Normal Glucose Tolerance and Gestational Diabetes Mellitus

Cianni, Graziano Di; Seghieri, Giuseppe; Lencioni, Cristina; Cuccuru, Ilaria; Anichini, Roberto; Bellis, Alessandra De; Ghio, Alessandra; Tesi, F.; Volpe, L; Prato, Stefano Del

doi:10.2337/dc07-0119

Cited by 70 publications

(53 citation statements)

References 31 publications

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“…Indeed, high IR is considered a leading risk factor for GDM (19). Our results were in accordance with those of previous studies (20,21) on average HOMA-IS and HOMA-IR values of IGT, indicating that IGT represents an intermediate phenotype between NGT and GDM.…”

Section: B a B Asupporting

confidence: 93%

Evaluation of oral glucose tolerance test, β-cell function and adverse obstetric outcomes

et al. 2013

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Abstract. This study was conducted in order to investigate the prevalence of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM), their effect on pregnancy and their association with adverse obstetric outcomes. A cross-sectional study was performed on 345 pregnant women, who were screened between the 24th and 28th gestational week with a 75-g oral glucose tolerance test following abnormal results at 1 h after a 50-g oral glucose challenge test. The obstetric outcomes were recorded along with plasma glucose and insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function index (HOMA-βCFI) and 50 subjects were excluded due to incomplete data recovery. Of the 295 pregnant women, 18.6% (55/295) were diagnosed with GDM and 32% (95/295) with IGT. The GDM group exhibited significantly higher fasting and 1-h blood glucose concentrations compared to the normal glucose tolerance (NGT) and IGT groups (P<0.01). The 2-and 3-h insulin values of the NGT group were significantly lower compared to those of the GDM group (P<0.05, P<0.01). In the IGT group, the 2-h insulin values were higher compared to the NGT group and the 3-h values were significantly higher (P<0.01), similar to the GDM group. There was a tendency for progressively decreased β-cell function and increased HOMA-IR from the NGT to the IGT to the GDM group. The adverse outcomes of pregnancy-induced hypertension, fetal distress, neonatal hyperbilirubinemia, preterm delivery, macrosomia and cesarean delivery indicated an association with HOMA-βCFI and HOMA-IR. In conclusion, these findings suggest a clinical significance of β-cell dysfunction in women with gestational IGT.

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Section: B a B Asupporting

confidence: 93%

Evaluation of oral glucose tolerance test, β-cell function and adverse obstetric outcomes

et al. 2013

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“…Traditionally, it has been felt that GIGT represents an intermediate phenotype between normal glucose tolerance (NGT) and GDM (6,7). Interestingly, however, it has recently emerged that GIGT is actually a heterogeneous metabolic disorder, as defined by the glycemic response on the OGTT (8).…”

Section: G Estational Diabetes Mellitus (Gdm)mentioning

confidence: 99%

Isolated Hyperglycemia at 1 Hour on Oral Glucose Tolerance Test in Pregnancy Resembles Gestational Diabetes Mellitus in Predicting Postpartum Metabolic Dysfunction

Retnakaran

Sermer

et al. 2008

Diabetes Care

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OBJECTIVE —Gestational impaired glucose tolerance (GIGT), defined by a single abnormal value on antepartum 3-h oral glucose tolerance test (OGTT), is a metabolically heterogeneous disorder. Indeed, the antepartum metabolic phenotype of women with a single abnormal value at 1 h during the OGTT (1-h GIGT) resembles that of women with gestational diabetes mellitus (GDM), whereas GIGT at 2 or 3 h (2/3-h GIGT) is similar to normal glucose tolerance (NGT). Thus, we hypothesized that 1-h GIGT would be associated with the same adverse outcomes as GDM, i.e., increased infant birth weight and postpartum metabolic dysfunction. RESEARCH DESIGN AND METHODS —A total of 361 women underwent an antepartum glucose challenge test (GCT) and a 3-h OGTT, assessment of obstetrical outcome at delivery, and metabolic characterization by OGTT at 3 months postpartum. The antepartum GCT/OGTT identified five study groups: GDM ( n = 97), 1-h GIGT ( n = 28), 2/3-h GIGT ( n = 34), abnormal GCT NGT (abnormal GCT with NGT on OGTT) ( n = 128), and normal GCT NGT (normal GCT with NGT on OGTT) ( n = 74). RESULTS —Caesarian section rate was higher in women with 1-h GIGT, but birth weight did not differ significantly between the non-GDM groups ( P = 0.1978). At 3 months postpartum, glycemia (area under the glucose curve) progressively increased across the groups from normal GCT NGT to abnormal GCT NGT to 2/3-h GIGT to 1-h GIGT to GDM ( P < 0.0001), while both insulin sensitivity (IS OGTT ) and β-cell function (insulinogenic index/homeostasis model assessment of insulin resistance [HOMA-IR]) progressively decreased ( P = 0.002 and P < 0.0001, respectively). The strongest independent negative predictors of insulinogenic index/HOMA-IR were GDM ( t = −4.1, P < 0.0001) and 1-h GIGT ( t = −3.8, P = 0.0002). CONCLUSIONS —Like GDM, 1-h GIGT is associated with postpartum glycemia, insulin resistance, and β-cell dysfunction.

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“…They showed that the insulinogenic index was significantly lower in the traditional GDM group (two or more abnormal values on OGTT) compared with the normal OGTT group [20]. Di Cianni et al reported that pregnant women with OAV and the traditional GDM group were older and had higher BMIs than the group with normal glucose tolerance [21]. Therefore, pregnant women with normal glucose tolerance had the highest ISI-composite.…”

Section: Discussionmentioning

confidence: 99%

“…Early-phase insulin secretion was found to be significantly reduced in pregnant women with OAV and the traditional GDM group, compared with pregnant women having normal glucose tolerance. They concluded that pregnant women with OAV and pregnant women with traditional GDM are clinically indistinguishable, and both groups are different from women with normal glucose tolerance [21].…”

Section: Discussionmentioning

confidence: 99%

“…However, our present study showed no significant correlation between fasting PG levels and insulin therapy. Di Cianni et al [21] showed that women with one abnormal glucose level at 1-h on 100-g 3hOGTT required more intensive treatment compared with the other OAV groups. Therefore fasting PG are characterized by an impairment in basal insulin secretion [21], and mild diabetes in pregnancy such as in women with OAV who might retain some basal insulin secretion ability.…”

Section: Discussionmentioning

confidence: 99%

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