Impaired microvascular reactivity in gestational diabetes is associated with altered glycemic parameters

Abstract

Objectives To assess microvascular reactivity and glycemic parameters in GDM compared to age and GA matched controls. Methods This study involved 21 GDM patients and 31 controls. Microvascular reactivity was assessed using LDF and PORH. Microvascular parameters; PORHmax, PORHpeak, and time to peak perfusion (Tp) were recorded after the release of 3 minutes’ upper arm occlusion. HOMA‐IR was performed to evaluate insulin resistance. Results Average age and GA for subjects were 32.9 years and 29.2 weeks. Mean FBG and a 2‐hour postprandial for GDM and controls were 4.87 ± 0.71 vs 3.99 ± 0.59 mmol/L; P < 0.001 and 9.50 ± 1.8 vs 5.67 ± 1.0 mmol/L; P < 0.001. Fasting insulin (13.88 ± 18.9 vs 8.37 ± 11.0 μLU/mL; P = 0.031) and HOMA‐IR (3.14 ± 4.6 vs 1.52 ± 2.2; P = 0.004) were higher in GDM. Tp was prolonged in GDM (16.27 ± 4.3 vs 13.86 ± 2.1 seconds; P = 0.011). Positive correlations were seen between Tp and FBG and 2‐hour postprandial levels. Conclusion Tp was prolonged in GDM compared to age‐matched controls, indicating impaired microvascular reactivity.

The relationship between advanced glycation end products and gestational diabetes: A systematic review and meta-analysis

“…AGEs can also promote insulin resistance and hence trigger diabetes by depleting the antioxidant defenses such as AGE receptor-1 and a survival factor sirtuin-1 [8]. AGEs can undergo post-translational modification of insulin molecule and impair its function [60,61]. Tan et al reported that serum level of AGEs is linked with insulin resistance even in non-obese and non-diabetic subjects, reinforcing the notion that AGEs can be an independent determinant of HOMA-IR [62].…”