Fan Yuxin, Wang Leishen, Liu Huikun, Zhang Shuang, Tian Huiguang, Shen Yun, Tuomilehto Jaakko, Yu Zhijie, Yang Xilin, Hu Gang, Liu Ming
Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
BMJ Open Diabetes Res Care. 2020 Sep;8(1). doi: 10.1136/bmjdrc-2019-001060.
To evaluate the single association of postpartum β-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum β-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk.
The study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of β-cell secretory function (HOMA-%β) and homeostatic model assessment of insulin resistance (HOMA-IR).
Multivariable-adjusted ORs of diabetes across quartiles of HOMA-%β and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (p <0.001), and 1.00, 2.11, 5.59, and 9.36 (p <0.001), respectively. Women with IR only had the same diabetes risk as women with β-cell dysfunction only. Obesity, together with IR or β-cell dysfunction, had a stronger effect on diabetes risk. This stronger effect was also found for a history of GDM with IR or β-cell dysfunction. Women with three risk factors, including obesity, a history of GDM and β-cell dysfunction/IR, showed the highest ORs of diabetes.
β-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and β-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.
评估产后β细胞功能障碍与胰岛素抵抗（IR）的单一关联，以及产后β细胞功能障碍、IR、肥胖和妊娠期糖尿病（GDM）病史的不同组合与产后2型糖尿病风险的关系。
该研究纳入了1263例既往有GDM的女性和705例无GDM的女性。采用稳态模型评估法来估计β细胞分泌功能的稳态模型评估（HOMA-%β）和胰岛素抵抗的稳态模型评估（HOMA-IR）。
HOMA-%β和HOMA-IR四分位数范围内糖尿病的多变量调整比值比分别为1.00、1.46、2.15和6.25（p<0.001），以及1.00、2.11、5.59和9.36（p<0.001）。仅患有IR的女性与仅患有β细胞功能障碍的女性患糖尿病的风险相同。肥胖与IR或β细胞功能障碍一起，对糖尿病风险的影响更强。对于有GDM病史且伴有IR或β细胞功能障碍的情况，也发现了这种更强的影响。具有肥胖、GDM病史和β细胞功能障碍/IR这三个危险因素的女性，糖尿病的比值比最高。
β细胞功能障碍或IR与产后糖尿病显著相关。IR和β细胞功能障碍，连同肥胖和GDM病史，具有最高的产后糖尿病风险比值比。
