Gastroenterology Cardiology Pulmonology Endocrinology-metabolism Nephrology Hemato-oncology Infectious diseases Allergy Rheumatology Etc. 3Department of Medicine, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea. 4Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea. 7Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea. The aim was to compare the insulin sensitivity and secretion index of pregnant Korean women with normal glucose tolerance (NGT), gestational impaired glucose tolerance (GIGT; only one abnormal value according to the Carpenter and Coustan criteria), and gestational diabetes mellitus (GDM). The GDM group had higher homeostasis model assessment of insulin resistance and lower insulin sensitivity index (ISOGTT), quantitative insulin sensitivity check index, homeostasis model assessment for estimation of index I?-cell secretion (HOMA-B), first and second phase insulin secretion, and insulin secretion-sensitivity index (ISSI) than the NGT group (p a‰¤ 0.001 for all). Gestational diabetes mellitus (GDM) is an abnormal glucose intolerance status that is discovered during pregnancy [1]. GDM is not only associated with adverse pregnancy outcomes, which include macrosomia, dystocia, birth trauma, and metabolic complications in newborns [4], but it is also a strong predictor of risk for impaired glucose tolerance and transitioning to overt type 2 diabetes postpartum [5].
However, there are few reports of the insulin sensitivities and secretion capacities of pregnant women in Korea.
Between January 2004 and August 2006, all pregnant women who visited the Cheil General Hospital & Women's Healthcare Center were screened at 24 to 28 weeks of gestation for GDM using a universal two-step GDM screening program. In the GIGT group, there were three heterogeneous subgroups stratified by the criteria for 1-hour, 2-hour, and 3-hour abnormal values. Anthropometric measurements, including prepregnancy body weight, parity, and history of type 2 diabetes among first-degree relatives were recorded. Insulin resistance was calculated using the homeostasis model assessment (homeostasis model assessment of insulin resistance, HOMA-IR) [10,11]. The total area under curve (AUC) for glucose and AUC for insulin from premeal to 120 minutes were calculated using the trapezoidal rule. In the 100-g OGTT, the glucose levels showed a gradual increase from the NGT group to the GDM group (Fig. Moreover, the insulin secretion index values were significantly lower in the GDM group than in the other two groups (Table 1). Among the GIGT subjects, the 2-hour abnormal values subgroup was the largest (135 subjects, 44% of the total GIGT subjects). To the best of our knowledge, this is the first report of the insulin sensitivity and secretion index of pregnant Korean women.
As the pathophysiology of GDM is similar to that of type 2 diabetes, we cautiously suggest that our results demonstrate that the insulin secretion and sensitivity capacities of Asian women are different from those of women in Western countries. In the present study, the 1-hour abnormal values group had significantly higher weight gain during pregnancy and higher values in the 50-g OGCT than did the other two groups. In conclusion, the GDM group showed decreased insulin secretion and increased insulin resistance.
This study was supported by a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant no. Division of Endocrinology and Metabolism, Department of Medicine, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, 17 Seoae-ro 1-gil, Jung-gu, Seoul 100-380, Korea. The 100-g oral glucose tolerance test (OGTT) was used to stratify the participants into three groups: NGT (n = 588), GIGT (n = 294), and GDM (n = 281).
In addition, GDM is similar to type 2 diabetes in terms of pathophysiology, in that insulin resistance is the primary factor [6]. In the present study, we examined the differences in the insulin sensitivity and secretion index between women with NGT, gestational impaired glucose tolerance (GIGT), and GDM. This study was approved by the Cheil General Hospital & Women's Healthcare Center Ethics Committee and the Institutional Review Boards at each study site, and written informed consent was obtained from all participants.
Women who had a positive result were followed up with a 3-hour 100-g oral glucose tolerance test (OGTT) according to the criteria outlined by Carpenter and Coustan [9].
Nine women had an abnormal fasting glucose value only, but these subjects were few in number and had heterogeneous metabolic profiles.
Estimated first and second phase insulin values were calculated according to the Stumvoll index, as described previously [14].
Differences between groups were assessed using one-way analysis of variance (ANOVA) or the Kruskal-Wallis test for continuous variables. The 1-hour abnormal values group and the 3-hour abnormal values group had similar numbers of subjects.


The present study shows that GIGT patients already have deteriorated insulin sensitivity and decreased insulin secretion. Since even nonobese Asians were found to exhibit onset of type 2 diabetes at a younger age, insulin secretion appears to be a major factor in the development of type 2 diabetes in Asian populations [21]. Furthermore, the GIGT group already showed I?-cell dysfunction and decreased insulin sensitivity, in contrast to the NGT group.
Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, metabolic complications in newborn and strong predictor of risk for impaired glucose tolerance and transitioning to overt type 2 diabetes postpartum. In previous studies, not only GDM but also gestational impaired glucose tolerance (GIGT) status resulted in perinatal complications. The p values represent overall differences across groups, as determined by ANOVA for continuous variables and Pearson's chi-squared test for categorical variables. The p values represent overall differences across groups as determined by Kruskal-Wallis' H-test for continuous variables.
Among the GIGT subjects, the 1-hour plasma glucose abnormal levels group showed significantly greater weight gain during pregnancy and higher values in the 50-g OGCT than the other two groups.
An increased risk of GDM is associated with obesity, age > 30 years, family history of diabetes, and glucosuria [3]. Therefore, the pathophysiology of GDM is important for understanding type 2 diabetes and assessing its associated risk factors. We also evaluated the clinical and metabolic phenotypes of women with GIGT in relation to the timing of isolated hyperglycemia during gestation.
The study was performed according to the Good Clinical Practice guidelines and the Declaration of Helsinki.
Blood samples were drawn after a 12-hour overnight fast and stored at -80a„? until laboratory analysis.
We also used the quantitative insulin sensitivity check index (QUICKI) to evaluate insulin resistance using the mathematical formula described previously [13]. We also calculated the insulin secretion-sensitivity index (ISSI) for insulin secretion capacity, as described previously [15]. Tukey's multiple comparison test and the Wilcoxon rank-sum test were used for multiple comparisons.
The subjects in the GDM group were on average older than those in the NGT group and they had significantly higher prepregnancy BMI values than the other two groups.
However, the insulin levels were significantly higher in the GIGT group than in the GDM group, except for fasting insulin (Fig. Importantly, the 1-hour abnormal values group showed a significantly higher weight gain during pregnancy, and the values of the 50-g OGCT for this group were higher than those for the other two groups.
In previous studies, not only GDM, but also GIGT status resulted in perinatal complications [16,17]. Both studies reported that women who had a history of GDM showed defects in insulin secretion and activity.
In Asians, the pancreatic I?-cell mass is relatively smaller than in Westerners, and insulin secretion capacity is also lower. Further studies involving more patients and follow-up periods of longer duration are needed to assess the metabolic profiles of GIGT and GDM patients.
Our study also showed that GIGT patients already had deteriorated insulin sensitivity and decreased insulin secretion in Korean women. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus.
Diagnostic criteria for gestational diabetes in Korean women: is new ADA criteria appropriate? Assocation of type 2 diabetes development and obesity in history of gestational diabetes 2001. A population-based study of maternal and perinatal outcome in patients with gestational diabetes.
Differences in insulin sensitivity in pregnant women with overweight and gestational diabetes mellitus. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.
Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.


Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans.
Oral glucose tolerance test indexes for insulin sensitivity and secretion based on various availabilities of sampling times. Measuring insulin sensitivity in postmenopausal women covering a range of glucose tolerance: comparison of indices derived from the oral glucose tolerance test with the euglycemic-hyperinsulinemic clamp. Perinatal outcomes in pregnant women with impaired glucose tolerance (IGT) proven through 100 g oral glucose tolerance test (OGTT). Clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance and gestational diabetes mellitus.
Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes.
Subsequent pregnancy after gestational diabetes mellitus: frequency and risk factors for recurrence in Korean women.
Isolated hyperglycemia at 1 hour on oral glucose tolerance test in pregnancy resembles gestational diabetes mellitus in predicting postpartum metabolic dysfunction.
Mutant p53 reactivation by PRIMA-1MET induces multiple signaling pathways converging on apoptosis.
Urinary calcium and magnesium excretion relates to increase in blood pressure during pregnancy. Moreover, the 1-hour and 2-hour abnormal levels groups had poorer insulin secretion status than the 3-hour abnormal levels group.
Furthermore, the subjects in the GDM group were more likely to have a family history of diabetes, a higher glucose value in the 50-g oral glucose challenge test (OGCT), and increased blood pressure. Although the HOMA-IR values showed differences between the groups by tests, the median values for the 1-hour abnormal values group and 3-hour abnormal values group were the same. These results implicated GIGT as an early, albeit serious, condition that led to neonatal complications and serious perinatal outcomes. However, these studies were conducted after delivery, and few studies have analyzed insulin secretion, resistance, and sensitivity during pregnancy. In addition, abdominal obesity is more common in Asians than in Westerners with similar body weights. However, our study comprised many gestational subjects and few articles describe insulin secretion and resistance in GIGT and gestational diabetes and NGT in Korea.
Fisher's exact test or Pearson's chi-squared test was used to analyze categorical variables. However, the percentage of nulliparous participants was significantly lower in the GDM group.
The 1-hour and 2-hour abnormal values groups showed poorer insulin secretion, according to the decreased HOMA-B, although the first phase insulin values of the 2-hour abnormal values group were higher than those of the other two groups (Table 3). In addition, GIGT has also been proposed as an important risk factor for type 2 diabetes after delivery. These pathophysiologic differences with regard to type 2 diabetes may explain the early onset of impaired glucose tolerance in Asian countries [21]. In 2010, the International Association of Diabetes and Pregnancy Groups proposed a new set of criteria, based on the incidence of adverse perinatal outcomes, as assessed in the Hyperglycemia and Adverse Pregnancy Outcomes study [23,24]. In addition, we intend to study postpartum glucose tolerance status and other perinatal outcomes of insulin sensitivity status to this work. Indeed, the 1-hour abnormal values group had higher weight gain during pregnancy, higher values in the 50-g OGTT, and higher HOMA-IR values than the other groups, and the 1-hour and 2-hour abnormal values groups had lower HOMA-B values than the 3-hour abnormal values group. There are many pathophysiologic similarities between gestational glucose impairment and gestational diabetes. Our findings support the criteria used for the diagnosis of GDM, as we show that the 1-hour and 2-hour abnormal values groups had worsened HOMA-B, and even the 1-hour abnormal values group had a higher HOMA-IR value. However, further studies are warranted to elucidate the factors that aggravate glucose tolerance status in Asians, and more specifically, Koreans.



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Comments

  1. 05.04.2015 at 18:18:14


    The blood sugar behaves in a fasted state) it is necessary to fast severe hypoglycemia that causes results might not.

    Author: SS
  2. 05.04.2015 at 22:51:21


    If you experience any sugar reactions won't happen can be very serious because the person may.

    Author: Odet_Ploxo
  3. 05.04.2015 at 21:29:40


    Until you throw it some sugar in the.

    Author: mulatka_girl