Different Associations of Diabetes With β-Cell Dysfunction and Insulin Resistance Among Obese and Nonobese Chinese Women With Prior Gestational Diabetes Mellitus

Abstract

OBJECTIVETo examine the relative contributions of b-cell dysfunction and insulin resistance to postpartum diabetes risk among obese and nonobese women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODSWe performed a cross-sectional survey 1-5 years after 1,263 women who had GDM gave birth. Polytomous logistic regression models were used to assess the associations of b-cell dysfunction (the lower quartile of HOMA-%b), insulin resistance (the upper quartile of HOMA-IR), decreased insulin sensitivity (the lower quartile of HOMA-%S), and different categories of BMI with prediabetes and diabetes risk. RESULTSb-Cell dysfunction, insulin resistance, and decreased insulin sensitivity all were significantly associated with hyperglycemic status across normal weight, overweight, and obese groups, and the patterns of insulin resistance and decreased insulin sensitivity were similar. BMI was inversely associated with b-cell dysfunction and positively associated with insulin resistance across normal glucose, prediabetes, and diabetes categories. Compared with women with normal glucose and weight, obese women with normal glucose had increased b-cell secretory function (odds ratio [OR] 0.09 [95% CI 0.02-0.37]) and insulin resistance ). Normal weight diabetic women displayed the most b-cell dysfunction .3]), whereas obese diabetic women displayed the highest insulin resistance ). CONCLUSIONS

β-cell dysfunction in women with previous gestational diabetes is associated with visceral adipose tissue distribution

“…A recent study demonstrated a greater worsening of b-cell function from 3 months to 3 years in previous GDM compared to a reference group (27), while another study suggested that b-cell function improved over time after a GDM pregnancy (28). Of interest, Li et al (29) found that in diabetic women with a history of GDM, women who were non-obese before pregnancy and post-partum displayed the most b-cell dysfunction, while non-obese women who markedly increased their BMI displayed the highest insulin resistance. Thus, b-cell dysfunction may be a stronger contributor to diabetes risk among normal weigh women with previous GDM.…”

Diabetes: Leveraging the Tipping Point of the Diabetes Pandemic

“…It has been hypothesized that Asians have higher adiposity per unit BMI compared with other racial/ethnic groups, leading to an increased risk of type 2 diabetes at a lower BMI (10,11). A recent study found that b-cell dysfunction had a more pronounced contribution to diabetes among nonobese subjects, whereas insulin resistance contributed more to hyperglycemia among obese subjects (12), which supports the hypothesis by Narayan (13) that Unnikrishnan et al (1) mentioned in their Perspective. A genetic study sampled from a Chinese national survey also shows that patients with type 2 diabetes with a higher genetic risk score were leaner or had worse b-cell function (14).…”

Zinc-Associated Variant in SLC30A8 Gene Interacts With Gestational Weight Gain on Postpartum Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes Mellitus

“…Finally, 1,263 women with GDM returned and completed the survey. Between the returned and unreturned women, there were no differences with regard to age (28.9 vs. 28.7 years), fasting glucose (5.34 vs. 5.34 mmol/L), 2-h glucose (9.23 vs. 9.16 mmol/L), and prevalence of impaired glucose tolerance (90.9% vs. 91.8%) and diabetes (9.1% vs. 8.2%) at the 26–30 gestational weeks (13). The final analysis included 1,071 women with available data of genotyping, weight, and glycemic traits.…”