Plasma adiponectin, insulin sensitivity, and subclinical inflammation in women with prior gestational diabetes mellitus.
OBJECTIVE
Women with prior gestational diabetes mellitus (pGDM) are at increased risk of developing type 2 diabetes and associated vasculopathy. Because increased fat mass and inflammatory processes are angiopathic risk factors, the relationship between insulin sensitivity, parameters of subclinical inflammation, and plasma concentrations of adipocytokines was investigated in pGDM both at 3 months and 12 months after delivery.


METHODS
Insulin sensitivity (through a frequently sampled intravenous glucose tolerance test) and plasma concentrations of ultrasensitive C-reactive protein (CRP), adiponectin, plasminogen activator inhibitor (PAI)-1, tumor necrosis factor-alpha, leptin, and interleukin-6 were measured in 89 pGDM (BMI 26.9 +/- 0.5 kg/m(2), age 32 +/- 0.5 years) and in 19 women with normal glucose tolerance during pregnancy (NGT) (23.7 +/- 0.9 kg/m(2), 31 +/- 1.3 years).


RESULTS
pGDM showed lower (P < 0.0001) plasma adiponectin (6.7 +/- 0.2 microg/ml) than NGT (9.8 +/- 0.6 microg/ml) and a decreased (P < 0.003) insulin sensitivity index (S(i)) and disposition index (P < 0.03), but increased plasma leptin (P < 0.003), PAI-1 (P < 0.002), and CRP (P < 0.03). After adjustment for body fat mass, plasma adiponectin remained lower in pGDM (P < 0.004) and correlated positively with S(i) (P < 0.003) and HDL cholesterol (P < 0.0001) but negatively with plasma glucose (2-h oral glucose tolerance test [OGTT]) (P < 0.0001), leptin (P < 0.01), CRP (P < 0.007), and PAI-1 (P < 0.0001). On regression analysis, only HDL cholesterol, postload (2-h OGTT) plasma glucose, and S(i) remained significant predictors of plasma adiponectin, explaining 42% of its variability. Of note, adiponectin further decreased (P < 0.05) only in insulin-resistant pGDM despite unchanged body fat content and distribution after a 1-year follow-up.


CONCLUSIONS
Lower plasma adiponectin concentrations characterize women with previous GDM independently of the prevailing insulin sensitivity or the degree of obesity and are associated with subclinical inflammation and atherogenic parameters.
Winzer
Christine
C
Department of Medicine III, Vienna University Hospital, Vienna, Austria.
Wagner
Oswald
O
Festa
Andreas
A
Schneider
Barbara
B
Roden
Michael
M
Bancher-Todesca
Dagmar
D
Pacini
Giovanni
G
Funahashi
Tohru
T
Kautzky-Willer
Alexandra
A
D052242:Adiponectin; D002097:C-Reactive Protein / Q000032:analysis; D016640:Diabetes, Gestational / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism; D007249:Inflammation / Q000453:epidemiology*; D007328:Insulin / Q000494:pharmacology; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism*; D009765:Obesity / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011247:Pregnancy
D052242:Adiponectin; D007328:Insulin; D036341:Intercellular Signaling Peptides and Proteins; D017395:Plasminogen Activator Inhibitor 1; D002097:C-Reactive Protein