Christian S Göbl, Latife Bozkurt, Thomas Prikoszovich, Andrea Tura, Giovanni Pacini, Alexandra Kautzky-Willer
Division of Feto-Maternal Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
American journal of physiology. Endocrinology and metabolism 2013 Mar 1Risk stratification after pregnancy with gestational diabetes mellitus (GDM) is based on screening with the 2-h oral glucose tolerance test (OGTT). Actually, prediabetes and diabetes are diagnosed by impaired fasting [fasting plasma glucose (FPG)] and 120 min-postload glucose levels (120'-PLG). We hypothesized that the clinical information could be improved by including measurements at different time points from the OGTT in the medical decision-making process. One hundred ten women with previous gestational diabetes (pGDM) and 41 controls were included 3-6 mo after delivery and underwent specific metabolic assessments: 3-h OGTT, frequently sampled intravenous glucose tolerance test (FSIGT) with markers of inflammation and endothelial function. pGDMs were annually invited for reexaminations for a maximum of 10 yr. Multiple linear regression suggested that postload glucose levels at 60 min (60'-PLG) were a better predictor for insulin sensitivity [β: -0.10, 95% confidence interval (CI) -0.14 to -0.05, P < 0.001] and disposition index (DI) (β: -0.07, 95% CI -0.12 to -0.02, P = 0.004) estimated from the FSIGT compared with other time points during the OGTT. The association between 60'-PLG and insulin secretion was of particular importance in women after GDM. We further identified associations of 60'-PLG with ultrasensitive C-reactive protein, plasminogen activator inhibitor 1, tissue plasminogen activator, endothelial-leukocyte adhesion molecule 1, and intercellular adhesion molecule (ICAM)-1. There appeared to be no interactions between females with pGDM and controls, suggesting comparable effects. We observed that 60'-PLG levels were closely related to the later onset of diabetes independent from the routinely measured FPG and 120'-PLG levels. Our data suggest that the sole interpretation of FPG and 120'-PLG of the OGTT leads to significant loss of information. Particularly 60'-PLG was shown to distinguish women at low or high metabolic and cardiovascular risk.
Christian S Göbl, Latife Bozkurt, Thomas Prikoszovich, Andrea Tura, Giovanni Pacini, Alexandra Kautzky-Willer. Estimating the risk after gestational diabetes mellitus: can we improve the information from the postpartum OGTT? American journal of physiology. Endocrinology and metabolism. 2013 Mar 1;304(5):E524-30
PMID: 23299502
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