title: Progression to type 2 diabetes in women with former gestational diabetes: time trajectories of metabolic parameters.
abstract: Aim of this study was analyzing the time trajectories of the metabolic parameters in European women with former gestational diabetes (fGDM), and determining predictors of type 2 diabetes onset. A group of seventy-six fGDM women were studied at the outpatient department of the University Clinic of Vienna. They were evaluated yearly with a 3 h-oral glucose tolerance test (OGTT) up to 7-years from delivery. At baseline, women also underwent an intravenous glucose tolerance test (IVGTT). Insulin sensitivity and beta-cell function were assessed by both OGTT and IVGTT. Women were divided into progressors (PROG) to diabetes (n = 19) and non-progressors (n = 57). Time trajectories of glycemia and other parameters were analyzed after synchronization to time of diabetes onset or last OGTT. Then, Cox proportional hazard regression analysis was performed to assess the predictive power of studied variables for diabetes onset. We found that, in PROG, time trajectories of glycemia were flat until diabetes onset, when they showed a marked increase (P<0.0001). Insulin sensitivity showed similar marked decrease (P<0.0001) at diabetes onset, together with a tendency to continuous slow decline in the previous years. At contrast, beta-cell function showed only continuous slow decline. Major predictors of diabetes onset were glycemic levels, BMI, insulin resistance, and condition of impaired glucose tolerance. In conclusion, in fGDM, marked deterioration of insulin sensitivity is associated with diabetes onset. Prevention strategies aimed at opposing to the insulin sensitivity derangement may be particularly beneficial.
authors.affiliation: Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy. tura@isib.cnr.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Tura
authors.forename: Angela
authors.initials: A
authors.lastname: Grassi
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Winhofer
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guolo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pacini
authors.forename: Andrea
authors.initials: A
authors.lastname: Mari
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis / Q000473:pathology; D018450:Disease Progression; D005260:Female; D018149:Glucose Intolerance; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism / Q000473:pathology; D008137:Longitudinal Studies; D011247:Pregnancy; D011379:Prognosis; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin