Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Endocrinol Metab (Seoul). 2024 Oct;39(5):701-710. doi: 10.3803/EnM.2024.1974. Epub 2024 Aug 21.
Identifying risk factors for postpartum type 2 diabetes in women with gestational diabetes mellitus (GDM) is crucial for effective interventions. We examined whether changes in insulin sensitivity after delivery affects the risk of type 2 diabetes in women with GDM.
This prospective cohort study included 347 women with GDM or gestational impaired glucose tolerance, who attended the follow-up visits at 2 months postpartum and annually thereafter. Changes in insulin sensitivity were calculated using the Matsuda index at GDM diagnosis and at 2 months postpartum (ΔMatsuda index). After excluding women with pregestational diabetes or those followed up only once, we analyzed the risk of postpartum type 2 diabetes based on the ΔMatsuda index tertiles.
The incidence of type 2 diabetes at the two-month postpartum visit decreased with increasing ΔMatsuda index tertiles (16.4%, 9.5%, and 1.8%, P=0.001). During a 4.1-year follow-up, 26 out of 230 women who attended more than two follow-up visits (11.3%) developed type 2 diabetes. Compared to the lowest tertile, subjects in the highest ΔMatsuda index tertile showed a significantly reduced risk of type 2 diabetes (hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.93; P=0.036) after adjusting for confounders.
Improvement in insulin sensitivity after delivery is associated with a reduced risk of postpartum type 2 diabetes in women with GDM. Postpartum changes in insulin sensitivity could be a useful prediction for future type 2 diabetes development in women with GDM.
识别患有妊娠糖尿病（GDM）的女性产后 2 型糖尿病的风险因素对于有效的干预至关重要。我们研究了产后胰岛素敏感性的变化是否会影响 GDM 女性发生 2 型糖尿病的风险。
这项前瞻性队列研究纳入了 347 名 GDM 或妊娠期糖耐量受损的女性，她们在产后 2 个月及此后每年进行随访。在 GDM 诊断时和产后 2 个月使用 Matsuda 指数计算胰岛素敏感性的变化（ΔMatsuda 指数）。排除孕前糖尿病或仅随访一次的女性后，我们根据ΔMatsuda 指数三分位数分析产后 2 型糖尿病的发病风险。
在产后 2 个月的随访中，2 型糖尿病的发病率随ΔMatsuda 指数三分位数的升高而降低（16.4%、9.5%和 1.8%，P=0.001）。在 4.1 年的随访期间，230 名至少随访两次的女性中有 26 名（11.3%）发生了 2 型糖尿病。与最低三分位数相比，ΔMatsuda 指数最高三分位数的受试者发生 2 型糖尿病的风险显著降低（风险比，0.33；95%置信区间，0.12 至 0.93；P=0.036），调整混杂因素后。
产后胰岛素敏感性的改善与 GDM 女性产后 2 型糖尿病风险降低相关。产后胰岛素敏感性的变化可能是预测 GDM 女性未来发生 2 型糖尿病的有用指标。
