Abstract
BackgroundHistory of gestational diabetes mellitus (GDM) identifies a very young population of females predisposed for type 2 diabetes and cardiovascular disease. Endothelial dysfunction might represent a shared precursor of both disorders. Hence, this study aimed to characterize endothelial biomarkers in relation to impaired insulin sensitivity and progression to overt diabetes early after index pregnancy.Methods108 women with previous GDM and 40 controls were included three to six months after delivery and underwent specific metabolic assessments including a frequently sampled intravenous glucose tolerance test and an oral glucose tolerance test. Diabetes progression was assessed in females with pGDM over 10 years of follow-up. Circulating sICAM-1 (intracellular-adhesion-molecule-1), sVCAM-1 (vascular-cell-adhesion-molecule-1) and sE-selectin, representing biomarkers of endothelial dysfunction were assessed at baseline and annually over five years.ResultsEndothelial biomarkers were significantly associated with insulin sensitivity (sICAM-1: r = -0.23, p = 0.009; sVCAM-1: r = -0.22, p = 0.011; sE-selectin: r = -0.21, p = 0.018) as well as with GDM status and parameters of subtle inflammation. Analysis of long-term trajectories revealed constantly elevated sICAM-1 (p = 0.033) and sE-selectin (p = 0.007) in 25 subjects with diabetes progression. Accordingly, sE-selectin levels at the early post partum visit predicted a later development of the disease (HR =1.02 95%CI 1.01 to 1.04, p = 0.013), however, this was attenuated after adjustment for BMI.ConclusionsElevated circulating markers of endothelial dysfunction in young females with GDM history might reflect an early stage on the pathway to the manifestation of future cardiometabolic disorders. Timely identification of women at high risk and optimization of follow-up management might provide an opportunity to prevent disease progression.
Highlights
History of gestational diabetes mellitus (GDM) identifies a very young population of females predisposed for type 2 diabetes and cardiovascular disease
Associations of endothelial biomarkers with insulin sensitivity, GDM status and subclinical inflammation at the early postpartum period A brief summary of the study sample in Table 1 shows that biomarkers of endothelial dysfunction at the baseline examination were highest in the pregnancy with GDM (pGDM)-IR subgroup (Figure 1)
This observation was confirmed by analyses of continuous data, as sICAM-1, sVCAM-1, and sE-selectin were inversely related to SIFSIGT 3–6 month after delivery (Table 2)
Summary
History of gestational diabetes mellitus (GDM) identifies a very young population of females predisposed for type 2 diabetes and cardiovascular disease. Females with history of gestational diabetes mellitus (GDM) are of particular interest for studying the relationship between endothelial dysfunction, impaired insulin sensitivity and cardiometabolic disorders, as this high risk entity represents the earliest stage of a prediabetic condition suffering from an increased risk for developing type 2 diabetes [9] and CVD [10,11] In this context, previous observational studies indicated that obesity and impaired glucose metabolism during the pregnant state is associated with markers of endothelial dysfunction [12], which might be apparent in the postpartal period [13,14]. Data on this issue is contradictory [15]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call