Antepartum predictors of the development of type 2 diabetes in Latino women 11-26 months after pregnancies complicated by gestational diabetes.
Abstract
In this study, we sought to identify antepartum characteristics that predict the de novo development of diabetes 11-26 months after the index pregnancy in a carefully characterized cohort of women with gestational diabetes mellitus (GDM). Oral and frequently sampled intravenous glucose tolerance tests (OGTTs and FSIGTs), hyperinsulinemic-euglycemic clamps with labeled glucose, and body composition studies were performed on 91 islet cell antibody-negative Latino women with GDM during the third trimester of pregnancy. The women were documented to be diabetes-free within 6 months postpartum. Their diabetes status was ascertained again between 11 and 26 months postpartum. Logistic regression analysis was used to identify independent predictors of the development of diabetes within that interval. Fourteen of the women developed diabetes by World Health Organization criteria 11-26 months after delivery of the index pregnancy. Three antepartum variables were independent predictors of diabetes: the 1-h postchallenge plasma glucose concentration from the 100-g OGTT at which GDM was diagnosed (higher = increased risk; P = 0.003); an index of pancreatic beta-cell compensation for insulin resistance, defined as the product of the 30-min incremental plasma insulin:glucose ratio on a 75-g OGTT and the insulin sensitivity index from a hyperinsulinemic-euglycemic clamp (lower = increased risk, P = 0.009); and the basal glucose production rate after an overnight fast (higher = increased risk; P = 0.04). We conclude that postchallenge hyperglycemia, poor pancreatic beta-cell compensation for insulin resistance, and elevated endogenous glucose production during pregnancy precede the development of type 2 diabetes in young Latino women by at least 1-2 years.
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Subjects at high risk of developing Type 2 diabetes, including first-degree relatives, women with a history of gestational diabetes or polycystic ovarian disease, older subjects, and subjects with impaired glucose tolerance, have diminished beta-cell function, manifest as a reduced first-phase insulin response to intravenous glucose relative to insulin sensitivity, even when many still have NGT.
“Based on the concept of a feedback loop, it has become evident that subjects who are at high risk of developing Type 2 diabetes have diminished beta-cell function at a time when many of them still have NGT.”
From The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of type 2 diabetes (2003) · cites this paper as [101]
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- Authors
- Buchanan, T. A., Xiang, A. H., Kjos, S. L., Trigo, E., Lee, W. P., & Peters, R. K.
- Affiliations
- University of Southern California (US)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1999-12-01
- Volume
- 48
- Issue
- 12
- Pages
- 2430-2436
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W1966633426
- Cited by
- 129
- References
- 17
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 2 · 2019: 2 · 2018: 7 · 2017: 4 · 2016: 4 · 2015: 3 · 2014: 11 · 2013: 5 · 2012: 6
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30-DK 17047, R01DK046374, R01DK46374, P30DK017047)
- National Center for Research Resources (M01 RR-43)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- gestational diabetes mellitus, type 2 diabetes, Hispanic women, postpartum diabetes risk, beta-cell compensation, insulin resistance, endogenous glucose production, hyperinsulinemic-euglycemic clamp, oral glucose tolerance test, islet cell antibodies
- MeSH terms
- Adult, Blood Glucose, Body Composition, California, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Hispanic or Latino, Humans, Insulin, Longitudinal Studies, Predictive Value of Tests, Pregnancy, Prognosis, Time Factors, Glucose Clamp Technique, Cohort Studies, Diabetes, Gestational
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