Tura A, Mari A, Prikoszovich T, Pacini G, Kautzky-Willer A
Institute of Biomedical Engineering, CNR, Padua, Italy.
Clin Endocrinol (Oxf). 2008 Aug;69(2):237-43. doi: 10.1111/j.1365-2265.2008.03178.x. Epub 2008 Jan 10.
Women with former gestational diabetes mellitus (fGDM) often show defects in both insulin sensitivity and beta-cell function but it is not clear which defect plays the major role or which appears first. This might be because fGDM women are often studied as a unique group and not divided according to their glucose tolerance. Different findings might also be the result of using different tests. Our aim was to study insulin sensitivity and beta-cell function with two independent glucose tolerance tests in fGDM women divided according to their glucose tolerance.
A total of 108 fGDM women divided into normal glucose tolerance (IGT; N = 82), impaired glucose metabolism (IGM; N = 20) and overt type 2 diabetes (T2DM; N = 6) groups, and 38 healthy control women (CNT) underwent intravenous (IVGTT) and oral glucose tolerance tests (OGTT). Measurements Insulin sensitivity and beta-cell function were assessed by both the IVGTT and the OGTT.
Both tests revealed impaired insulin sensitivity in the normotolerant group compared to controls (IVGTT: 4.2 +/- 0.3 vs. 5.4 +/- 0.4 10(-4) min(-1) (microU/ml)(-1); OGTT: 440 +/- 7 vs. 472 +/- 9 ml min(-1) m(-2)). Conversely, no difference was found in beta-cell function from the IVGTT. However, some parameters of beta-cell function by OGTT modelling analysis were found to be impaired: glucose sensitivity (106 +/- 5 vs. 124 +/- 7 pmol min(-1) m(-2) mm(-1), P = 0.0407) and insulin secretion at 5 mm glucose (168 +/- 9 vs. 206 +/- 10 pmol min(-1) m(-2), P = 0.003).
Both insulin sensitivity and beta-cell function are impaired in normotolerant fGDM but the subtle defect in beta-cell function is disclosed only by OGTT modelling analysis.
既往有妊娠期糖尿病（fGDM）的女性通常在胰岛素敏感性和β细胞功能方面均存在缺陷，但尚不清楚哪种缺陷起主要作用或哪种缺陷先出现。这可能是因为fGDM女性常作为一个独特群体进行研究，未根据其糖耐量进行划分。不同的研究结果也可能是使用不同检测方法的结果。我们的目的是通过两项独立的糖耐量试验，对根据糖耐量划分的fGDM女性的胰岛素敏感性和β细胞功能进行研究。
总共108例fGDM女性被分为正常糖耐量（IGT；N = 82）、糖代谢受损（IGM；N = 20）和显性2型糖尿病（T2DM；N = 6）组，38例健康对照女性（CNT）接受了静脉葡萄糖耐量试验（IVGTT）和口服葡萄糖耐量试验（OGTT）。测量 通过IVGTT和OGTT评估胰岛素敏感性和β细胞功能。
与对照组相比，两项试验均显示糖耐量正常组的胰岛素敏感性受损（IVGTT：4.2±0.3 vs. 5.4±0.4×10⁻⁴ min⁻¹（μU/ml）⁻¹；OGTT：440±7 vs. 472±9 ml·min⁻¹·m⁻²）。相反，IVGTT检测的β细胞功能未发现差异。然而，通过OGTT模型分析发现β细胞功能的一些参数受损：葡萄糖敏感性（106±5 vs. 124±7 pmol·min⁻¹·m⁻²·mm⁻¹，P = 0.0407）和血糖为5 mmol/L时的胰岛素分泌（168±9 vs. 206±10 pmol·min⁻¹·m⁻²，P = 0.003）。
糖耐量正常的fGDM患者胰岛素敏感性和β细胞功能均受损，但β细胞功能的细微缺陷仅通过OGTT模型分析才能揭示。
