Early impairment of beta-cell function and insulin sensitivity characterizes normotolerant Caucasian women with previous gestational diabetes.
OBJECTIVE
Women with previous gestational diabetes (pGDM) are at high risk of developing type 2 diabetes mellitus. The aim of this study was to evaluate insulin action and insulin secretion in women with pGDM.


RESULTS
One hundred and fifty-three pGDM women and 45 with normal glucose tolerance during pregnancy (controls) were studied 1-3years after delivery. Insulin sensitivity (ISI) and beta-cell secretory capacity (beta-index) were derived from 75-g OGTT. Disposition Index was calculated as the product of beta-index and ISI. One hundred and twenty-two pGDM were normotolerant (NGT) and 31 had impaired glucose regulation (IGR) i.e. impaired glucose tolerance and/or impaired fasting glucose. NGT-pGDM, as compared to controls, had significant impairment in insulin action (ISI: 5.46+/-2.81 vs. 7.38+/-3.68, P<0.01) and insulin secretion (beta-index: 4.68+/-1.01 vs. 5.24+/-0.82 pmol/min/m(2); P<0.01). A further impairment was apparent in IGR-pGDM for beta-index (4.16+/-1.09; P<0.05). The disposition index was reduced in NGT-pGDM as compared to controls (33.9%) and further reduced in IGR-pGDM (28.6%, vs. NGT-pGDM; ANOVA P<0.001). In women of normal weight, ISI and beta-index were significantly (P<0.01) impaired in NGT-pGDM compared to controls and further reduced in IGR-pGDM, although a more pronounced defect in insulin secretion was apparent in these women (beta-index: 4.02+/-0.9; P<0.05).


CONCLUSIONS
Normotolerant women with pGDM show both impairment in insulin secretion and action irrespective of body weight. A more pronounced defect in insulin secretion seems to characterize normal weight women while a more prominent defect in insulin action is found in overweight women.
Lencioni
Cristina
C
Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa and Azienda Ospedaliera Pisana, Ospedale Cisanello, Via Paradisa 2, I-56126 Pisa, Italy.
Volpe
Laura
L
Miccoli
Roberto
R
Cuccuru
Ilaria
I
Chatzianagnostou
Kyriazoula
K
Ghio
Alessandra
A
Benzi
Luca
L
Bonadonna
Riccardo C
RC
Del Prato
Stefano
S
Di Cianni
Graziano
G
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000502:physiology*; D011247:Pregnancy; D044465:White People
D001786:Blood Glucose; D007328:Insulin