Göbl Christian S, Bozkurt Latife, Mittlböck Martina, Leutner Michael, Yarragudi Rajashri, Tura Andrea, Pacini Giovanni, Kautzky-Willer Alexandra
Department of Gynecology and Obstetrics, Division of Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria; and Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria;
Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine, Medical University of Vienna, Vienna, Austria;
Am J Physiol Regul Integr Comp Physiol. 2015 Jul 1;309(1):R13-21. doi: 10.1152/ajpregu.00059.2015. Epub 2015 Apr 29.
Early reexamination of carbohydrate metabolism via an oral glucose tolerance test (OGTT) is recommended after pregnancy with gestational diabetes (GDM). In this report, we aimed to assess the dominant patterns of dynamic OGTT measurements and subsequently explain them by meanings of the underlying pathophysiological processes. Principal components analysis (PCA), a statistical procedure that aims to reduce the dimensionality of multiple interrelated measures to a set of linearly uncorrelated variables (the principal components) was performed on OGTT data of glucose, insulin and C-peptide in addition to age and body mass index (BMI) of 151 women (n = 110 females after GDM and n = 41 controls) at 3-6 mo after delivery. These components were explained by frequently sampled intravenous glucose tolerance test (FSIGT) parameters. Moreover, their relation with the later development of overt diabetes was studied. Three principal components (PC) were identified, which explained 71.5% of the variation of the original 17 variables. PC1 (explained 47.1%) was closely related to postprandial OGTT levels and FSIGT-derived insulin sensitivity (r = 0.68), indicating that it mirrors insulin sensitivity in the skeletal muscle. PC2 (explained 17.3%) and PC3 (explained 7.1%) were shown to be associated with β-cell failure and fasting (i.e., hepatic) insulin resistance, respectively. All three components were related with diabetes progression (occurred in n = 25 females after GDM) and showed significant changes in long-term trajectories. A high amount of the postpartum OGTT data is explained by principal components, representing pathophysiological mechanisms on the pathway of impaired carbohydrate metabolism. Our results improve our understanding of the underlying biological processes to provide an accurate postgestational risk stratification.
妊娠合并妊娠期糖尿病（GDM）后，建议通过口服葡萄糖耐量试验（OGTT）尽早复查碳水化合物代谢情况。在本报告中，我们旨在评估动态OGTT测量的主要模式，并随后通过潜在病理生理过程的意义对其进行解释。除了151名女性（n = 110名GDM后女性和n = 41名对照）产后3 - 6个月的年龄和体重指数（BMI）外，还对葡萄糖、胰岛素和C肽的OGTT数据进行了主成分分析（PCA），这是一种旨在将多个相互关联的测量维度降低为一组线性不相关变量（主成分）的统计程序。这些成分通过频繁采样静脉葡萄糖耐量试验（FSIGT）参数进行解释。此外，还研究了它们与显性糖尿病后期发展的关系。确定了三个主成分（PC），它们解释了原始17个变量71.5%的变异。PC1（解释了47.1%）与餐后OGTT水平和FSIGT衍生的胰岛素敏感性密切相关（r = 0.68），表明它反映了骨骼肌中的胰岛素敏感性。PC2（解释了17.3%）和PC3（解释了7.1%）分别与β细胞功能衰竭和空腹（即肝脏）胰岛素抵抗相关。所有三个成分都与糖尿病进展（在n = 25名GDM后女性中发生）相关，并在长期轨迹中显示出显著变化。主成分解释了大量的产后OGTT数据，代表了碳水化合物代谢受损途径上的病理生理机制。我们的结果增进了我们对潜在生物学过程的理解，以提供准确的产后风险分层。
