Xiang Anny H, Takayanagi Miwa, Black Mary Helen, Trigo Enrique, Lawrence Jean M, Watanabe Richard M, Buchanan Thomas A
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, 5th Floor, Pasadena, CA, 91101, USA,
Diabetologia. 2013 Dec;56(12):2753-60. doi: 10.1007/s00125-013-3048-0. Epub 2013 Sep 13.
AIMS/HYPOTHESIS: The aim of the study was to compare longitudinal changes in insulin sensitivity (SI) and beta cell function between women with and without a history of gestational diabetes mellitus (GDM).
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.
At baseline, women with prior GDM (mean age 36.3 years) had similar values of SI 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 SI (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 SI 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.
目的/假设：本研究旨在比较有和没有妊娠期糖尿病（GDM）病史的女性之间胰岛素敏感性（SI）和β细胞功能的纵向变化。
前瞻性随访队列包括235名已生育的非糖尿病墨西哥裔美国女性，其中93名有GDM病史，142名无GDM病史。参与者在基线时以及随访中位数4.1年时接受了双能X线吸收法、口服葡萄糖耐量试验（OGTT）和静脉葡萄糖耐量试验（IVGTT）。比较了两组之间代谢指标的基线值和变化率。
在基线时，有既往GDM病史的女性（平均年龄36.3岁）与无GDM病史的女性（平均年龄37.9岁）相比，SI值相似，但体脂和躯干脂肪百分比更高（p≤0.02），急性胰岛素反应更低，β细胞代偿（处置指数[DI]）更差（p<0.0001）。在随访期间，有GDM病史的女性比无GDM病史的女性SI（p=0.02）和DI（p=0.02）下降更快，体重或脂肪变化无显著差异（p>0.50）。对基线年龄、肥胖、卡路里摄入量、身体活动、首次怀孕年龄、额外怀孕次数以及随访期间肥胖变化进行调整后，增加了两组之间SI和DI变化率的差异（p≤0.003）。
结论/解读：近期有GDM病史的墨西哥裔美国女性比无GDM病史的已生育女性胰岛素敏感性和β细胞代偿恶化更快。这些差异不能用肥胖差异来解释，这表明现有脂肪的更有害影响和/或GDM女性β细胞稳健性降低。
