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Diabetes Care. 2014 Sep;37(9):2533-9. doi: 10.2337/dc14-0573. Epub 2014 Jun 9.

Different associations of diabetes with β-cell dysfunction and insulin resistance among obese and nonobese Chinese women with prior gestational diabetes mellitus.

Author information

  • 1Tianjin Women's and Children's Health Center, Tianjin, China Pennington Biomedical Research Center, Baton Rouge, LA.
  • 2Tianjin Women's and Children's Health Center, Tianjin, China.
  • 3Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia, Canada.
  • 4Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China.
  • 5Tianjin Women's and Children's Health Center, Tianjin, China Tianjin Public Health Bureau, Tianjin, China.
  • 6Pennington Biomedical Research Center, Baton Rouge, LA gang.hu@pbrc.edu.

Abstract

OBJECTIVE:

To examine the relative contributions of β-cell dysfunction and insulin resistance to postpartum diabetes risk among obese and nonobese women with prior gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS:

We 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 β-cell dysfunction (the lower quartile of HOMA-%β), 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.

RESULTS:

β-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 β-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 β-cell secretory function (odds ratio [OR] 0.09 [95% CI 0.02-0.37]) and insulin resistance (OR 17.4 [95% CI 9.47-31.9]). Normal weight diabetic women displayed the most β-cell dysfunction (OR 13.6 [95% CI 4.06-45.3]), whereas obese diabetic women displayed the highest insulin resistance (OR 45.8 [95% CI 18.5-113]).

CONCLUSIONS:

For women with prior GDM, β-cell dysfunction had more pronounced contribution to postpartum diabetes among nonobese subjects, whereas insulin resistance contributed more to postpartum hyperglycemia among obese subjects.

© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

[PubMed - indexed for MEDLINE]
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