Postpartum Microalbuminuria After Gestational Diabetes: The Impact of Current Glucose Tolerance Status

Abstract

Current glucose intolerance, rather than previous GDM, may be associated with an increased risk of microalbuminuria in the early postpartum years.

Gestational Diabetes Mellitus and Renal Function: A Prospective Study With 9- to 16-Year Follow-up After Pregnancy

“…Few studies have investigated longterm renal outcomes among women with GDM-complicated pregnancies (12)(13)(14)(15)(16). Further, most were retrospective or cross-sectional designs.…”

“…Indeed, as shown in our study, these prepregnancy characteristics substantially confounded the association, which was attenuated after adjusting for them. The only prospective study to examine the association between GDM and renal function found that GDM alone, without subsequent diabetes, was not significantly associated with risk of elevated UACR (16). This prospective study included fewer GDM cases (n = 100) and had a follow-up period of only 3 years (16).…”

“…Despite its resolution soon after delivery among the majority of women, accumulating evidence supports that GDM is associated with subsequent dyslipidemia, hypertension, vascular dysfunction, and other cardiometabolic abnormalities (7)(8)(9)(10)(11), which are risk factors for renal impairment. Emerging, yet limited, studies (12)(13)(14)(15)(16) have reported an association between GDM history and subsequent renal morbidity. However, most of the current evidence has been based on retrospective or cross-sectional analysis, with the most critical limitation being the inadequate control for potential confounding factors including prepregnancy BMI, which is a major risk factor for GDM.…”

Effect of Short-term Intensive Insulin Therapy on Post-challenge Hyperglucagonemia in Early Type 2 Diabetes

“…Another limitation is that ␤-cell function and insulin sensitivity/resistance were assessed with OGTT-based surrogate indices rather than more cumbersome and labor-intensive clamp studies. However, it should be noted that ISSI-2, ⌬ISR 0 -120 / ⌬gluc 0 -120 ϫ Matsuda index, HOMA-IR, and Matsuda index are validated indices that have been widely used in previous studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Furthermore, the ␤-cell measures showed the anticipated response to IIT (5) and relationship to glycemic variability (6), but were not associated with the change in glucagonemia.…”

“…As previously described (4, 6, 10), ␤-cell function was assessed with the Insulin Secretion-Sensitivity Index-2 (ISSI-2), a validated OGTT-derived measure of ␤-cell function that is analogous to the disposition index obtained from the iv glucose tolerance test (13,14). ISSI-2 has been directly validated against the disposition index from the iv glucose tolerance test, with which it exhibits stronger correlation than do other OGTT-derived measures of ␤-cell function (including insulinogenic index-based measures and the HOMA of ␤-cell function) (14) and has been used to measure ␤-cell function in both clinical trials and observational studies in patients with and without diabetes (4,6,10,(15)(16)(17)(18). ISSI-2 is defined as the product of: 1) insulin secretion measured by the ratio of AUC ins to AUC gluc ; and 2) insulin sensitivity measured by the Matsuda index (13,14).…”