title: Longitudinal changes in insulin sensitivity and beta cell function between women with and without a history of gestational diabetes mellitus.
abstract: OBJECTIVE
  The aim of the study was to compare longitudinal changes in insulin sensitivity (SI) and beta cell function between women with and without a history of gestational diabetes mellitus (GDM).
  
  
  METHODS
  The prospective follow-up cohort included 235 parous non-diabetic Mexican-American women, 93 with and 142 without a history of GDM. The participants underwent dual-energy x-ray absorptiometry, OGTTs and IVGTTs at baseline and at a median of 4.1 years follow-up. The baseline values and rates of change of metabolic measures were compared between groups.
  
  
  RESULTS
  At baseline, women with prior GDM (mean age 36.3 years) had similar values of SI but higher percentages of body fat and trunk fat (p ≤ 0.02), a lower acute insulin response and poorer beta cell compensation (disposition index [DI]) (p < 0.0001) than women without GDM (mean age 37.9 years). During the follow-up, women with GDM had a faster decline in SI (p = 0.02) and DI (p = 0.02) than their counterparts without GDM, with no significant differences in changes of weight or fat (p > 0.50). Adjustment for baseline age, adiposity, calorie intake, physical activity, age at first pregnancy, additional pregnancies and changes in adiposity during follow-up increased the between-group differences in the rates of change of SI and DI (p ≤ 0.003).
  
  
  CONCLUSIONS
  Mexican-American women with recent GDM had a faster deterioration in insulin sensitivity and beta cell compensation than their parous counterparts without GDM. The differences were not explained by differences in adiposity, suggesting more deleterious effects of existing fat and/or reduced beta cell robustness in women with GDM.
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 5th Floor, Pasadena, CA, 91101, USA, anny.h.xiang@kp.org.
authors.forename: Anny H
authors.initials: AH
authors.lastname: Xiang
authors.forename: Miwa
authors.initials: M
authors.lastname: Takayanagi
authors.forename: Mary Helen
authors.initials: MH
authors.lastname: Black
authors.forename: Enrique
authors.initials: E
authors.lastname: Trigo
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Richard M
authors.initials: RM
authors.lastname: Watanabe
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchanan
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001835:Body Weight; D016640:Diabetes, Gestational / Q000235:genetics / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000235:genetics; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D017058:Mexican Americans; D011247:Pregnancy; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
references.citation: CMAJ. 2008 Jul 29;179(3):229-34
references.pmid: 18663202
references.citation: Diabetes. 2006 Feb;55(2):517-22
references.pmid: 16443789
references.citation: Diabetes Technol Ther. 2003;5(6):1003-15
references.pmid: 14709204
references.citation: Diabetes Care. 2010 Feb;33(2):396-401
references.pmid: 19933993
references.citation: J Clin Endocrinol Metab. 2008 Dec;93(12):4774-9
references.pmid: 18826999
references.citation: Am J Obstet Gynecol. 1999 Apr;180(4):903-16
references.pmid: 10203659
references.citation: Am J Physiol. 1993 Jan;264(1 Pt 1):E60-7
references.pmid: 8430789
references.citation: Diabetes. 2008 Apr;57(4):1048-56
references.pmid: 18162503
references.citation: Diabetologia. 2011 Dec;54(12):3016-21
references.pmid: 22016046
references.citation: Nat Rev Endocrinol. 2012 Nov;8(11):639-49
references.pmid: 22751341
references.citation: J Clin Endocrinol Metab. 2001 Feb;86(2):568-73
references.pmid: 11158010
references.citation: J Clin Invest. 2005 Mar;115(3):485-91
references.pmid: 15765129
references.citation: Obesity (Silver Spring). 2009 Apr;17(4):729-36
references.pmid: 19148120
references.citation: Diabetes Care. 2013 Mar;36(3):638-44
references.pmid: 23223346
references.citation: Diabetes Care. 2010 Aug;33(8):1798-804
references.pmid: 20484133
references.citation: Cancer Causes Control. 2007 Mar;18(2):165-75
references.pmid: 17219012
references.citation: Lancet. 2009 May 23;373(9677):1773-9
references.pmid: 19465232
references.citation: Diabetes. 1989 Dec;38(12):1512-27
references.pmid: 2684710
references.citation: Diabetes. 1999 Apr;48(4):848-54
references.pmid: 10102703
references.citation: Diabetes. 2007 May;56(5):1481-5
references.pmid: 17317761
references.citation: Diabetes. 2012 Feb;61(2):531-41
references.pmid: 22233651
references.citation: Diabetes. 2006 Apr;55(4):1074-9
references.pmid: 16567531
references.citation: Am J Epidemiol. 1985 Jul;122(1):51-65
references.pmid: 4014201
references.citation: Am J Epidemiol. 2000 Feb 15;151(4):346-57
references.pmid: 10695593
references.citation: Diabetes. 2002 Sep;51(9):2796-803
references.pmid: 12196473
references.citation: J Clin Endocrinol Metab. 2009 Oct;94(10):4094-102
references.pmid: 19622628