title: Insulin need in gestational diabetes is associated with a worse cardiovascular risk profile after pregnancy.
abstract: OBJECTIVE
  Women with gestational diabetes mellitus (GDM) treated with insulin are more likely to develop type 2 diabetes after pregnancy compared to mild GDM cases treated with medical nutrition treatment (MNT) alone. We aimed to compare levels of subclinical atherosclerosis markers in women with previous GDM treated with insulin and MNT alone.
  
  
  METHODS
  Eighty-one women with previous GDM (45 treated with insulin, 36 treated with MNT) and 35 age-matched lean controls were included. Fasting glucose, insulin and lipids, circulating fibrinogen, CRP, PAI-1 and IL-6 levels were assayed. Carotid intima media thickness (IMT) was measured.
  
  
  RESULTS
  Women with previous GDM treated with insulin in pregnancy had significantly higher fasting glucose, plasma PAI-1 levels and carotid IMT compared to women treated with MNT alone. In multiple regression analysis, insulin need in pregnancy was associated with increased carotid IMT and plasma PAI-1 levels (corrected for age, BMI, postpartum duration, fasting glucose and lipids; model r(2)=0.132; beta=0.297, p=0.014 for carotid IMT; model r(2)=0.198; beta=0.345, p=0.003 for PAI-1).
  
  
  CONCLUSIONS
  Women with previous GDM treated with insulin in pregnancy had a worse cardiovascular risk profile compared to mild GDM patients. An intensive preventive approach for cardiovascular disorders is particularly essential for this subgroup of women.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Turkey.
authors.forename: Firat
authors.initials: F
authors.lastname: Bayraktar
authors.forename: Baris
authors.initials: B
authors.lastname: Akinci
authors.forename: Aygul
authors.initials: A
authors.lastname: Celtik
authors.forename: Sunay
authors.initials: S
authors.lastname: Tunali
authors.forename: Sinan
authors.initials: S
authors.lastname: Genc
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Ozcan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Secil
authors.forename: Sena
authors.initials: S
authors.lastname: Yesil
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin