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Insulin secretion and insulin resistance in Korean women with gestational diabetes mellitus and impaired glucose tolerance

Korean Journal of Internal Medicine 2013년 28권 3호 p.306 ~ p.313

양세정(Yang Sae-Jeong) - Korea University College of Medicine Department of Internal Medicine
김태년(Kim Tae-Nyun) - Inje University Haeundae Paik Hospital Department of Internal Medicine
백세현(Baik Sei-Hyun) - Korea University College of Medicine Department of Internal Medicine
김태순(Kim Tae-Sun) - Kwandong University College of Medicine Cheil General Hospital & Women’s Healthcare Center Department of Medicine
이관우(Lee Kwan-Woo) - Ajou University School of Medicine Department of Endocrinology and Metabolism
남문석(Nam Moon-Suk) - Inha University School of Medicine Department of Internal Medicine
박용수(Park Yong-Soo) - Hanyang University College of Medicine Department of Internal Medicine
(Woo Jeong-Teak) - Kyung Hee University School of Medicine Department of Endocrinology and Metabolism
김영설(Kim Young-Seol) - Kyung Hee University School of Medicine Department of Endocrinology and Metabolism
김성훈(Kim Sung-Hoon) - Kwandong University College of Medicine Cheil General Hospital & Women’s Healthcare Center Department of Medicine

Abstract

Background/Aims: The aim was to compare the insulin sensitivity and secretion index of pregnant Korean women with normal glucose tolerance (NGT), gestational impaired glucose tolerance (GIGT; only one abnormal value according to the Carpenter and Coustan criteria), and gestational diabetes mellitus (GDM).

Methods: A cross-sectional study was performed with 1,163 pregnant women with positive (1-hour plasma glucose ≥ 7.2 mmol/L) in a 50-g oral glucose challenge test (OGCT). The 100-g oral glucose tolerance test (OGTT) was used to stratify the participants into three groups: NGT (n = 588), GIGT (n = 294), and GDM (n = 281).

Results: The GDM group had higher homeostasis model assessment of insulin resistance and lower insulin sensitivity index (ISOGTT), quantitative insulin sensitivity check index, homeostasis model assessment for estimation of index β-cell secretion (HOMA-B), first and second phase insulin secretion, and insulin secretion-sensitivity index (ISSI) than the NGT group (p ≤ 0.001 for all). Moreover, the GIGT group had lower ISOGTT, HOMA-B, first and second phase insulin secretion, and ISSI than the NGT group (p < 0.001 for all). Among the GIGT subjects, the 1-hour plasma glucose abnormal levels group showed significantly greater weight gain during pregnancy and higher values in the 50-g OGCT than the other two groups. Moreover, the 1-hour and 2-hour abnormal levels groups had poorer insulin secretion status than the 3-hour abnormal levels group.

Conclusions: Korean women with GDM show impairments of both insulin secretion and insulin sensitivity. In addition, GIGT is associated with both β-cell dysfunction and insulin resistance.