Insulin Sensitivity in the Offspring of Women With Type 1 and Type 2 Diabetes

Abstract

OBJECTIVE -To determine if insulin sensitivity is altered in prepubertal offspring exposed to a diabetic intrauterine environment.RESEARCH DESIGN AND METHODS -Fifteen control children, 17 offspring of type 1 diabetic women, and 10 offspring of type 2 diabetic women, aged between 5 and 10 years, underwent a frequently sampled intravenous glucose tolerance test (FSIGTT). Weight and height were measured, and body composition was calculated using bioelectrical impedance. Bergman's minimal model was applied to the glucose and insulin measurements to obtain values for insulin sensitivity (S i ), acute insulin response (AIR), and glucose effectiveness (S g ). RESULTS-S i was lowest in the offspring of type 2 diabetic mothers, and AIR was highest in this group, although neither of these changes reached significance (S i , P ϭ 0.2, and AIR, P ϭ 0.3). Offspring of type 2 diabetic mothers had higher BMI SD scores (P ϭ 0.004) and percentage fat mass (P ϭ 0.002) than the children in the other two groups. The BMI SD score and percentage fat mass in the subjects, as well as maternal insulin dose, were negatively correlated with offspring insulin sensitivity.CONCLUSIONS -Intrauterine exposure to hyperglycemia by itself was not associated with alterations in glucose regulation in prepubertal offspring. Children of mothers with type 2 diabetes, however, were overweight, and they had a tendency for a reduced S i . The combined effect of genetic and postnatal environmental factors, rather than prenatal exposure to hyperglycemia, may place this group at risk for developing impaired glucose tolerance in later life.

Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort

“…Given the mean age at diagnosis of diabetes in these women (12 years) and the fact that the majority were treated with insulin, we can assume that most of these women had type 1 diabetes. Studies to date that have examined the association of existing maternal type 1 diabetes with future offspring BMI or other markers of adiposity have produced varied results, with some showing greater BMI/adiposity in offspring of such mothers [30,33] and others, like ours, showing no association [34,35]. This variation could be due to small sample sizes in all of these studies, the number of mothers with existing diabetes in each study being 17 [35], 26 (our study), 61 [34], 75 [33] and 160 [30].…”

“…Studies to date that have examined the association of existing maternal type 1 diabetes with future offspring BMI or other markers of adiposity have produced varied results, with some showing greater BMI/adiposity in offspring of such mothers [30,33] and others, like ours, showing no association [34,35]. This variation could be due to small sample sizes in all of these studies, the number of mothers with existing diabetes in each study being 17 [35], 26 (our study), 61 [34], 75 [33] and 160 [30]. In addition to these studies, a recent study demonstrated that the adult offspring of mothers with existing type 1 diabetes during their pregnancy (n=15) had similar mean BMI, waist/hip ratio and total fat mass to offspring whose fathers had type 1 diabetes (n=15) [36].…”

The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis

“…Two additional studies were identified through a search of forward citations [15,48] and four [49][50][51][52] from hand-searching the reference lists of included papers, giving 34 papers in total. Five cohorts were reported in more than one paper, so only the study that reported the outcomes at an age closest to the overall median age of all studies (7 years) was included in the meta-analysis; 10 papers were excluded on this basis [25, 35, 36, 38-40, 42, 47-49].…”

Birth Weight and Parental BMI Predict Overweight in Children From Mothers With Gestational Diabetes

“…Similar to a prior study by Plagemann et al (7), in our GDM offspring cohort, low birth weight was not associated with childhood obesity. The focus of most studies of diabetic pregnancies has been on preexisting type 1 or type 2 diabetes (4,6,18,19), or populations with preexisting and gestational diabetes were combined (20,21,4). Here, we explicitly excluded women with preexisting diabetes because diabetic vascular disorders may cause placental dysfunction and intrauterine growth retardation.…”