Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

We compared the prevalence of diabetes in women who experienced gestational diabetes mellitus (GDM) with that in the general population and identified risk factors for the development of diabetes.The analysis included 868 subjects (620 GDM and 248 single positive (SP) for one of the diagnostic criteria). The post-partum examinations included 2 h 75 g oral glucose tolerance tests, lipid profiles, anthropometric measurements, and documentation of medical history, diet, and lifestyle. All participants were followed up at 6 weeks after parturition and subsequent follow-ups were conducted annually. General population subjects were identified from the 2001 Korean National Health and Nutrition Survey and age-matched for case–control analysis.Eleven (4.4%) and 71 (11.5%) subjects in the SP and GDM groups, respectively, developed diabetes, while 22 (2.5%) subjects in the general population group presented with diabetes. The risk of developing diabetes was 3.5 times greater for GDM subjects than for general population subjects, after adjusting for confounding factors. A multiple logistic regression model revealed that GDM, a family history of diabetes, and waist circumference were independently associated with the development of diabetes.We concluded that GDM women in Korea are at high risk of diabetes irrespective of the absence of putative risk factors.     

A case of diabetes mellitus associated with anti-insulin autoantibodies without previous insulin injection

A case of diabetes mellitus who had high levels of fasting immunoreactive insulin (IRI) and low levels of immunoreactive C-peptide (CPR) is reported. Examination of her serum disclosed the presence of IgG class k + lambda type anti-insulin autoantibodies. She has never been treated with insulin, nor had drugs which have been reported to be responsible for inducing insulin autoimmune syndrome. Despite the presence of autoantibodies against insulin, she has never experienced hypoglycemia. Significance of the production of autoantibodies against insulin and physicochemical parameters of anti-insulin antibodies in her serum are discussed.     

Vascular function in women with previous gestational diabetes mellitus

It is hypothesised that vascular dysfunction, which characterises type 2 diabetes, may predate development of hyperglycaemia. 17 women with previous gestational diabetes mellitus, and thus at risk of developing type 2 diabetes, were matched with normal controls for body mass index, menstrual phase, smoking, age, blood pressure, and lipid profiles. All had normal glucose tolerance. Tests of microvascular and macrovascular function, including endothelium-dependent and -independent vasodilatation, were performed. Laser Doppler fluximetry of maximum skin microvascular hyperaemia in response to local heating of the dorsum of the foot to 42 degrees C for 30 min was impaired in subjects compared to controls [subjects = 1.15 (0.73-1.73) V median (range) versus controls = 1.50 (0.95-2.29) V, p = 0.008]. There were no differences in laser Doppler perfusion imaging of responses to forearm skin iontophoresis of acetylcholine [subjects = 1.59 (0.32-2.55) V median (range) versus controls = 1.79 (0.72-2.06) V; p = 0.81] and sodium nitroprusside [subjects = 1.39 (0.8-3.14) V versus controls = 1.41 (0.34-2.19) V; p = 0.68], ultrasound estimation of brachial artery flow-mediated dilatation [subjects = 1.65 (-0.5-9.07)% versus controls = 2.77 (0.63-6.6)%; p = 0.42] and glyceryl trinitrate-induced dilatation [subjects = 15.20 (6.64-20.91)% versus controls = 15.92 (3.94-22.09)%; p = 0.48]. Microvascular maximum hyperaemia was impaired in the index group, suggesting the presence of a defect in vascular function. This defect was not explained by those aspects of endothelial function measured by the other techniques.     

脂蛋白相关磷脂酶A2与妊娠期糖尿病患者产后糖代谢异常的相关性

目的 通过产前脂蛋白相关磷脂酶A2（Lp-PLA2）检测评估妊娠期糖尿病（GDM）患者产后糖代谢异常的发生风险.方法 收集2009年1月至2012年8月系统产检并住院分娩的GDM患者190例作为研究组,同期健康孕妇261例作为对照组.并于妊娠24～28周抽取外周血检测血糖、血脂以及血清Lp-PLA2等.于2012年11月至2013年4月进行随访,其中GDM患者172例,健康孕妇249例,进行口服葡萄糖耐量试验（OGTT）及糖化血红蛋白（HbA1c）.分类计数资料比较采用x2检验.Lp-PLA2与GDM产后糖代谢异常的相关性采用logistic回归分析和ROC曲线分析.结果 （1）GDM患者产后2型糖尿病（T2DM） [4.65％（8/172）比0（0/249）]、糖尿病前期[39.53％ （68/172）比12.45％（31/249）]发生率比健康孕妇高.（2）与健康孕妇相比,GDM患者产后空腹血糖（FBG）[（4.5±0.7）比（4.2±0.3） mmol/L; t=5.6,P＜0.01],空腹胰岛素（FINS）[（9.7±4.9）比（8.7±4.2） mmol/L;t=2.3,P＜0.05],稳态模型胰岛素抵抗指数（HOMA-IR）[（2.0±1.3）比（1.7±1.1）;t=2.6,P＜0.05]均明显升高（P＜0.05）.（3）GDM患者产前血清Lp-PLA2活性明显高于健康孕妇[（33±1 1）比（24±8） nmol·min^-1·ml^-1;t=9.4,P＜0.05].（4）Lp-PLA2活性与GDM产后糖代谢异常显著正相关（OR=1.35,95％CI 1.07～1.66,P=0.001）;受试者工作特征（ROC）曲线分析,以Lp-PLA2活性27.96 nmol· min^-1·ml^-1为产后糖代谢异常诊断切值,其灵敏度为71.3％,特异度为82.1％.结论 GDM患者产后糖代谢异常发生风险显著升高,Lp-PLA2是GDM产后糖代谢异常发生的独立风险因子,对预测GDM产后发生糖代谢异常有一定价值.     

妊娠糖尿病患者血游离脂肪酸与β细胞功能及胰岛素抵抗的关系

检测36例孕24～36周妊娠糖尿病患者和同期30例健康孕妇凌晨3:00、5:00及75 g葡萄糖负荷后血游离脂肪酸和胰岛素水平,比较两组胰岛素敏感性和胰岛素分泌功能.结果提示凌晨及糖负荷后高游离脂肪酸均与妊娠糖尿病患者胰岛素抵抗相关[胰岛素:(7.18±3.19)对(5.05±1.80)mIU/L(3:00)、(8.19±4.42)对(5.31±1.82)mIU/L(5:00)、(59.18±30.85)对(40.52±15.07)mIU/L(糖负荷后);游离脂肪酸:(0.39±0.20)对(0.23±0.11)mmol/L(3:00)、(0.46±0.17)对(0.29±0.12)mmol/L(5:00)、(0.19±0.13)对(0.09±0.06)mmol/L(糖负荷后);均P<0.01],糖负荷后30 min(早期相)的高水平的游离脂肪酸可能与妊娠糖尿病患者早期胰岛素分泌功能缺陷有关.     

The nature of changes in lipid metabolism in patients with diabetes mellitus associated with ischemic heart disease

To elucidate the nature of lipid defects in patients with diabetes mellitus (DM) concurrent with acute myocardial infarction (MI), the study was undertaken to examine the serum concentrations of total cholesterol, triglycerides, alpha- and beta-lipoproteins with DM in the presence of acute MI. 40 non-diabetic patients with acute MI, 23 diabetics with postinfarct cardiosclerosis, and 17 non-insulin-dependent diabetics without signs of coronary atherosclerosis. Urinary epinephrine and norepinephrine excretion was additionally determined in the acute period and 3-4 weeks after therapy. Homogeneous lipid metabolic parameters were found in CHD patients with and without DM and when transient hyperglycemia developed. The patients with acute MI exhibited some increase in lipid consumption to satisfy the energy need for the cardiovascular system, this being true for triglycerides in DM patients. The DM patients who showed low triglyceride levels had more frequently transmural MI and MI complicated with heart failure. Obesity and familial histories of DM and CHD in DM patients with acute MI were ascertained to be accompanied by reduced serum alpha-lipoprotein concentrations.     

Longitudinal changes in insulin sensitivity and beta cell function between women with and without a history of gestational diabetes mellitus

Aims/hypothesis

The aim of the study was to compare longitudinal changes in insulin sensitivity (S_I) and beta cell function between women with and without a history of gestational diabetes mellitus (GDM).

Methods

The prospective follow-up cohort included 235 parous non-diabetic Mexican–American women, 93 with and 142 without a history of GDM. The participants underwent dual-energy x-ray absorptiometry, OGTTs and IVGTTs at baseline and at a median of 4.1 years follow-up. The baseline values and rates of change of metabolic measures were compared between groups.

Results

At baseline, women with prior GDM (mean age 36.3 years) had similar values of S_I but higher percentages of body fat and trunk fat (p?≤?0.02), a lower acute insulin response and poorer beta cell compensation (disposition index [DI]) (p?<?0.0001) than women without GDM (mean age 37.9 years). During the follow-up, women with GDM had a faster decline in S_I (p?=?0.02) and DI (p?=?0.02) than their counterparts without GDM, with no significant differences in changes of weight or fat (p?>?0.50). Adjustment for baseline age, adiposity, calorie intake, physical activity, age at first pregnancy, additional pregnancies and changes in adiposity during follow-up increased the between-group differences in the rates of change of S_I and DI (p?≤?0.003).

Conclusions/interpretation

Mexican–American women with recent GDM had a faster deterioration in insulin sensitivity and beta cell compensation than their parous counterparts without GDM. The differences were not explained by differences in adiposity, suggesting more deleterious effects of existing fat and/or reduced beta cell robustness in women with GDM.     

In middle-aged siblings of patients with type 2 diabetes mellitus normal glucose tolerance is associated with insulin resistance and with increased insulin secretion. The SPIDER study

OBJECTIVES: To evaluate the frequency of impaired glucose tolerance (IGT) and of Type 2 diabetes mellitus (Type 2 DM) in siblings of patients with Type 2 DM, and to assess insulin release and insulin sensitivity in siblings with normal glucose tolerance (NGT), compared with NGT spouses of probands without family history of Type 2 DM. DESIGN AND METHODS: We evaluated 87 families including 103 Type 2 DM patients (87 probands), and we carried out an oral glucose tolerance test (OGTT) in 130 siblings and in 60 spouses. Among NGT subjects, 12 siblings and 16 spouses underwent a low-dose insulin-glucose infusion test (LDIGIT) to evaluate C-peptide release and insulin sensitivity. RESULTS: After the OGTT, 24 siblings were classified as having Type 2 DM, 31 as IGT, and only 14 spouses as IGT (P=0.0012 vs siblings). NGT siblings (n=75) showed higher insulin levels at 120 min than NGT spouses (n=46) at OGTT, in spite of identical blood glucose levels; at LDIGIT, NGT siblings secreted more C-peptide and showed a lower insulin sensitivity than NGT spouses. CONCLUSIONS: These data indicate that middle-aged siblings of probands with Type 2 DM have a high frequency of IGT and Type 2 DM, and that NGT siblings have increased insulin resistance and increased insulin secretion when compared with adequate controls.     

Fibrinolytic dysfunction after gestation is associated to components of insulin resistance and early type 2 diabetes in latino women with previous gestational diabetes

Among patients with metabolic syndrome (MS), atherosclerosis and abnormal fibrinolytic function are frequently present, mostly owing to an increase in plasminogen activator inhibitor-1(PAI-1). We analyze PAI-1 in pregnant women, both normal and with gestational diabetes (GDM) and postpartum regarding its correlation to MS surrogates. Clinical characteristics, glucose tolerance (100g-OGTT), lipids, PAI-1 antigen, insulin sensitivity (HOMA-S), and pancreatic beta-cell function (HOMA-B) were investigated in 34 women. Eleven had normal glucose tolerance (NGT) during pregnancy and 23 had GDM (all GAD antibodies-negative). All patients were studied at 28-34 weeks of gestation and 16-24 weeks after delivery (75 g-OGTT). Parameters of interest were determined using commercial test systems. During pregnancy, PAI-1 was not statistically different between NGT and GDM (47+/-25 ng/ml versus 47+/-28 ng/ml, p=0.9). After gestation, 19 (56%) women had NGT (11 of them from previous NGT group) and 15 (44%) had impaired glucose tolerance (IGT) or DM. The IGT (IGT+DM) group had higher PAI-1 (p=0.01), which did not decreased after delivery NGT-NGT before and after delivery (47+/-25 ng/ml versus 6+/-5 ng/ml; p<0.001), GDM-NGT (62+/-36 ng/ml versus 14+/-15 ng/ml; p=0.001) and GDM-IGT (39+/-20 ng/ml versus 27+/-23 ng/ml; p=0.15). PAI-1 levels were positively correlated (p<0.05) to total cholesterol (r(s)=0.37), triglycerides (r(s)=0.48), fasting plasma glucose (r(s)=0.52), 2-h plasma glucose in the OGTT (r(s)=0.58) and were negatively correlated (p<0.05) with HOMA-S (r(s)=-0.42) and HOMA-B (r(s)=-0.38). Fibrinolytic dysfunction is still present in GDM women and is associated with early development of IGT or T2DM. PAI correlated with surrogate markers of MS levels and may identify a group of women at risk for macroangiopathy.     

Acute suppression of VLDL1 secretion rate by insulin is associated with hepatic fat content and insulin resistance

Aims/hypothesis Overproduction of VLDL₁ seems to be the central pathophysiological feature of the dyslipidaemia associated with type 2 diabetes. We explored the relationship between liver fat and suppression of VLDL₁ production by insulin in participants with a broad range of liver fat content. Methods A multicompartmental model was used to determine the kinetic parameters of apolipoprotein B and TG in VLDL₁ and VLDL₂ after a bolus of [²H₃]leucine and [²H₅]glycerol during a hyperinsulinaemic–euglycaemic clamp in 20 male participants: eight with type 2 diabetes and 12 control volunteers. The participants were divided into two groups with low or high liver fat. All participants with diabetes were in the high liver-fat group. Results The results showed a rapid drop in VLDL₁-apolipoprotein B and -triacylglycerol secretion in participants with low liver fat during the insulin infusion. In contrast, participants with high liver fat showed no significant change in VLDL₁ secretion. The VLDL₁ suppression following insulin infusion correlated with the suppression of NEFA, and the ability of insulin to suppress the plasma NEFA was impaired in participants with high liver fat. A novel finding was an inverse response between VLDL₁ and VLDL₂ secretion in participants with low liver fat: VLDL₁ secretion decreased acutely after insulin infusion whereas VLDL₂ secretion increased. Conclusions/interpretation Insulin downregulates VLDL₁ secretion and increases VLDL₂ secretion in participants with low liver fat but fails to suppress VLDL₁ secretion in participants with high liver fat, resulting in overproduction of VLDL₁. Thus, liver fat is associated with lack of VLDL₁ suppression in response to insulin. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorised users.     

Subclinical inflammation and vascular dysfunction in women with previous gestational diabetes mellitus

CONTEXT: A history of gestational diabetes (GDM) significantly increases the risk of developing type 2 diabetes, an independent risk factor for cardiovascular disease (CVD). It is not known whether nondiabetic women with prior GDM are also at increased risk of CVD. OBJECTIVE: The aim of this study was to compare biochemical and hemodynamic surrogate markers of CVD in nondiabetic women with and without a history of GDM who were at least 1 yr post delivery. DESIGN: This was a single center cross-sectional study. SETTING: The study was performed in an academic referral center. SUBJECTS: Forty-eight premenopausal healthy women with a history of GDM (n = 25) or a history of normal pregnancy (n = 23) were studied in the follicular phase of the menstrual cycle. MAIN OUTCOME MEASURES: The main outcome measures were: 1) inflammatory markers associated with CVD including C-reactive protein, IL-6, and plasminogen activator inhibitor-1; 2) the adipokine adiponectin; and 3) conduit vessel stiffness. RESULTS: When compared to normal controls, women with prior GDM had higher mean levels of C-reactive protein (3.58 +/- 3.86 vs. 0.52 +/- 0.16 mg/liter; P < 0.001), IL-6 (1.81 +/- 1.04 vs. 0.99 +/- 0.52 pg/ml; P = 0.001), plasminogen activator inhibitor-1 (29.6 +/- 17.6 vs. 16.5 +/- 14.0 ng/ml; P = 0.001), and lower levels of adiponectin (8.9 +/- 3.9 vs. 15.9 +/- 7.3 microg/ml; P = 0.001). Women with prior GDM also had significantly (P 相似文献   

Increased insulin sensitivity is associated with reduced insulin and glucagon secretion and increased insulin clearance in man

Insulin secretion is increased in insulin resistance. In this study, we examined whether high insulin sensitivity results in low insulin secretion. Twelve male master athletes [age 25.6 +/- 4.1 (mean +/- SD) yr] and seven male sedentary students (age 25.0 +/- 2.0 yr) underwent a hyperinsulinemic, euglycemic clamp and a glucose-dependent arginine stimulation test. Athletes had high insulin sensitivity [230 +/- 18 vs. 92 +/- 12 (nmol glucose/kg.min)/(pmol insulin/liter), P < 0.001] and low insulin response to arginine (at fasting glucose 135 +/- 22 vs. 394 +/- 60 pmol/liter, P < 0.001), which resulted in unaltered disposition index (32.8 +/- 3.8 vs. 33.5 +/- 3.3 micro mol glucose/kg.min, NS). Also, the C-peptide response to arginine was reduced (at fasting glucose 0.71 +/- 0.09 vs. 0.89 +/- 0.09 nmol/liter, P = 0.034). However, the C-peptide reduction was not as large as the insulin reduction yielding increased disposition index in athletes when calculated from C-peptide data (184 +/- 9 vs. 76 +/- 11 micro mol glucose/kg.min, P < 0.001). This difference is explained by increased insulin clearance among the athletes during the first 5 min after arginine (81.1% +/- 1.8% vs. 53.6% +/- 4.7%, P < 0.001). Also, the glucagon response to arginine was reduced in the athletes (58.8 +/- 6.7 vs. 90.1 +/- 9.9 ng/liter at fasting glucose, P = 0.009). We conclude that high insulin sensitivity results in low islet hormone secretion and increased insulin clearance.     

Serum osteoprotegerin is associated with carotid intima media thickness in women with previous gestational diabetes

Circulating levels of osteoprotegerin (OPG) have been shown to be increased in patients with cardiovascular disorders and diabetes. The aim of this study was to determine serum OPG levels in women with previous gestational diabetes (GDM), and to investigate the relationship between OPG and carotid intima media thickness (IMT) and circulating cardiovascular risk factors. Serum OPG was measured in 46 women with previous GDM and 30 age-matched healthy controls. Carotid IMT was evaluated. Serum lipid, insulin and hsCRP levels, plasma fibrinogen, vWF and PAI-1 levels were measured. Serum OPG levels tended to be increased in women with previous GDM (p=0.058). Carotid IMT was increased in the study group. Women with previous GDM had elevated levels of hsCRP and PAI-1. OPG levels were positively correlated with age, fasting and post-load glucose levels, hsCRP, and carotid IMT. Multiple regression analysis showed that serum OPG was a statistically significant predictor for elevated carotid IMT. Our results revealed that OPG levels tended to be elevated in women with previous GDM. Significant association of OPG with carotid IMT suggested that OPG might play a role in the pathogenesis of endothelial dysfunction in women with previous GDM.     

Early manifestation of cardiovascular disease risk factors in offspring of mothers with previous history of gestational diabetes mellitus

This study investigated the long-term adverse effects of maternal gestational diabetes mellitus (GDM) on cardiovascular disease (CVD) risk factors in offspring. A total of 298 offspring (202 offspring of GDM mothers and 96 offspring of mothers with impaired glucose tolerance [IGT]) participated in the study. CVD risk factors included elevated body mass index (BMI), skinfold thickness, body fat, blood pressure, lipid profiles, and glucose values measured with a 2h oral glucose tolerance test. The BMI of offspring >or=5 years of age of GDM mothers was significantly higher than that of offspring of mothers with IGT when analysed according to age. In offspring of GDM mothers, CVD risk factors were positively correlated with age, except for lipid profiles. A significant negative relationship between age and BMI was observed in offspring of IGT mothers. The slope of the linear regression lines for BMI and fasting plasma insulin levels with age were significantly steeper for the offspring of GDM mothers than for those of IGT mothers. We conclude that childhood obesity, as well as altered glucose metabolism influenced by the maternal uterine environment, is more likely with advancing years in the offspring of GDM mothers than in the offspring of IGT mothers.     

Correlation of iron metabolism with some stress hormones and insulin resistance in patients with gestational diabetes mellitus

正Objective To investigate the association of iron with stress hormones and insulin resistance in patients with gestational diabetes mellitus (GDM).Methods Seventyfive pregnant women diagnosed as GDM during 24-28weeks were collected from January to November 2015 in Yantai Yuhuangding Hospital, and 75 normal pregnant women were used as control group. Blood glucose, insulin, stress hormones and iron metabolism related indexes