Use of insulin glargine during pregnancy: a case-control pilot study

OBJECTIVE: To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. DESIGN: A matched case-control study. SETTING: Women's Centre, John Radcliffe Hospital, Oxford, UK. SAMPLE: Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. METHODS: Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). MAIN OUTCOME MEASURES: Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. RESULTS: There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. CONCLUSIONS: The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.     

Evaluation of serum ischemia-modified albumin levels in pregnant women with and without gestational diabetes mellitus

Objective. To investigate serum ischemia-modified albumin (IMA) levels in gestational diabetes mellitus and the effect of treatment with continuous subcutaneous insulin infusion on the biomarker. Methods. The gestational diabetes mellitus women in the second trimester were evaluated before and after the two kinds of treatments with continuous subcutaneous insulin infusion and medical nutrition therapy for 6 weeks. Maternal serum ischemia-modified albumin and metabolic parameters were measured at baseline and at the 6th week. Results.Serum ischemia-modified albumin levels and metabolic parameters were higher in patients with gestational diabetes mellitus at baseline than in controls. Ischemia-modified albumin levels were correlated with plasma glucose (p < 0.05). Variables of glycemic control and ischemia-modified albumin levels were significantly reduced at the 6th week. The effect of insulin treatment was generally better than diet therapy. Linear regression analysis showed that fasting plasma glucose was an independent determinant for IMA levels (β = 0.611, p = 0.035).Fetal outcome was similar except for macrosomia and Apgar score at 5 min. Conclusion.Serum ischemia-modified albumin levels were higher in gestational diabetes mellitus compared to normal pregnancy. Continuous subcutaneous insulin infusion consistently improved metabolic disorder control. Gestational diabetes mellitus women were associated to a higher risk of oxidative stress and pregnancy complications.     

Postnatal testing for diabetes in Australian women following gestational diabetes mellitus

Background:  Postnatal blood glucose testing is recommended for reclassification of glucose tolerance following a pregnancy affected by gestational diabetes mellitus (GDM); however, there are limited data on the postnatal follow-up sought by Australian women.
Aims:  To describe postnatal diabetes testing patterns in Australian women following a pregnancy affected by GDM and identify factors associated with return for follow-up testing in accordance with the Australasian Diabetes in Pregnancy Society (ADIPS) guidelines.
Methods:  A cross-sectional self-administered survey of 1372 women diagnosed with GDM between 2003 and 2005, sampled from the National Diabetes Services Scheme database.
Results:  Postnatal diabetes testing was reported by 73.2% of survey respondents with 27.4% returning for an oral glucose test tolerance at six to eight weeks post-GDM pregnancy. Using logistic regression analysis, factors associated with appropriate postnatal testing were receiving individualised risk reduction advice (odds ratio (OR) 1.41 (1.08,1.84)) or written information (OR 1.35 (1.03,1.76)) and in two-way interactions, being under the care of an endocrinologist and not tertiary educated (OR 2.09 (1.49,2.93)) as well as seeing an obstetrician and diabetes educator during pregnancy (OR 1.72 (1.19,2.48)). Every five years increase in age reduced the likelihood of a woman returning for testing by 17%.
Conclusions:  Specialist diabetes care in non-tertiary educated women, or a team approach to management with diabetes education and obstetric care may act to reinforce the need for postnatal diabetes testing in accordance with the ADIPS guidelines. Individualised follow up from a health professional and provision of written information following a GDM pregnancy may also encourage return for postnatal testing in this high-risk group.     

非妊娠糖尿病巨大胎儿影响因素的病例对照研究

目的　探讨非妊娠糖尿病性巨大胎儿发生的危险因素。方法　对 5 3例非妊娠糖尿病巨大胎儿和 1 76例对照组进行各项相关因素分析。结果　单因素分析表明孕妇的孕前体重、孕前BMI、孕期增重、孕晚期体重、孕中期糖筛值、孕中晚期进食主食情况、分娩孕周、分娩方式、母血胰岛素、脐血血糖和胰岛素与巨大胎儿发生显著相关。经多因素分析后 ,孕前体重、孕中晚期进食主食情况、分娩孕周、分娩方式、脐血胰岛素与巨大胎儿发生仍有显著相关性。结论　巨大胎儿是遗传和环境多方面因素共同作用的结果 ,孕前高体重、孕期营养过剩和孕龄延长是巨大胎儿的高危因素 ,应针对具体情况采取综合措施积极预防。胰岛素在胎儿宫内发育中起重要的作用     

Predictors for antenatal insulin requirement in gestational diabetes

The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p?相似文献   

妊娠期糖尿病对女性远期糖代谢异常的影响

妊娠期糖尿病(GDM)是妊娠期常见合并症,血糖控制不佳者可导致严重的不良妊娠结局,威胁母儿健康.虽然患者产后大多可以恢复正常糖代谢水平,但有GDM史的患者再次妊娠发生糖代谢异常的风险增加,且随着生存时间的延长,发生肥胖、糖尿病和心血管疾病的风险也会明显增加.加强GDM患者产后糖代谢的研究,有助于减低女性远期糖尿病发生的...     

Metformin – a potentially effective drug for gestational diabetes mellitus: a systematic review and meta-analysis

Metformin has been gradually used in the management of gestational diabetes mellitus (GDM). In order to prove the safety and efficacy of metformin used in pregnancy, we searched several databases for the reports of randomized trials comparing insulin and metformin used in GDM and conducted a meta-analysis. Data showed the rates of neonatal large for gestational age, cesarean section, neonatal respiratory distress and preterm birth were similar in both groups. Maternal glycated hemoglobin-% at gestational week 36–37 was significantly lower in metformin group, indicating good glycemic control of metformin. Maternal weight gain since enrollment to gestational week 36–37 was also lower in metformin group, making metformin worth using even when metformin is insufficient and supplementary insulin is needed. Data also showed that metformin significantly reduced the gestational hypertension complications in GDM patients, probably by reducing the endothelial activation and maternal inflammatory response of insulin resistance. Although metformin can cross the placenta, it is less likely to cause severe neonatal hypoglycemia compared with insulin since it neither stimulates pancreatic insulin release nor increases circulating insulin levels. According to most maternal and neonatal outcomes, metformin is an effective and safe alternative to insulin for GDM patients.     

孕前糖尿病围孕期咨询和评估及降糖药应用

孕前糖尿病占所有妊娠合并糖尿病的5%~10%,妊娠前咨询内容包括了解血糖水平、评估慢性并发症及合并症以确定合适的妊娠时机。资料表明,相对比较安全的孕期口服降糖药是格列本脲和二甲双胍,目前仍推荐孕期使用胰岛素控制血糖。     

Does a High Carbohydrate Preparatory Diet Affect the 3-Hour Oral Glucose Tolerance Test in Pregnancy?

The aim of this study was to determine the effect of a high carbohydrate preparatory diet on the performance of the 3-hour oral glucose tolerance test (OTT) in pregnancy. This prospective clinical trial was performed at a university hospital outpatient obstetric clinic. Gravidas who had an abnormal blood sugar screening test were asked to ingest one of two preparatory diets: ≥ 150g/day of carbohydrate for 3 days (Carbo) or six Snickers? candy bars per day for 3 days (Candy), or to remain on their usual diet (Ad lib) prior to the GTT. A 100g oral OTT was performed after an overnight fast, and blood glucose values were determined at 1, 2, and 3 hours. Patients with either a fasting whole blood glucose > 120 mg/dl or ≥ two abnormal values on the GTT were considered to have gestational diabetes mellitus and received diet therapy. Women who failed diet therapy also received insulin. Our primary outcome parameter was the intergroup incidence of gestational diabetes mellitus. Other parameters included the mean 1-, 2-, and 3-hour glucose values and the rates of both cesarean delivery and large-for-gestational age infants. Of the 354 women studied, 108 entered the Carbo group, 105 entered the Candy group, and 141 comprised the Ad Lib group. The three groups were comparable with regard to historic and demographic risk factors for gestational diabetes mellitus. After the OTT, 29% of the Carbo group were considered to have gestational diabetes mellitus vs. 28% in both the Ad lib and Candy groups (P = 0.98). Additionally, both the mean intergroup fasting, 1-hour, 2-hour, and 3-hour whole blood glucose values and selected clinical outcomes were similar (P = 0.35–0.99). Compared to usual dietary intake, recommending a high carbohydrate diet had a negligible effect on the 100g oral OTT in pregnancy.     

妊娠期糖尿病产后糖代谢异常的危险因素

目的通过对妊娠期糖尿病(GDM)患者进行产后随访,回顾性分析影响GDM患者产后糖代谢变化的高危因素。方法收集2009年1月至2011年6月在河北省沧州市中心医院门诊产前检查并分娩的GDM患者236例,产后42d回访者158例,记录其孕前和孕期信息,包括:孕期年龄、身高、孕前体重、有否糖尿病家族史、孕期使用胰岛素情况、孕期并发症及合并症情况、新生儿出生时情况;并按OGTT试验结果分为研究组和对照组,进行高危因素筛查。结果研究组为60例糖耐量异常者,包括39例IGT/IFG患者和21例DM患者;对照组为98例糖耐量正常者,比较两组患者孕前、孕期和妊娠结局情况,结果可见高龄、糖尿病家族史、孕期应用胰岛素、合并子痫前期、早产是产后发生糖代谢异常的高危因素,差异有统计学意义(P<0.05)。结论存在高危因素的GDM患者产后糖代谢异常发生率较高,应针对性地对GDM患者进行产后临床筛查和随访。     

妊娠期糖尿病患者与正常孕妇妊娠中晚期胰岛素抵抗及胰岛B细胞功能观察

目的前瞻性纵向观察中期妊娠诊断为妊娠期糖尿病(GDM)患者及血糖正常孕妇在妊娠中晚期胰岛素抵抗及胰岛B细胞功能变化,并比较两者之间的差别。方法 2009年2月至2010年3月在中山大学孙逸仙纪念医院产前检查的82例孕妇于妊娠20～24周行葡萄糖耐量试验(OGTT)及胰岛素释放试验,诊断为GDM43例为GDM组,血糖正常的39例为对照组。于32～36周复查OGTT及胰岛素释放试验,纵向观察两组孕妇胰岛素抵抗及胰岛B细胞功能的变化。结果两组的胰岛B细胞分泌指数(HOMA-β)晚期妊娠均高于中期妊娠,时间主效应有统计学意义(F=7.863,P=0.007);GDM组的早期胰岛素分泌指数(△I30/△G30)中期妊娠及晚期妊娠均低于对照组,组间主效应差异有统计学意义(F=6.052,P=0.018),但GDM组从中期妊娠到晚期妊娠有所升高,而对照组逐渐下降。GDM组的血糖曲线下面积(AUCG)在中期妊娠及晚期妊娠均大于对照组(分别为P<0.0001,P=0.001),同时对照组的AUCG晚期妊娠显著高于中期妊娠(P=0.001);稳态模式胰岛素抵抗指数(HOMA-IR)及混合胰岛素敏感度的时间及组间主效应差异均无统计学意义。结论中晚期妊娠正常孕妇及GDM患者胰岛素抵抗均增加,后者胰岛素抵抗程度高于前者,胰岛B细胞代偿功能两者均增强;GDM组的早期胰岛素分泌功能较正常妊娠组下降。胰岛素抵抗和胰岛素分泌代偿不足是GDM发生、发展的重要机制。     

Gestational diabetes

Gestational diabetes mellitus (GDM) is the commonest medical condition in pregnancy. It is associated with a range of maternal and infant complications including large-for-gestational-age, stillbirth, pre-term birth, shoulder dystocia, caesarean section, and neonatal hypoglycaemia. Increasingly, longer-term metabolic risks are also being recognized for women who have GDM and their children. Because the relationship between maternal glucose and complications is linear, the appropriate thresholds for diagnosis and treatment remain controversial. Because screening for and treating, GDM can improve outcomes for women and their children, optimizing management warrants widespread attention and implementation. Diet and lifestyle interventions offer sufficient treatment for the majority of women with GDM, however evidence to support specific dietary interventions, and to support either oral hypoglycaemic agents or insulin as the preferred pharmacotherapy is inconsistent. This review provides an up-to-date summary of evidence related to prevention, screening, diagnosis, management, and follow-up of GDM.     

Glucose screening test results in first and early third trimester of pregnancy: is there any correlation?

OBJECTIVE: This study aims to find correlation between glucose screening test (GST) results done in the first trimester and again in the early third trimester of pregnancy. METHODS: Analysis of the records of 458 cases of pregnant women (non-diabetic in early pregnancy as detected by glucose screening test and glucose tolerance test) between 22 and 35 years of age with a body mass index of less than 25 kg/m2 was done. These women underwent GST in the first trimester (GST-1) and again in the early third trimester (GST-2). When the GST-2 was 140 mg% or above, a standard '3 hour glucose tolerance test' was done (GT TEST) with 100 g of glucose. The GST was done by measuring the plasma glucose level 1 hour after taking 50 g of glucose, irrespective of food intake. RESULTS: A substantial correlation between the two groups of measurements was found. Based on the available data, a GST-1 value of 99 mg% or less was seldom associated with GST-2 value of 140 mg% or more (GT TEST was positive in none). It was observed that 100% of cases with GST-1 value of 140 mg% or more had GST-2 of 140 mg% or more. Out of those having GST-2 value of 140 mg% or more, 72% had GT TEST positive. In the intermediate group (i.e. those patients having GST-1 value of 100 mg%-139 mg%), 51.7% had GST-2 values of 140 mg% or more. Out of these 51.7% cases, only 23% cases turned out to be GT TEST positive. The correlation coefficients (CC) worked out to be 0.38 (substantial correlation for 0.20 < CC < 0.70). CONCLUSION: From the observations stated above, it is concluded that for women with GST-1 of 99 mg% or less, a GST-2 is not necessary. For those having GST-1 of 140 mg% or more, a GT TEST is absolutely necessary instead of repeating the screening test again in the third trimester. But it is in the intermediate group (i.e. with GST-1 value of 100 mg%-139 mg%) where the glucose screening test should be repeated in the early third trimester and GT TEST as and when necessary.     

Interconception Care for Women With Prior Gestational Diabetes Mellitus

The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long‐term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged.     

Pregestational type 2 diabetes and gestational diabetes exhibit different sexual steroid profiles during pregnancy

Higher androgen levels are observed in non-pregnant women with diabetes. Whether this hormonal profile is found during pregnancy is unknown. The aim of this study was to determine the sexual steroids levels in pregnant women with pregestational type 2 (T2D) and gestational diabetes (GD) compared to healthy control (C) pregnant women during the second half of pregnancy. A prospective study of 69 pregnant women with T2D (n?=?21), GD (n = 24) and control (C, n?=?24) was followed up during the second half of gestation. Clinical assessments and blood samples were collected at 26.7 (25–27.8); 34 (32–34.9) and 37.5 (37–40) weeks of gestation. Androgens, sex hormone-binding globulin (SHBG), estrogens, estradiol/testosterone (E/T) ratio, insulin, glucose, HOMA-IR, were measured. Testosterone, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) levels were higher in T2D compared with C at each sampling point during pregnancy, even after adjusting for BMI and age. Estrogens levels and estradiol/testosterone ratio were lower in T2D and GD compared with C. Hyperandrogenemia, and higher insulin resistance is observed in T2D, but not in GD during pregnancy. Decreased estrogen and E/T ratio found in T2D and GD suggests a diminished aromatase activity during gestation. T2D and GD are associated with specific changes in sexual steroids and insulin resistance levels during pregnancy.     

Irisin在妊娠合并糖尿病中的研究进展

妊娠合并糖尿病有两种情况,一种是原有糖尿病基础上合并妊娠,即糖尿病合并妊娠,另一种是妊娠期首次发生的糖尿病,即妊娠期糖尿病（GDM）。妊娠合并糖尿病易发生不良妊娠结局。肥胖在妊娠合并糖尿病的发生发展中起着至关重要的作用,而运动则通过减轻肥胖以改善妊娠合并糖尿病的病情。近年研究发现Irisin可能是运动改善糖脂代谢的调控因子。Irisin是一种由骨骼肌运动产生的肌肉因子,其主要作用于脂肪、肝脏及胰岛细胞等与糖脂代谢相关的靶器官。研究表明在肥胖、糖尿病、GDM患者中,Irisin与血糖、血脂、能量代谢水平、胰岛素抵抗及胰岛素分泌能力有关。Irisin具有促进脂肪细胞燃烧,抑制肝糖异生,增加胰岛细胞再生等作用。Irisin可能与肥胖相关的妊娠合并糖尿病的发生发展有关,亦可能通过改善肥胖,减少胰岛素抵抗而有望成为肥胖相关代谢性疾病的防治靶点。     

Heterogeneity of cardiovascular risk factors profile in non-diabetic women 2–24 months post gestational diabetes mellitus.

Previously gestational diabetic (pGDM) women are characterized by high cardiovascular risk (CVR). The aim of this study was to assess the CVR markers levels in non-diabetic pGDM women in relation to time postpartum and to soluble E-selectin (sES) level. We investigated 125 women aged 18–40 years with a history of GDM between 2 and 24 months after their pregnancy. We evaluated age, body mass index (BMI), waist circumference, glucose levels during the oral glucose tolerance test (OGTT), levels of insulin and the parameters of endothelial dysfunction, fibrinolysis activity, low-grade systemic inflammation and lipid profiles. Prediabetes was identified in 38 women (30%), while in the remaining women OGTT results were normal. The tests performed >6 months revealed decreased hs-CRP (p?=?0.01), sICAM-1 (p?=?0.01), and elevated sES (p?=?0.01) >12 months after adjustment for age, BMI, waist circumference and 2?h OGTT glucose. In the subgroup tested ≤12 months after an index pregnancy sES was independently associated with hs-CRP (p?p?=?0.0139). No association was found between sES and remaining parameters in women tested >12 months postpartum. We conclude that the period 2–24 months post GDM is heterogeneous with respect to the CVR markers. The plasma level of hs-CRP could be useful as an important cardiovascular risk marker up to 12 months postpartum in non-diabetic pGDM women.     

The benefit of early treatment without rescreening in women with a history of gestational diabetes

Objective: In this center, women with a history of gestational diabetes (GDM) are treated without rescreening from early pregnancy in any subsequent pregnancies, commencing with a low glycemic diet and insulin if and when indicated. The objective of this study was to see if this practice reduced the incidence of macrosomia compared with the index pregnancy. Method: The analysis was confined to women who required insulin in the subsequent pregnancy. Results: Among 369 women who were prospectively identified with a history of previous GDM, 95 required insulin – the study cohort. Insulin treatment was commenced at an earlier gestation in the subsequent pregnancy. The incidence of macrosomia was significantly less in the subsequent pregnancy in the group of women who required insulin in both pregnancies (p = 0.02). Conclusion: This data suggests early treatment is of benefit to this high-risk group in the reduction of macrosomia.     

Insulin during pregnancy, labour and delivery

Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. The daily glucose profile measured by the patients themselves through measurements performed in capillary blood obtained by finger stick provides valuable information needed to adjust insulin therapy. Hypoglycaemia is the major threat to the pregnant woman or the woman with tight glycaemic control in the run-up to pregnancy. Repetitive hypoglycaemia can lead to hypoglycaemia unawareness, which is reversible with prevention of hypoglycaemia. A delicate balance should be struck between preventing hyperglycaemia and hypoglycaemia. Insulin requirements are not uniform across the day: it is low during the night with a more or less pronounced rise at dawn, followed by a gradual decrease during the remainder of the day. A basal amount of insulin is needed to regulate the endogenous glucose production, short-acting insulin shots are needed to handle exogenous glucose loads. Insulin therapy means two choices: the type of insulin used and the method of insulin administration. Regarding the type of insulin, the choice is between human and analogue insulins. The analogue short-acting insulin aspart has been shown to be safe during pregnancy in a randomised trial and has received registration for this indication; the short-acting analogue insulin lispro has been shown to be safe in observational studies. No such information is available on the long-acting insulin analogues detemir and glargine and both are prescribed off-label with human long-acting insulin as obvious alternatives. Randomised trials have not been able to show superiority of continuous subcutaneous insulin administration (CSII (insulin pump)) over intensive insulin injection therapy (multiple-dose insulin (MDI)) on any maternal or foeto-neonatal end point. However, group sizes were far too small to allow assessment of superiority and issues such as manageability of the disease and quality of life were never assessed. These two issues are of major importance to patients. The first trimester is often the period of most hypoglycaemic events, and insulin therapy should be especially closely monitored and adjusted in this period. After midterm, insulin requirements increase. Continuous glucose monitoring can offer better insights into the glycaemic profile than self-monitoring of blood glucose levels by the patients but the place of these new monitoring techniques has yet to be established more clearly. Insulin therapy during labour means short-acting insulin adjusted to achieve glucose levels between 4 and 8 mmol l(-1) to prevent neonatal hypoglycaemia as much as possible. After delivery, glycaemic control must be relaxed to prevent hypoglycaemia, especially in women who breastfeed.     

Normal secretion of the incretin hormones glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 during gestational diabetes mellitus

Background and aim. Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM2) are suggested to be caused by the same metabolic disorder. Defects in gut hormone-dependent regulation of β-cell function (entero-insular axis) have been proposed to contribute to the pathogenesis of DM2. The aim of study was to evaluate whether an impaired secretion of glucagon-like peptide-1 (GLP-1) and/or glucose-dependent insulinotropic polypeptide (GIP) could play a role in the development of carbohydrate disorders during pregnancy.

Subjects and methods. The study group (GDM) consisted of 13 gestational women with diabetes mellitus in whom GDM was diagnosed according to the World Health Organization criteria (75-g oral glucose tolerance test (OGTT)). The control group consisted of 13 pregnant women with normal glucose tolerance (NGT), matched according to age and duration of pregnancy. For all patients, plasma glucose, insulin, GLP-1 and GIP concentrations were evaluated after an OGTT, i.e. at 0, 30, 60, 90 and 120 min after glucose load.

Results. Fasting plasma glucose concentrations were similar in both groups, but the 0–120 min area under the curve (AUC) for glucose was significantly greater in the GDM group than in the NGT group (p < 0.0005). Fasting insulin concentration was higher (p < 0.05) and the 2-h insulin response (AUC_total) was significantly greater (p = 0.01) in the GDM group than in the NGT group. Insulin resistance was significantly higher in GDM compared with control women (homeostasis model assessment, p = 0.003). Fasting GLP-1 concentrations were higher in the GDM group (p = 0.05), but no differences were observed in GLP-1 response (AUC) between the studied groups. Fasting and stimulated GIP response did not differ between groups at any time of the study (p > 0.05). Positive correlations were observed between fasting GLP-1 and insulin concentration (r = 0.56, p < 0.004) and between fasting GLP-1 and insulin resistance (r = 0.43, p < 0.029).

Conclusion. An impaired secretion of GLP-1 and GIP does not seem to play a major role in the pathogenesis of GDM.