1011: Differences in Metabolic Profiles in Asian versus Hispanic Pregnant Women with Gestational and Type 2 Diabetes

Abstract

The purpose of the study is to evaluate the racial differences in metabolic profile in Asian vs. Hispanic pregnant women with gestational diabetes (GDM) and Type 2 diabetes (T2 DM) and its impact on management. We conducted a 2 year retrospective study on all pregnant women who were diagnosed as GDM or T2DM during third trimester of pregnancy. All patients were exogenous insulin naïve at the time of inclusion into the study. T2DM women were referred as GDM and were not treated with insulin. Women with confirmed self-reported race were included. Fasting C-peptide and simultaneous fasting blood sugar were drawn prior to insulin use. Total cholesterol (TC) and high density lipoprotein (HDL) were also drawn on these patients at that time. This study consisted of 127 patients, 70% GDM and 30% T2DM. Welch Two Sample t-test was performed on fasting C-peptide values for Asian versus Hispanic pregnant women p < .000001 and fasting glucose levels p = 0.83. Average C-peptide level for Asian 1.42 ng/mL, SD 0.698, min=0.14, max=2.52; for Hispanic 2.82 ng/mL, SD 1.368, min 0.55, max 8.4 (difference, -1.25, 95% CI -1.65, -0.85). Average fasting glucose values for Asian 79 mg/dl, SD 10.25, min 58, max 99; Hispanic 82 mg/dl, SD 10.81, min 53, max 100. After adjusting for BMI respective to race, the difference in C-peptide values was still found to be significant, p < 0.04. Differences in insulin sensitivity as determined by ISHOMA (C peptide)(Asians: 0.011±0.018, Hispanics: 0.004±0.003) also demonstrated this effect, p < 0.04. 68.9% of Asians required insulin versus 36.7% of Hispanics, the remainder of whom were effectively managed with Insulin sensitizer Metformin monotherapy. HDL and TC were noted to be higher on average for Asian v. Hispanics p = 0.015 and p = 0.037, respectively. Average HDL for Asians 69.14 mg/dL, SD 19.84, min = 29, max = 101; for Hispanics 59.85 mg/dL, SD 16.32, min = 31, max = 117. Average TC for Asians 221.83 mg/dL, SD 51.58, min = 140, max = 347; Hispanics 200.53 mg/dL, SD 42.90, min = 119, max = 279. Pregnant Asian women with glucose intolerance likely have beta cell defects resulting in low fasting insulin levels as measured by fasting C-peptide but higher insulin sensitivity on ISHOMA (C peptide), and a higher HDL and TC profile in contrast to Hispanics who have higher insulin content but lower insulin sensitivity with lower HDL and TC.