Detailed Physiological Characterization of the Development of Type 2 Diabetes in Hispanic Women With Prior Gestational Diabetes Mellitus

  1. Thomas A. Buchanan3,5
  1. 1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California;
  2. 2Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group, Pasadena, California;
  3. 3Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California;
  4. 4Harbor–University of California, Los Angeles Medical Center, Torrance, California;
  5. 5Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
  1. Corresponding author: Anny H. Xiang, anny.h.xiang{at}kp.org.

Abstract

OBJECTIVE To identify physiological and clinical variables associated with development of type 2 diabetes up to 12 years after pregnancies complicated by gestational diabetes.

RESEARCH DESIGN AND METHODS Seventy-two islet cell antibody–negative nondiabetic Hispanic women had oral (oGTT) and intravenous (ivGTT) glucose tolerance tests, glucose clamps, and body composition assessed between 15 and 30 months after pregnancies complicated by gestational diabetes mellitus (GDM). They returned for oGTTs at 15-month intervals until they dropped out, developed diabetes, or reached 12 years postpartum. Cox regression analysis was used to identify baseline predictors and changes during follow-up that were associated with development of type 2 diabetes.

RESULTS At baseline, relatively low insulin sensitivity, insulin response, and β-cell compensation for insulin resistance were independently associated with development of diabetes. During follow-up, weight and fat gain and rates of decline in β-cell compensation were significantly associated with diabetes, while additional pregnancy and use of progestin-only contraception were marginally associated with diabetes risk.

CONCLUSIONS In Hispanic women, GDM represents detection of a chronic disease process characterized by falling β-cell compensation for chronic insulin resistance. Women who are farthest along at diagnosis and/or deteriorating most rapidly are most likely to develop type 2 diabetes within 12 years after the index pregnancy. Weight gain, additional pregnancy, and progestin-only contraception are potential modifiable factors that increase diabetes risk.

Footnotes

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  • Received April 12, 2010.
  • Accepted July 12, 2010.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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  1. Diabetes vol. 59 no. 10 2625-2630
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