Body mass index correlates positively with insulin resistance and secretion but inversely with insulin sensitivity in gestational diabetes
, 1, 2, 3, 14, 14, 1
Abstract
Background. To assess fasting C-peptide and insulin
indices using homeostatic model assessment (HOMA)
in gestational diabetes mellitus (GDM).
Methods. Gestational diabetes mellitus (n = 64, age:
27.02 ± 0.53 years, BMI: 26.3 ± 0.5 kg/m2; mean ±
SEM) and normal glucose tolerance NGT (n = 56, age:
26.11 ± 0.55 years, BMI: 24.4 ± 0.4 kg/m2; mean ±
SEM) screened according to WHO 2013 criteria. Glucose
was measured by oxidase method whereas fasting
insulin and C-peptide by ELISA. HOMA-IR, HOMA-B and
HOMA-%S were calculated.
Results. C-peptide was found higher in GDM compared
to NGT without any significant difference (P = 0.465).
Fasting insulin (P = 0.063) and HOMA-IR (P < 0.001)
were significantly higher while HOMA-B (P = 0.015)
and HOMA-%S (P = 0.012) were significantly lower in
GDM than those of NGT. BMI, bad obstetric history,
multiparity and blood glucose were higher (P ≤ 0.05)
in GDM while age, duration of gestation, family history
of DM did not differ (P = NS). C-peptide (0.185 ± 0.06
vs 0.331 ± 0.44; P < 0.05), fasting insulin (4.88 ± 0.74
vs 10.37 ± 0.74; P < 0.01) and HOMA-IR (1.04 ± 0.14 vs
2.48 ± 0.18; P < 0.011) as well as HOMA-B were found
lower in GDM having BMI < 23 kg/m2 than those of
GDM with BMI ≥ 23. Conversely, HOMA-%S (115.52 ±
14.63 vs 50.62 ± 3.39; P < 0.011) was higher in the
subgroup with BMI < 23 than the rest. Fasting blood
glucose (FBG) (P < 0.01) and fasting insulin (P < 0.05)
were independent predictors for GDM.
Conclusions. Fasting C-peptide did not differ between
GDM and NGT. BMI was positively related with resistance
and secretion of insulin but inversely with sensitivity.
HOMA model analyses revealed decreased insulin
sensitivity and secretory capacity in GDM than NGT.
Keywords: GDMInsulinC-peptideHOMA IRHOMA B & HOMA-%S
References
- Retnakaran R, Ye C, Kramer CK, et al. Evaluation of circulating determinants of beta-cell function in women with and without gestational diabetes. J Clin Endocrinol Metab. 2016; 101(7): 2683–2691.
- Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations With Neonatal Anthropometrics. Diabetes. 2008; 58(2): 453–459.
- Ferrara A, Ehrlich SF. Strategies for diabetes prevention before and after pregnancy in women with GDM. Curr Diabetes Rev. 2011; 7(2): 75–83.
- Catalano PM, Drago NM, Amini SB. Longitudinal changes in pancreatic beta-cell function and metabolic clearance rate of insulin in pregnant women with normal and abnormal glucose tolerance. Diabetes Care. 1998; 21(3): 403–408.
- Kautzky-Willer A, Prager R, Waldhausl W, et al. Pronounced insulin resistance and inadequate beta-cell secretion characterize lean gestational diabetes during and after pregnancy. Diabetes Care. 1997; 20(11): 1717–1723.
- Ryan EA, O'Sullivan MJ, Skyler JS. Insulin action during pregnancy. Studies with the euglycemic clamp technique. Diabetes. 1985; 34(4): 380–389.
- Shimoyama R, Ray TK, Savage CR, et al. In vivo and in vitro effects of antiinsulin receptor antibodies. J Clin Endocrinol Metab. 1984; 59(5): 916–923.
- Yang SJ, Kim TN, Baik SH, et al. Insulin secretion and insulin resistance in Korean women with gestational diabetes mellitus and impaired glucose tolerance. Korean J Intern Med. 2013; 28(3): 306–313.
- Catalano PM, Huston L, Amini SB, et al. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol. 1999; 180(4): 903–916.
- Mørkrid K, Jenum AK, Sletner L, et al. Failure to increase insulin secretory capacity during pregnancy-induced insulin resistance is associated with ethnicity and gestational diabetes. Eur J Endocrinol. 2012; 167(4): 579–588.
- Jones AG, Hattersley AT. The clinical utility of C-peptide measurement in the care of patients with diabetes. Diabet Med. 2013; 30(7): 803–817.
- Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7): 412–419.
- WHO | Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. WHO 2013.
- Homko C, Sivan E, Chen X, et al. Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. J Clin Endocrinol Metab. 2001; 86(2): 568–573.
- MA H. TCF7L2 gene rs7903146 polymorphism may confer expression of gestational diabetes mellitus in relatively young and lean mothers. Diabetes & Obesity International Journal. 2016; 1(6).
- Genova M, Todorova-Ananieva K, Tzatchev K. Impact of body mass index on insulin sensitivity/ resistance in pregnant women with and without gestational diabetes mellitus. vol XL, 2013.
- Fakhrul-Alam M, Rakibul-Hasan M, Farid-Uddin M, et al. Insulin secretory defect may be the major determinant of GDM in lean mothers. J Clin Transl Endocrinol. 2020; 20: 100226.
- Sokup A, Ruszkowska-Ciastek B, Góralczyk K, et al. 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. BMC Endocr Disord. 2013; 13: 21.
- Wei J, Gao J, Cheng J. Gestational diabetes mellitus and impaired glucose tolerance pregnant women. Pak J Med Sci. 2014; 30(6): 1203–1208.
- Genova MP, Todorova-Ananieva K, Atanasova B, et al. Assessment of beta-cell function during pregnancy and after delivery. Acta Medica Bulgarica. 2014; 41(1): 5–12.