Detailed physiological characterization of the development of type 2 diabetes in Hispanic women with prior gestational diabetes mellitus.
OBJECTIVE
To identify physiological and clinical variables associated with development of type 2 diabetes up to 12 years after pregnancies complicated by gestational diabetes.


METHODS
Seventy-two islet cell antibody-negative nondiabetic Hispanic women had oral (oGTT) and intravenous (ivGTT) glucose tolerance tests, glucose clamps, and body composition assessed between 15 and 30 months after pregnancies complicated by gestational diabetes mellitus (GDM). They returned for oGTTs at 15-month intervals until they dropped out, developed diabetes, or reached 12 years postpartum. Cox regression analysis was used to identify baseline predictors and changes during follow-up that were associated with development of type 2 diabetes.


RESULTS
At baseline, relatively low insulin sensitivity, insulin response, and β-cell compensation for insulin resistance were independently associated with development of diabetes. During follow-up, weight and fat gain and rates of decline in β-cell compensation were significantly associated with diabetes, while additional pregnancy and use of progestin-only contraception were marginally associated with diabetes risk.


CONCLUSIONS
In Hispanic women, GDM represents detection of a chronic disease process characterized by falling β-cell compensation for chronic insulin resistance. Women who are farthest along at diagnosis and/or deteriorating most rapidly are most likely to develop type 2 diabetes within 12 years after the index pregnancy. Weight gain, additional pregnancy, and progestin-only contraception are potential modifiable factors that increase diabetes risk.
Xiang
Anny H
AH
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. anny.h.xiang@kp.org
Kjos
Siri L
SL
Takayanagi
Miwa
M
Trigo
Enrique
E
Buchanan
Thomas A
TA
D052242:Adiponectin / Q000097:blood; D000328:Adult; D001823:Body Composition; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003267:Contraception / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D016640:Diabetes, Gestational / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D017097:Electric Impedance; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D011372:Progestins / Q000009:adverse effects; D012044:Regression Analysis; D018570:Risk Assessment; D014280:Triglycerides / Q000097:blood; D015430:Weight Gain
D052242:Adiponectin; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D011372:Progestins; D014280:Triglycerides; D002784:Cholesterol