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Oral Glucose Tolerance Testing Allows Better Prediction of Diabetes in Women with a History of Gestational Diabetes Mellitus

  • Oh, Tae Jung (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Yeong Gi (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kang, Sunyoung (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Moon, Joon Ho (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kwak, Soo Heon (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Choi, Sung Hee (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Lim, Soo (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Park, Kyong Soo (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jang, Hak C. (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Hong, Joon-Seok (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospita) ;
  • Cho, Nam H. (Department of Preventive Medicine, Ajou University School of Medicine)
  • Received : 2018.05.24
  • Accepted : 2018.08.09
  • Published : 2019.06.30

Abstract

Background: We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes. Methods: We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter. Results: The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes. Conclusion: We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.

Keywords

Acknowledgement

This study was supported by a grant from Seoul National University Bundang Hospital (02-2012-009), Korea.

References

  1. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002;25:1862-8. https://doi.org/10.2337/diacare.25.10.1862
  2. Jang HC. Gestational diabetes in Korea: incidence and risk factors of diabetes in women with previous gestational diabetes. Diabetes Metab J 2011;35:1-7. https://doi.org/10.4093/dmj.2011.35.1.1
  3. Lim S, Choi SH, Park YJ, Park KS, Lee HK, Jang HC, Cho NH, Metzger BE. Visceral fatness and insulin sensitivity in women with a previous history of gestational diabetes mellitus. Diabetes Care 2007;30:348-53. https://doi.org/10.2337/dc06-1405
  4. Metzger BE, Cho NH, Roston SM, Radvany R. Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus. Diabetes Care 1993;16:1598-605. https://doi.org/10.2337/diacare.16.12.1598
  5. Kwak SH, Choi SH, Jung HS, Cho YM, Lim S, Cho NH, Kim SY, Park KS, Jang HC. Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus. J Clin Endocrinol Metab 2013;98:E744-52. https://doi.org/10.1210/jc.2012-3324
  6. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373:1773-9. https://doi.org/10.1016/S0140-6736(09)60731-5
  7. Lee H, Jang HC, Park HK, Metzger BE, Cho NH. Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus. Diabetes Res Clin Pract 2008;81:124-9. https://doi.org/10.1016/j.diabres.2008.02.017
  8. Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X, Fowler S, Kahn SE; Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008;93:4774-9. https://doi.org/10.1210/jc.2008-0772
  9. Aroda VR, Christophi CA, Edelstein SL, Zhang P, Herman WH, Barrett-Connor E, Delahanty LM, Montez MG, Ackermann RT, Zhuo X, Knowler WC, Ratner RE; Diabetes Prevention Program Research Group. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up. J Clin Endocrinol Metab 2015;100:1646-53. https://doi.org/10.1210/jc.2014-3761
  10. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. Diabetes 2002;51:2796-803. https://doi.org/10.2337/diabetes.51.9.2796
  11. Shek NW, Ngai CS, Lee CP, Chan JY, Lao TT. Lifestyle modifications in the development of diabetes mellitus and metabolic syndrome in Chinese women who had gestational diabetes mellitus: a randomized interventional trial. Arch Gynecol Obstet 2014;289:319-27. https://doi.org/10.1007/s00404-013-2971-0
  12. Grant PT, Oats JN, Beischer NA. The long-term follow-up of women with gestational diabetes. Aust N Z J Obstet Gynaecol 1986;26:17-22. https://doi.org/10.1111/j.1479-828X.1986.tb01521.x
  13. Henry OA, Beischer NA. Long-term implications of gestational diabetes for the mother. Baillieres Clin Obstet Gynaecol 1991;5:461-83. https://doi.org/10.1016/S0950-3552(05)80107-5
  14. Coustan DR, Carpenter MW, O'Sullivan PS, Carr SR. Gestational diabetes: predictors of subsequent disordered glucose metabolism. Am J Obstet Gynecol 1993;168:1139-44. https://doi.org/10.1016/0002-9378(93)90358-p
  15. Lobner K, Knopff A, Baumgarten A, Mollenhauer U, Marien-feld S, Garrido-Franco M, Bonifacio E, Ziegler AG. Predictors of postpartum diabetes in women with gestational diabetes mellitus. Diabetes 2006;55:792-7. https://doi.org/10.2337/diabetes.55.03.06.db05-0746
  16. Buchanan TA, Xiang AH, Kjos SL, Trigo E, Lee WP, Peters RK. Antepartum predictors of the development of type 2 diabetes in Latino women 11-26 months after pregnancies complicated by gestational diabetes. Diabetes 1999;48:2430-6. https://doi.org/10.2337/diabetes.48.12.2430
  17. Xiang AH, Kjos SL, Takayanagi M, Trigo E, Buchanan TA. Detailed physiological characterization of the development of type 2 diabetes in Hispanic women with prior gestational diabetes mellitus. Diabetes 2010;59:2625-30. https://doi.org/10.2337/db10-0521
  18. Moon JH, Kwak SH, Jung HS, Choi SH, Lim S, Cho YM, Park KS, Jang HC, Cho NH. Weight gain and progression to type 2 diabetes in women with a history of gestational diabetes mellitus. J Clin Endocrinol Metab 2015;100:3548-55. https://doi.org/10.1210/JC.2015-1113
  19. Moon JH, Kwak SH, Jang HC. Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus. Korean J Intern Med 2017;32:26-41. https://doi.org/10.3904/kjim.2016.203
  20. Kim C, Chames MC, Johnson TR. Identifying post-partum diabetes after gestational diabetes mellitus: the right test. Lancet Diabetes Endocrinol 2013;1:84-6. https://doi.org/10.1016/S2213-8587(13)70044-5
  21. Ferrara A, Peng T, Kim C. Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: a report from the Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care 2009;32:269-74. https://doi.org/10.2337/dc08-1184
  22. Jang HC, Yim CH, Han KO, Yoon HK, Han IK, Kim MY, Yang JH, Cho NH. Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum. Diabetes Res Clin Pract 2003;61:117-24. https://doi.org/10.1016/S0168-8227(03)00110-4
  23. Balion CM, Raina PS, Gerstein HC, Santaguida PL, Morrison KM, Booker L, Hunt DL. Reproducibility of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) classification: a systematic review. Clin Chem Lab Med 2007;45:1180-5. https://doi.org/10.1515/CCLM.2007.505
  24. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998;21 Suppl 2:B161-7.
  25. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35 Suppl 1:S64-71. https://doi.org/10.2337/dc12-s064
  26. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9. https://doi.org/10.1007/BF00280883
  27. Stumvoll M, Mitrakou A, Pimenta W, Jenssen T, Yki-Jarvinen H, Van Haeften T, Renn W, Gerich J. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care 2000;23:295-301. https://doi.org/10.2337/diacare.23.3.295
  28. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999;22:1462-70. https://doi.org/10.2337/diacare.22.9.1462
  29. Boston RC, Stefanovski D, Moate PJ, Sumner AE, Watanabe RM, Bergman RN. MINMOD Millennium: a computer program to calculate glucose effectiveness and insulin sensitivity from the frequently sampled intravenous glucose tolerance test. Diabetes Technol Ther 2003;5:1003-15. https://doi.org/10.1089/152091503322641060
  30. Bergman RN. Lilly lecture 1989. Toward physiological understanding of glucose tolerance. Minimal-model approach. Diabetes 1989;38:1512-27. https://doi.org/10.2337/diabetes.38.12.1512
  31. Ohn JH, Kwak SH, Cho YM, Lim S, Jang HC, Park KS, Cho NH. 10-Year trajectory of ${\beta}$-cell function and insulin sensitivity in the development of type 2 diabetes: a community-based prospective cohort study. Lancet Diabetes Endocrinol 2016;4:27-34. https://doi.org/10.1016/S2213-8587(15)00336-8
  32. Cho YM, Kim TH, Lim S, Choi SH, Shin HD, Lee HK, Park KS, Jang HC. Type 2 diabetes-associated genetic variants discovered in the recent genome-wide association studies are related to gestational diabetes mellitus in the Korean population. Diabetologia 2009;52:253-61. https://doi.org/10.1007/s00125-008-1196-4

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