
  4. 4.Department of Gynecology and ObstetricsHerlev HospitalHerlevDenmark
  5. 5.Department of Gynecology and ObstetricsNordsjællands HospitalHillerødDenmark
  6. 6.Center for Pregnant Women with Diabetes, Department of EndocrinologyRigshospitaletCopenhagenDenmark
  7. 7.Center for Pregnant Women with Diabetes, Department of ObstetricsRigshospitaletCopenhagenDenmark
  8. 8.Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark

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