Gestational diabetes mellitus and type 2 diabetes: same disease in a different moment of life? Maybe not

Abstract

G estational diabetes mellitus (GDM) is a medical condition that has motivated many debates in the last decades regarding its etiology, pathophysiology, diagnosis, treatment and long-term consequences to the mother and to the fetus.Women who develop GDM present a metabolic condition similar to that found in type 2 diabetes (T2D) characterized by insulin resistance associated with inadequate insulin secretion (1). Due to similar pathophysiologic mechanisms found between T2D and GDM, there is a great interest in finding markers that will lead to the understanding of a possible common origin to both diseases. Women with GDM also present an inflammatory state that, together with insulin resistance can alter placental gene transcription and many features of fetal programming, that can lead to the development of several metabolic diseases later in life such as glucose intolerance, metabolic syndrome and also a high risk of presenting cardiovascular disease. Women with GDM have sevenfold higher risk of having T2D in the future (2).Identifying risk markers for the development of GDM or for poor perinatal outcomes will allow the implementation of precocious preventive or therapeutic interventions. Recently, several biomarkers have been evaluated in order to establish this possible relationship such as cord blood adiponectin, C-reactive protein (CRP), advanced glycation end products (AGEs) and a variety of genetic polymorphisms.Adiponectin exhibits an anti-inflammatory action and may potentially play a protective role in the development of GDM and T2D. Data regarding the relationship between cord blood levels of adiponectin, newborns birth weight and children adiposity are contradictory, with some studies finding a positive correlation (3) and others not showing any correlation (4).In the present issue of the "Archives of Endocrinology and Metabolism" in a study conducted by Aramesh and cols. in Iran, 52 women with GDM and 52 with normal glucose tolerance (NGT) were evaluated regarding fetal anthropometric parameters, cord blood adiponectin and CRP. It was found that adiponectin levels were higher in the presence of GDM and was also associated with higher birth weight and later gestational ages. The levels of CRP were not different between the two groups (5). This finding contrasts with most studies associating low levels of adiponectin and increased levels of CRP with the risk of progression to T2D (6). Also published in this issue of "Archives of Endocrinology and Metabolism", Lobo Jr. and cols. performed a study with 442 Euro-Brazilian women of which 225 had GDM and 217 presented NGT. Their study had the objective of evaluating the use of serum AGEs as a screening tool for GDM (7). It is well known that AGEs concentrations are associated with several diseases including type 1 and type 2 diabetes mainly in the presence of diabetes-related chronic complications (8). It is supposed that

The Pathophysiology of Gestational Diabetes Mellitus

“…It is thought that β-cells deteriorate due to excessive insulin production in response to excess energy consumption and insulin resistance, exhausting the cells over time. The fact that this pathology closely resembles that of T2DM has spurred much debate about whether the two diseases should be considered to be etiologically indistinct [ 24 , 25 ]. As this form of GDM is by far the most common, it will be the focus of this review.…”

The fecal metabolome is associated with gestational diabetes mellitus

“…2,3 Although GDM shares similar symptoms with T2DM, onset only during pregnancy is the exclusive feature of GDM. 4 GDM has attracted intensive studies due to its poor outcomes, however, the pathogenesis of GDM remains incompletely understood. 5 Gut microbiota has been recently correlated with GDM.…”

Pharmacodynamics of Metformin in Pregnant Women With Gestational Diabetes Mellitus and Nonpregnant Women With Type 2 Diabetes Mellitus

“…Metformin is approved by the Food and Drug Administration for treatment of patients with T2DM. There has been discussion in the literature as to whether or not gestational diabetes mellitus and T2DM are the same condition . Both conditions are associated with insulin resistance and decreased pancreatic β‐cell compensation ability …”

“…There has been discussion in the literature as to whether or not gestational diabetes mellitus and T2DM are the same condition. 25 Both conditions are associated with insulin resistance and decreased pancreatic β-cell compensation ability. 6,26 Insulin sensitivity, β-cell responsivity, and disposition index with glyburide have been reported for patients with gestational diabetes mellitus and T2DM.…”