Insulin secretion and insulin resistance in Korean women with gestational diabetes mellitus and impaired glucose tolerance
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Background/Aims: The aim was to compare the insulin sensitivity and secretion index of pregnant Korean women with normal glucose tolerance (NGT), gestational impaired glucose tolerance (GIGT; only one abnormal value according to the Carpenter and Coustan criteria), and gestational diabetes mellitus (GDM). Methods: A cross-sectional study was performed with 1,163 pregnant women with positive (1-hour plasma glucose ≥ 7.2 mmol/L) in a 50-g oral glucose challenge test (OGCT). The 100-g oral glucose tolerance test (OGTT) was used to stratify the participants into three groups: NGT (n = 588), GIGT (n = 294), and GDM (n = 281). Results: The GDM group had higher homeostasis model assessment of insulin resistance and lower insulin sensitivity index (ISOGTT), quantitative insulin sensitivity check index, homeostasis model assessment for estimation of index β-cell secretion (HOMA-B), first and second phase insulin secretion, and insulin secretion-sensitivity index (ISSI) than the NGT group (p ≤ 0.001 for all). Moreover, the GIGT group had lower ISOGTT, HOMA-B, first and second phase insulin secretion,and ISSI than the NGT group (p < 0.001 for all). Among the GIGT subjects, the 1-hour plasma glucose abnormal levels group showed significantly greater weight gain during pregnancy and higher values in the 50-g OGCT than the other two groups. Moreover, the 1-hour and 2-hour abnormal levels groups had poorer insulin secretion status than the 3-hour abnormal levels group. Conclusions: Korean women with GDM show impairments of both insulin secretion and insulin sensitivity. In addition, GIGT is associated with both β-cell dysfunction and insulin resistance.
Abstract
Background/Aims: The aim was to compare the insulin sensitivity and secretion index of pregnant Korean women with normal glucose tolerance (NGT), gestational impaired glucose tolerance (GIGT; only one abnormal value according to the Carpenter and Coustan criteria), and gestational diabetes mellitus (GDM). Methods: A cross-sectional study was performed with 1,163 pregnant women with positive (1-hour plasma glucose ≥ 7.2 mmol/L) in a 50-g oral glucose challenge test (OGCT). The 100-g oral glucose tolerance test (OGTT) was used to stratify the participants into three groups: NGT (n = 588), GIGT (n = 294), and GDM (n = 281). Results: The GDM group had higher homeostasis model assessment of insulin resistance and lower insulin sensitivity index (ISOGTT), quantitative insulin sensitivity check index, homeostasis model assessment for estimation of index β-cell secretion (HOMA-B), first and second phase insulin secretion, and insulin secretion-sensitivity index (ISSI) than the NGT group (p ≤ 0.001 for all). Moreover, the GIGT group had lower ISOGTT, HOMA-B, first and second phase insulin secretion,and ISSI than the NGT group (p < 0.001 for all). Among the GIGT subjects, the 1-hour plasma glucose abnormal levels group showed significantly greater weight gain during pregnancy and higher values in the 50-g OGCT than the other two groups. Moreover, the 1-hour and 2-hour abnormal levels groups had poorer insulin secretion status than the 3-hour abnormal levels group. Conclusions: Korean women with GDM show impairments of both insulin secretion and insulin sensitivity. In addition, GIGT is associated with both β-cell dysfunction and insulin resistance.
참고문헌 (25)
- Metzger BE, "Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus", Diabetes, 40(2), pp.197~201 (1991)
- 장학철, "한국인 임신부에게도 미국당뇨병학회의 임신성 당뇨병 진단기준을 적용할 것인가?", Diabetes and Metabolism Journal, 26(4), pp.221~228 (2002), 대한당뇨병학회
- Hong EK, "Assocation of type 2 diabetes development and obesity in history of gestational diabetes", 14th Spring Congress of Korea Diabetes Association, pp.180~ (2001), Korea Diabetes Association
- Jacobson JD, "A population-based study of maternal and perinatal outcome in patients with gestational diabetes", Am J Obstet Gynecol, 161, pp.981~986 (1989)
- Kim C, "Gestational diabetes and the incidence of type 2 diabetes: a systematic review", Diabetes Care, 25, pp.1862~1868 (2002)
- Fisher PM, "The pathophysiology of chemical gestational diabetes", BJOG, 84, pp.234~ (1977)
- Endo S, "Differences in insulin sensitivity in pregnant women with overweight and gestational diabetes mellitus", Gynecol Endocrinol, 22, pp.343~349 (2006)
- Retnakaran R, "Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes", Diabetes Care, 31, pp.2026~2031 (2008)
- Carpenter MW, "Criteria for screening tests for gestational diabetes", Am J Obstet Gynecol, 144, pp.768~773 (1982)
- Bonora E, "Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity", Diabetes Care, 23, pp.57~63 (2000)
- Matthews DR, "Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28, pp.412~419 (1985)
- Matsuda M, "Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp", Diabetes Care, 22, pp.1462~1470 (1999)
- Katz A, "Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans", J Clin Endocrinol Metab, 85, pp.2402~2410 (2000)
- Stumvoll M, "Oral glucose tolerance test indexes for insulin sensitivity and secretion based on various availabilities of sampling times", Diabetes Care, 24, pp.796~797 (2001)
- Piche ME, "Measuring insulin sensitivity in postmenopausal women covering a range of glucose tolerance: comparison of indices derived from the oral glucose tolerance test with the euglycemic-hyperinsulinemic clamp", Metabolism, 56, pp.1159~1166 (2007)
- Yi KW, "Perinatal outcomes in pregnant women with impaired glucose tolerance (IGT) proven through 100 g oral glucose tolerance test (OGTT)", Korean J Perinatol, 17, pp.25~32 (2006)
- 이원종, "임신성 내당능장애 및 임신성 당뇨를 동반한 임신의 양상 및 주산기 예후", Obstetrics & Gynecology Science, 44(6), pp.1033~1039 (2001), 대한산부인과학회
- Buchanan TA, "Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes", Am J Obstet Gynecol, 162, pp.1008~1014 (1990)
- Ryan EA, "Defects in insulin secretion and action in women with a history of gestational diabetes", Diabetes, 44, pp.506~512 (1995)
- Kwak SH, "Subsequent pregnancy after gestational diabetes mellitus: frequency and risk factors for recurrence in Korean women", Diabetes Care, 31, pp.1867~1871 (2008)
- Yoon KH, "Epidemic obesity and type 2 diabetes in Asia", Lancet, 368, pp.1681~1688 (2006)
- Retnakaran R, "Isolated hyperglycemia at 1 hour on oral glucose tolerance test in pregnancy resembles gestational diabetes mellitus in predicting postpartum metabolic dysfunction", Diabetes Care, 31, pp.1275~1281 (2008)
- Lopez-Ridaura R, "Magnesium intake and risk of type 2 diabetes in men and women", Diabetes Care, 27, pp.134~140 (2004)
- Lambert JM, "Mutant p53 reactivation by PRIMA-1MET induces multiple signaling pathways converging on apoptosis", Oncogene, 29, pp.1329~1338 (2010)
- Nielsen TF, "Urinary calcium and magnesium excretion relates to increase in blood pressure during pregnancy", Arch Gynecol Obstet, 283, pp.443~447 (2011)