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Diabetes Care. 2016 Jun;39(6):1052-5. doi: 10.2337/dc15-2672. Epub 2016 May 13.

Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus.

Author information

1
Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA.
2
Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
3
Harvard Medical School, Boston, MA Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, MA.
4
Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA.
5
Harvard Medical School, Boston, MA Division of Nephrology, Massachusetts General Hospital, Boston, MA.
6
Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA mhivert@partners.org.

Abstract

OBJECTIVE:

To characterize physiologic subtypes of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS:

Insulin sensitivity and secretion were estimated in 809 women at 24-30 weeks' gestation, using oral glucose tolerance test-based indices. In women with GDM (8.3%), defects in insulin sensitivity or secretion were defined below the 25th percentile in women with normal glucose tolerance (NGT). GDM subtypes were defined based on the defect(s) present.

RESULTS:

Relative to women with NGT, women with predominant insulin sensitivity defects (51% of GDM) had higher BMI and fasting glucose, larger infants (birth weight z score 0.57 [-0.01 to 1.37] vs. 0.03 [-0.53 to 0.52], P = 0.001), and greater risk of GDM-associated adverse outcomes (57.6 vs. 28.2%, P = 0.003); differences were independent of BMI. Women with predominant insulin secretion defects (30% of GDM) had BMI, fasting glucose, infant birth weights, and risk of adverse outcomes similar to those in women with NGT.

CONCLUSIONS:

Heterogeneity of physiologic processes underlying hyperglycemia exists among women with GDM. GDM with impaired insulin sensitivity confers a greater risk of adverse outcomes.

PMID:
27208340
PMCID:
PMC4878218
DOI:
10.2337/dc15-2672
[Indexed for MEDLINE]
Free PMC Article

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