Insulin resistance as estimated by the homeostatic method at diagnosis of gestational diabetes: estimation of disease severity and therapeutic needs in a population-based study

Abstract

BackgroundChronic insulin resistance, exacerbated in the course of pregnancy, is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). We hypothesise that the degree of insulin resistance, assessed at diagnosis of GDM, is a parameter of its pathophysiologic heterogeneity and/or severity. Thus, it offers potential to open new avenues for the personalization of therapy in affected women.Methods1254 Polish Caucasian women with GDM were recruited into the study. The following parameters were assessed in the course of the study: body mass index (BMI), parity, weight gain during pregnancy, glycated haemoglobin, glucose level during an oral glucose tolerance test (OGTT), insulin, insulin resistance and insulin secretion. The severity of GDM was assessed based on insulin use and daily insulin dose during gestation. In order to evaluate insulin secretion and insulin resistance the homeostatic method was used (HOMA-B and HOMA-IR, respectively). We compared all the metabolic parameters and methods of treatment of GDM in women subdivided by quartiles of insulin resistance.ResultsThe HOMA-IR in the whole population ranged from 0.34 to 20.39. The BMI, fasting insulin, fasting glucose and insulin dose per day increased along with increasing quartiles (HOMA-IR > 1.29). We observed a decrease of HOMA-B in the third quartile (1.92-2.89) compared with the first quartile (0.34-1.29). Insulin treatment was associated with HOMA-IR (<1.29 vs. >2.89), OR: 3.37, fasting glucose (≤6.11 vs. >6.11 mmol/dl), OR: 2.61, age (≤30 vs. >30 y. o.), OR: 1.54, and BMI (<25 vs. ≥25 kg/m2), OR: 1.45. Maximum insulin dose was associated with HOMA-IR, OR: 2.00, after adjustment for family history of diabetes, and 2-h OGTT glucose.ConclusionInsulin resistance assessed by the HOMA index at diagnosis is associated with the severity and pathophysiological heterogeneity of GDM. A HOMA-IR >1.29 points to the major role of insulin resistance, indicating the need for a treatment aimed at improving tissue sensitivity to insulin. A HOMA-IR 1.29-2.89 suggests reduced insulin secretion, which is an indication for the introduction of insulin therapy. A HOMA-IR >2.89 indicates insufficient compensation for insulin resistance, which suggests the need for a treatment aimed at improving susceptibility of tissues to insulin combined with insulin therapy.

One‐hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance

“…The exact reason for this phenomenon is unclear. However, Sokup et al . reported that 25% of 1,254 Polish Caucasian women with GDM showed a low degree of insulin resistance (HOMA‐IR <1.29), and a HOMA‐IR index value higher than 1.29 is associated with greater pregestational BMI.…”

Impacto do diabetes gestacional nos desfechos neonatais: uma coorte retrospectiva

“…O diagnóstico do DMG é associado com o aumento do risco de complicações tanto para a mãe como para o feto, durante a gestação e, até mesmo, anos após o parto. Esse risco pode ser diminuído com uma dieta apropriada associada à atividade física, possivelmente em combinação com a administração de drogas orais ou insulina [4]. Os desfechos adversos associados ao DMG incluem anomalias fetais, recém-nascidos grandes para a idade gestacional, sofrimento fetal, desequilíbrio no crescimento e outras complicações em longo prazo, incluindo obesidade e danos ao desenvolvimento neuropsicomotor [5].…”

Body Mass Index and Insulin Sensitivity/Resistance: Cross Talks in Gestational Diabetes, Normal Pregnancy and Beyond

“…Several previous studies performed on smaller populations have demonstrated that HOMA-IR index assessed at diagnosis of GDM is ranged from 1.6 to 25 [130,176,251,252]. HOMA-IR values of ≥1.29 at diagnosis may indicate insulin resistance in the studied population of women and are associated with a higher value of the prepregnancy BMI [177]. Maternal obesity-prepregnancy at the time of GDM diagnosis is in connection to enhance insulin resistance.…”

“…The mechanisms leading to increased insulin secretion in pregnancy, primary or compensatory to resistance, are not entirely elucidated yet. They are partly related to metabolic effects of several hormones and cytokines which are elevated in maternal circulation during pregnancy [177]. Decreased insulin sensitivity or increased insulin resistance is defined as the decreased biological response of a nutrient to a given concentration of insulin at the target tissue, e.g., liver, muscle, or adipose tissue.…”