Insulin secretion and insulin resistance in Korean women with gestational diabetes mellitus and impaired glucose tolerance

Abstract

Background/AimsThe 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).MethodsA 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).ResultsThe 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.ConclusionsKorean 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.

β-Cell dysfunction and insulin resistance in gestational glucose intolerance

“…Yang et al [5] found that the insulin resistance indices were significantly worse in the GDM group than in the GIGT group, as expected. However, the insulin levels at each time point in the 100-g OGTT and the area under the curve for insulin were significantly higher in the GIGT group than in the GDM group.…”

“…However, recent studies showed that the maternal and fetal outcomes are poorer if GIGT is not treated [3,4]. In this issue of The Korean Journal of Internal Medicine , Yang et al [5] analyzed various indices of insulin resistance and insulin secretion in 1,163 pregnant Korean women undergoing 100-g OGTT. Based on the OGTT results, the study subjects were subdivided into three groups: NGT, GIGT (only one abnormal value based on the criteria of Carpenter and Coustan), and GDM.…”

Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus

“…East Asians have a relatively low body mass index (BMI), and the underlying pathophysiology of diabetes in this population is thought to differ from that in other ethnicities [39]. In previous studies, the development of diabetes in Korean individuals was attributed to a genetic predisposition to β-cell dysfunction and/or impaired β-cell compensation to insulin resistance [40,41].…”

Urinary C-Peptide Secretion(UCPS): Can It be A New Index to Reflect Insulin Sensitivity and A Predictor in Pregnant Women?

“…while BMI and UCPS120 are noninvasive ones. HOMA-IR and Matsuda index had better predictions for GDM in previous studies [11,12].…”