Increased Intramyocellular Lipid Concentration Identifies Impaired Glucose Metabolism in Women With Previous Gestational Diabetes
- Alexandra Kautzky-Willer1,
- Martin Krssak1,
- Christine Winzer1,
- Giovanni Pacini2,
- Andrea Tura2,
- Serdar Farhan1,
- Oswald Wagner3,
- Georg Brabant4,
- Rüdiger Horn4,
- Harald Stingl1,
- Barbara Schneider5,
- Werner Waldhäusl1 and
- Michael Roden1
- 1Department of Internal Medicine III, Division of Endocrinology and Metabolism, University of Vienna, Vienna, Austria
- 2Metabolic Unit, Institute of Biomedical Engineering, National Research Council (ISIB-CNR), Padova, Italy
- 3Institute for Medical Laboratory Diagnostics, University of Vienna, Vienna, Austria
- 4Division of Endocrinology, University of Hannover, Hannover, Germany
- 5Institute of Biostatistics, University of Vienna, Vienna, Austria
Abstract
Women with previous gestational diabetes (pGDM) are frequently insulin-resistant, which could relate to intramyocellular lipid content (IMCL). IMCL were measured with 1H nuclear magnetic resonance spectroscopy in soleus (IMCL-S) and tibialis-anterior muscles (IMCL-T) of 39 pGDM (32 ± 2 years, waist-to-hip ratio 0.81 ± 0.01) and 22 women with normal glucose tolerance (NGT; 31 ± 1 years, 0.76 ± 0.02) at 4–6 months after delivery. Body fat mass (BFM) was assessed from bioimpedance analysis, insulin sensitivity index (SI), and glucose effectiveness (SG) from insulin-modified frequently sampled glucose tolerance tests. pGDM exhibited 45% increased BFM, 35% reduced SI and SG (P < 0.05), and 40% (P < 0.05) and 55% (P < 0.005) higher IMCL-S and IMCL-T, respectively. IMCL related to body fat (BFM P < 0.005, leptin P < 0.03), but only IMCL-T correlated (P < 0.03) with SI and glucose tolerance index independent of BMI. Insulin-resistant pGDM (n = 17) had higher IMCL-S (+66%) and IMCL-T (+86%) than NGT and insulin-sensitive pGDM (+28%). IMCL were also higher (P < 0.005, P = 0.05) in insulin-sensitive pGDM requiring insulin treatment during pregnancy and inversely related to the gestational week of GDM diagnosis. Thus, IMCL-T reflects insulin sensitivity, whereas IMCL-S relates to obesity. IMCL could serve as an additional parameter of increased diabetes risk because it identifies insulin-resistant pGDM and those who were diagnosed earlier and/or required insulin during pregnancy.
Footnotes
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Address correspondence and reprint requests to Michael Roden, MD, Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria. E-mail: michael.roden{at}akh-wien.ac.at.
Received for publication 25 June 2002 and accepted in revised form 16 October 2002.
AIRg 3–10, acute insulin response 3–10 min after glucose ingestion; BFM, body fat mass; BW, body weight; FFM, fat-free mass; GDM, gestational diabetes mellitus; IMCL, intramyocellular lipid content; IMCL-S, IMCL of soleus muscle; IMCL-T, IMCL of tibialis anterior; NGT, normal glucose tolerance; NMRS, nuclear magnetic resonance spectroscopy; OGIS, insulin sensitivity parameter; OGTT, oral glucose tolerance test; pGDM, previous gestational diabetes mellitus; SI, insulin sensitivity index.
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