Glucose Metabolism Prognosis and the Recovery of Insulin Resistance in Postpartum Gestational Diabetes Women

Abstract

Objective ①To investigate the glucose metabolism after 3~6 months of delivery in women with gestational diabetes mellitus (GDM), and to find out factors associated with the prognosis of GDM. ②To investigate the insulin level, insulin resistance(IR) and function of pancreatic β cells in 3~6 months postpartum. Methods Clinical data of 82 women with GDM who were delivered in SUN Yat-sen Memorial Hospital from June 2009 to June 2010 were collected. All patients underwent 75 g oral glucose tolerance test(OGTT) in 3~6 months after delivery. They were divided into back to normal group (n=32) and continuous abnormal group (n=50)according to the postnatal status of glucose. Multivariate logistic regression model was used to analyze the factors affected glucose, and explore the insulin level, IR and function of pancreatic β cells. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of SUN Yat-sen Memorial Hospital, SUN Yat-sen University. Informed consent was obtained from all participants. Results Among 82 women with GDM: ① 32(39.02%) were reported with abnormal glucose metabolism, including 26 (31.71%) with impaired glucose tolerance(IGT), 4(4.88%) with diabetes mellitus and 2(2.44%) with impaired fasting glucose(IFG). ② Logistic regression model showed that early diagnosis (OR=0.951, 95%CI: 0.887-0.998), elevated 2nd hour plasma glucose level (OR=1.464, 95%CI: 1.008-2.116) and lower 2nd hour insulin level(OR=0.981, 95%CI: 0.965-0.998) in OGTT were risk factors for postpartum abnormal glucose metabolism.③There were no statistical differences in fasting glucose and fasting insulin levels after delivery(P>0.05), but the glucose and insulin levels after glucose loaded and AUCGlu, AUCINS and (homeostasis model assessment)HOMA-β were lower than those of pregnancy, the differences had statistical significance(P 0.05). ④Compared the back to normal group with the continuous abnormal group, The first and second hour plasma glucose levels and the 2nd hour insulin levels in OGTT were significantly increased in the back to abnormal group, the differences had statistical significance(P<0.05). Conclusions ①Women with GDM are more likely to present with abnormal glucose metabolism and mainly manifest in elevated glucose after glucose loaded.② Early diagnosis, elevated 2nd hour plasma glucose level and lower 2nd hour insulin level in OGTT were risk factors for postpartum abnormal glucose metabolism.③The glucose and insulin release curve was back to normal in women with normal glucose metabolism but in women with abnormal glucose metabolism the curve manifest in peak moved backwards. Key words: diabetes, gestational; follow-up study; insulin resistance; pancreatic β cell function