Gestational Diabetes: Should It Be Added to the Syndrome of Insulin Resistance?

Clark, Charles M.; Qiu, Chunfu; Amerman, Barbara; Porter, Beverly D.; Fineberg, Naomi S.; Aldasouqi, Saleh; Golichowski, Alan M.

doi:10.2337/diacare.20.5.867

Cited by 100 publications

(64 citation statements)

References 10 publications

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“…Although gestational diabetes shares many features of the insulin resistance syndrome [49], no change was observed in plasma leptin following oral glucose loading despite increased insulin secretion in this study as well as by others [50,51]. Noteworthy is the impaired stimulated insulin secretion for prevailing insulin sensitivity despite post-prandial hyperglycaemia compared to normal glucose tolerance.…”

Section: Discussionmentioning

confidence: 41%

Increased plasma leptin in gestational diabetes

Kautzky‐Willer

Pacini²,

Tura³

et al. 2001

Diabetologia

171

127

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Leptin, a polypeptide hormone originating from adipocytes, contributes to body weight control and provides negative feedback between adipose tissue and the hypothalamic satiety centre. In animal models, leptin decreases food intake but increases energy expenditure and body temperature [1±3]. Furthermore, it is found to be higher in women than in men [4] and to influence the reproductive function [5]. In humans plasma leptin is highly correlated with body fat Diabetologia (2001) Abstract Aims/hypothesis. Insulin resistance as well as marked changes in body weight and energy metabolism are associated with pregnancy. Its impact on plasma leptin is not known and was determined in this longitudinal study in both diabetic and normal pregnancy. Methods. At 28 gestational weeks plasma concentrations of leptin and B-cell hormones were measured at fasting and after an oral glucose load (OGTT:75 g) in women with gestational diabetes and pregnant women with normal glucose tolerance and compared with women who were not pregnant (C).Results. Plasma leptin (ng/ml) was higher (p < 0.001) in women with gestational diabetes (24.9 1.6) than in women with normal glucose tolerance (18.2 1.5) and increased in both groups when compared with the non-pregnant women (8.2 1.3; p < 0.0005). No change in plasma leptin concentrations was induced by OGTT in any group. Basal insulin release was higher (p < 0.05) in women with gestational diabetes compared with the pregnant women with normal glucose tolerance. Marked insulin resistance was confirmed by a 20 % lower (p < 0.05) insulin sensitivity in subgroup analysis and a decrease of almost 40 % in fasting glucose/insulin ratio (p < 0.005) in women with gestational diabetes. Leptin correlated in women with gestational diabetes with basal plasma concentrations of glucose (p < 0.02), insulin (p < 0.004) and proinsulin (p < 0.01) as well as with BMI (p < 0.001) and overall pregnancy induced maternal weight gain (p < 0.009). With normalisation of blood glucose 8 weeks after delivery in women with gestational diabetes their plasma leptin decreased (p < 0.0005) to 17.3 1.9 ng/ml but did not completely normalize (p < 0.05 vs non-pregnant women). Conclusion/interpretation. Our data show that women with gestational diabetes without any change in plasma leptin upon oral glucose loading have increased plasma leptin concentrations during and after pregnancy, a clear association of plasma leptin with the respective concentration of glucose and insulin resistance as well as with changes in body weight, and a failure to normalize spontaneously BMI to the same extent as pregnant women with normal glucose tolerance when compared with matched control subjects. [Diabetologia (2001) 44: 164±172]

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Section: Discussionmentioning

confidence: 41%

Increased plasma leptin in gestational diabetes

Kautzky‐Willer

Pacini²,

Tura³

et al. 2001

Diabetologia

171

127

View full text Add to dashboard Cite

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“…In this context, it is possible that increased insulin sensitivity prior to pregnancy may enable better maintenance of insulin sensitivity in late pregnancy, thereby allowing for appropriate beta-cell compensation and the maintenance of normoglycemia. Such an effect may be particularly important in women at risk of GDM, since this patient population exhibits chronic insulin resistance that is believed to pre-date pregnancy (31,32). Indeed, as increased insulin resistance in 1 st trimester (which largely reflects the pre-gravid state) predicts a higher risk of developing GDM later in pregnancy (33,34), it is plausible that improving insulin sensitivity prior to pregnancy would reduce GDM risk.…”

Section: Discussionmentioning

confidence: 99%

Pre‐gravid physical activity and reduced risk of glucose intolerance in pregnancy: the role of insulin sensitivity

Retnakaran

Sermer

et al. 2009

Clinical Endocrinology

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Objective-Pre-gravid physical activity has been associated with a reduced risk of gestational diabetes mellitus (GDM), although neither the types of exercise nor the physiologic mechanisms underlying this protective effect have been well studied. Thus, we sought to study the relationships between types of pre-gravid physical activity and metabolic parameters in pregnancy, including glucose tolerance, insulin sensitivity and beta-cell function.Design/Patients/Measurements-851 women underwent a glucose challenge test (GCT) and a 3-hr oral glucose tolerance test (OGTT) in late pregnancy, yielding 4 glucose tolerance groups: (i) GDM; (ii) gestational impaired glucose tolerance (GIGT); (iii) abnormal GCT with normal glucose tolerance on OGTT (abnormal GCT NGT); and (iv) normal GCT with NGT on OGTT (normal GCT NGT). Pre-gravid physical activity was assessed using the Baecke questionnaire, which measures (i) total physical activity and (ii) its 3 component domains: work, non-sport leisure-time, and vigorous/sports activity.Results-Glucose tolerance status improved across increasing quartiles of pre-gravid total physical activity (p=0.0244). Whereas neither work nor non-sport leisure-time activity differed between glucose tolerance groups, pre-gravid vigorous/sports activity was significantly higher in women with normal GCT NGT compared to women with (i) abnormal GCT NGT (p=0.0018), (ii) GIGT (p=0.0025), and (iii) GDM (p=0.0044). In particular, vigorous/sports activity correlated with insulin sensitivity (measured by IS OGTT ) (r=0.21,p<0.0001). Furthermore, on multiple linear regression analysis, pre-gravid vigorous/sports activity emerged as a significant independent predictor of IS OGTT in pregnancy (t=4.97,p<0.0001). CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusions-Pre-gravid vigorous/sports activity is associated with a reduced risk of glucose intolerance in pregnancy, an effect likely mediated by enhanced insulin sensitivity.

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“…Indeed, GDM has even been proposed to be a component of the metabolic syndrome (Clark et al 1997). In their study, Clark et al (1997) showed that, at the time of their antepartum OGTT, women with GDM expressed markers of the metabolic syndrome, including low serum HDL cholesterol and higher fasting plasma insulin, triglycerides, free fatty acids and pre-pregnancy BMI. These common features of the metabolic syndrome were each individually predictive of GDM, and persisted after adjustment for differences in BMI (Clark et al, 1997).…”

Section: Prediction Of Gdm By Metabolic Syndrome Components In Early mentioning

confidence: 99%

“…In their study, Clark et al (1997) showed that, at the time of their antepartum OGTT, women with GDM expressed markers of the metabolic syndrome, including low serum HDL cholesterol and higher fasting plasma insulin, triglycerides, free fatty acids and pre-pregnancy BMI. These common features of the metabolic syndrome were each individually predictive of GDM, and persisted after adjustment for differences in BMI (Clark et al, 1997). In addition to conventional measures of metabolic syndrome, several non-traditional biomarkers have also emerged as possible predictors of GDM.…”

Section: Prediction Of Gdm By Metabolic Syndrome Components In Early mentioning

confidence: 99%