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The impact of ethnicity on glucose homeostasis after gestational diabetes mellitus

Ignell, Claes LU orcid ; Shaat, Nael LU orcid ; Ekelund, Magnus LU and Berntorp, Kerstin LU (2012) 48th European Association for the Study of Diabetes Annual Meeting In Diabetologia 55(Suppl 1). p.440-441
Abstract
Background and aims: Ethnicity influences the prevalence of gestational
diabetes (GDM) and its progression to manifest diabetes postpartum, being
higher in non-European populations. This may partly be explained by differences in insulin secretion and action. Aims of the present study were to
evaluate glucose homeostasis after GDM, the impact of ethnicity and other
determinants of glucose tolerance postpartum.
Material and methods: Women in southern Sweden undergoing a 75 g oral
glucose tolerance test (OGTT) during pregnancy in 2003-2005 were invited to follow-up postpartum. Diagnostic criteria were those defined by the
WHO in 1999. At 1-2 years after delivery 470 women with GDM and 166
women with normal... (More)
Background and aims: Ethnicity influences the prevalence of gestational
diabetes (GDM) and its progression to manifest diabetes postpartum, being
higher in non-European populations. This may partly be explained by differences in insulin secretion and action. Aims of the present study were to
evaluate glucose homeostasis after GDM, the impact of ethnicity and other
determinants of glucose tolerance postpartum.
Material and methods: Women in southern Sweden undergoing a 75 g oral
glucose tolerance test (OGTT) during pregnancy in 2003-2005 were invited to follow-up postpartum. Diagnostic criteria were those defined by the
WHO in 1999. At 1-2 years after delivery 470 women with GDM and 166
women with normal glucose tolerance (NGT) during pregnancy performed
an OGTT with measurements of plasma glucose and insulin concentrations
at fasting, 30 min and 120 min. Homeostasis model assessment (HOMA-IR)
was used to estimate insulin resistance. Beta cell function was quantified as
the ratio of the incremental insulin to glucose during the first 30 min of the
OGTT (I/G30). The disposition index was used to adjust insulin secretion for
the degree of insulin resistance ([I/G30)]/HOMA-IR). Women were grouped
according to ethnicity based on stated country of origin in at least three of
their grandparents. Indices were log transformed and differences in means
were tested by ANCOVA, adjusting for age, parity and interval to follow-up
(results given as geometric mean [95% confidence interval (CI)]). Frequency
differences were tested by the Chi-square test. Multivariate logistic regression
analysis was used to assess the association of known predictor variables (age,
BMI, parity, first degree relative(s) with diabetes, non-European origin) with
diabetes postpartum, adjusting for time to follow-up.
Results: Comparing women with previous GDM (n=470) to controls (NGT
during pregnancy and follow-up, n=150), the former had higher HOMA-IR
Diabetologia (2012) 55:[Suppl1]S1–S538 S 441
1 C
(1.5 [1.4-1.7] vs. 1.3 [1.2-1.5], p=0.020) and lower disposition index (8.4 [7.7-
9.2] vs. 12.8 [10.8-15.2], p<0.001). These differences were more pronounced
in women with GDM who had diabetes postpartum (HOMA-IR 3.1 [2.2-4.4],
disposition index 2.6 [1.9-3.7]) compared to controls (p<0.001), while those
who stayed normoglycaemic had similar HOMA-IR as controls but lower disposition index (9.6 [8.7-10.6], p<0.001). Among women with GDM, estimates
of beta cell function did not differ between non-European (n=94) and European women (n=362), whereas non-European women were more insulin resistant (HOMA-IR 2.0 [1.7-2.3] vs. 1.5 [1.3-1.6], p=0.002, after adjustment for
BMI p=0.015). Similarly, Arabic women (n=41) had higher HOMA-IR (2.1
[1.6-2.7]) than European women (p=0.006), but insignificant after adjustment for BMI. Non-European origin was associated with higher frequency of
diabetes at follow-up (16%) than was European origin (4%, p<0.001). Of the
predictor variables tested for an association with diabetes after GDM, BMI
and non-European origin showed the highest associations; odds ratio (95%
CI), 1.1 (1.1-1.2), p<0.001, and 5.3 (1.9-14.9), p=0.002, respectively.
Conclusions: Women with a history of GDM display abnormalities in glucose homeostasis, also in the presence of NGT postpartum, including beta
cell dysfunction and insulin resistance. These derangements may be influenced by ethnicity and BMI. (Less)
Abstract (Swedish)
Background and aims: Ethnicity influences the prevalence of gestational diabetes (GDM) and its progression to manifest diabetes postpartum, being higher in non-European populations. This may partly be explained by differences in insulin secretion and action. Aims of the present study were to evaluate glucose homeostasis after GDM, the impact of ethnicity and other determinants of glucose tolerance postpartum.
Material and methods: Women in southern Sweden undergoing a 75 g oral glucose tolerance test (OGTT) during pregnancy in 2003-2005 were invited to follow-up postpartum. Diagnostic criteria were those defined by the WHO in 1999. At 12 years after delivery 470 women with GDM and 166 women with normal glucose tolerance (NGT) during... (More)
Background and aims: Ethnicity influences the prevalence of gestational diabetes (GDM) and its progression to manifest diabetes postpartum, being higher in non-European populations. This may partly be explained by differences in insulin secretion and action. Aims of the present study were to evaluate glucose homeostasis after GDM, the impact of ethnicity and other determinants of glucose tolerance postpartum.
Material and methods: Women in southern Sweden undergoing a 75 g oral glucose tolerance test (OGTT) during pregnancy in 2003-2005 were invited to follow-up postpartum. Diagnostic criteria were those defined by the WHO in 1999. At 12 years after delivery 470 women with GDM and 166 women with normal glucose tolerance (NGT) during pregnancy performed an OGTT with measurements of plasma glucose and insulin concentrations at fasting, 30 min and 120 min. Homeostasis model assessment (HOMA-IR) was used to estimate insulin resistance. Beta cell function was quantified as the ratio of the incremental insulin to glucose during the first 30 min of the OGTT (I/G30). The disposition index was used to adjust insulin secretion for the degree of insulin resistance ([I/G30)]/HOMA-IR). Women were grouped according to ethnicity based on stated country of origin in at least three of their grandparents. Indices were log transformed and differences in means were tested by ANCOVA, adjusting for age, parity and interval to follow-up (results given as geometric mean [95% confidence interval (CI)]). Frequency differences were tested by the Chi-square test. Multivariate logistic regression analysis was used to assess the association of known predictor variables (age, BMI, parity, first degree relative(s) with diabetes, non-European origin) with diabetes postpartum, adjusting for time to follow-up.
Results: Comparing women with previous GDM (n=470) to controls (NGT during pregnancy and follow-up, n=150), the former had higher HOMA-IR (1.5 [1.41.7] vs. 1.3 [1.21.5], p=0.020) and lower disposition index (8.4 [7.79.2] vs. 12.8 [10.815.2], p<0.001). These differences were more pronounced in women with GDM who had diabetes postpartum (HOMA-IR 3.1 [2.24.4], disposition index 2.6 [1.93.7]) compared to controls (p<0.001), while those who stayed normoglycaemic had similar HOMA-IR as controls but lower disposition index (9.6 [8.710.6], p<0.001). Among women with GDM, estimates of beta cell function did not differ between non-European (n=94) and European women (n=362), whereas non-European women were more insulin resistant (HOMA-IR 2.0 [1.72.3] vs. 1.5 [1.31.6], p=0.002, after adjustment for BMI p=0.015). Similarly, Arabic women (n=41) had higher HOMA-IR (2.1 [1.62.7]) than European women (p=0.006), but insignificant after adjustment for BMI. Non-European origin was associated with higher frequency of diabetes at follow-up (16%) than was European origin (4%, p<0.001). Of the predictor variables tested for an association with diabetes after GDM, BMI and non-European origin showed the highest associations; odds ratio (95% CI), 1.1 (1.11.2), p<0.001, and 5.3 (1.914.9), p=0.002, respectively.
Conclusions: Women with a history of GDM display abnormalities in glucose homeostasis, also in the presence of NGT postpartum, including beta cell dysfunction and insulin resistance. These derangements may be influenced by ethnicity and BMI. (Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetologia
volume
55
issue
Suppl 1
article number
1074
pages
440 - 441
publisher
Springer
conference name
48th European Association for the Study of Diabetes Annual Meeting
conference location
Berlin, Germany
conference dates
2012-10-01 - 2012-10-05
ISSN
1432-0428
DOI
10.1007/s00125-012-2688-9
language
English
LU publication?
yes
id
7373fa16-390a-49de-87ed-a75201232667
date added to LUP
2019-06-20 08:52:14
date last changed
2023-04-18 17:16:13
@misc{7373fa16-390a-49de-87ed-a75201232667,
  abstract     = {{Background and aims: Ethnicity influences the prevalence of gestational<br/>diabetes (GDM) and its progression to manifest diabetes postpartum, being<br/>higher in non-European populations. This may partly be explained by differences in insulin secretion and action. Aims of the present study were to<br/>evaluate glucose homeostasis after GDM, the impact of ethnicity and other<br/>determinants of glucose tolerance postpartum.<br/>Material and methods: Women in southern Sweden undergoing a 75 g oral<br/>glucose tolerance test (OGTT) during pregnancy in 2003-2005 were invited to follow-up postpartum. Diagnostic criteria were those defined by the<br/>WHO in 1999. At 1-2 years after delivery 470 women with GDM and 166<br/>women with normal glucose tolerance (NGT) during pregnancy performed<br/>an OGTT with measurements of plasma glucose and insulin concentrations<br/>at fasting, 30 min and 120 min. Homeostasis model assessment (HOMA-IR)<br/>was used to estimate insulin resistance. Beta cell function was quantified as<br/>the ratio of the incremental insulin to glucose during the first 30 min of the<br/>OGTT (I/G30). The disposition index was used to adjust insulin secretion for<br/>the degree of insulin resistance ([I/G30)]/HOMA-IR). Women were grouped<br/>according to ethnicity based on stated country of origin in at least three of<br/>their grandparents. Indices were log transformed and differences in means<br/>were tested by ANCOVA, adjusting for age, parity and interval to follow-up<br/>(results given as geometric mean [95% confidence interval (CI)]). Frequency<br/>differences were tested by the Chi-square test. Multivariate logistic regression<br/>analysis was used to assess the association of known predictor variables (age,<br/>BMI, parity, first degree relative(s) with diabetes, non-European origin) with<br/>diabetes postpartum, adjusting for time to follow-up.<br/>Results: Comparing women with previous GDM (n=470) to controls (NGT<br/>during pregnancy and follow-up, n=150), the former had higher HOMA-IR <br/>Diabetologia (2012) 55:[Suppl1]S1–S538 S 441<br/>1 C<br/>(1.5 [1.4-1.7] vs. 1.3 [1.2-1.5], p=0.020) and lower disposition index (8.4 [7.7-<br/>9.2] vs. 12.8 [10.8-15.2], p&lt;0.001). These differences were more pronounced<br/>in women with GDM who had diabetes postpartum (HOMA-IR 3.1 [2.2-4.4],<br/>disposition index 2.6 [1.9-3.7]) compared to controls (p&lt;0.001), while those<br/>who stayed normoglycaemic had similar HOMA-IR as controls but lower disposition index (9.6 [8.7-10.6], p&lt;0.001). Among women with GDM, estimates<br/>of beta cell function did not differ between non-European (n=94) and European women (n=362), whereas non-European women were more insulin resistant (HOMA-IR 2.0 [1.7-2.3] vs. 1.5 [1.3-1.6], p=0.002, after adjustment for<br/>BMI p=0.015). Similarly, Arabic women (n=41) had higher HOMA-IR (2.1<br/>[1.6-2.7]) than European women (p=0.006), but insignificant after adjustment for BMI. Non-European origin was associated with higher frequency of<br/>diabetes at follow-up (16%) than was European origin (4%, p&lt;0.001). Of the<br/>predictor variables tested for an association with diabetes after GDM, BMI<br/>and non-European origin showed the highest associations; odds ratio (95%<br/>CI), 1.1 (1.1-1.2), p&lt;0.001, and 5.3 (1.9-14.9), p=0.002, respectively.<br/>Conclusions: Women with a history of GDM display abnormalities in glucose homeostasis, also in the presence of NGT postpartum, including beta<br/>cell dysfunction and insulin resistance. These derangements may be influenced by ethnicity and BMI.}},
  author       = {{Ignell, Claes and Shaat, Nael and Ekelund, Magnus and Berntorp, Kerstin}},
  issn         = {{1432-0428}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  number       = {{Suppl 1}},
  pages        = {{440--441}},
  publisher    = {{Springer}},
  series       = {{Diabetologia}},
  title        = {{The impact of ethnicity on glucose homeostasis after gestational diabetes mellitus}},
  url          = {{http://dx.doi.org/10.1007/s00125-012-2688-9}},
  doi          = {{10.1007/s00125-012-2688-9}},
  volume       = {{55}},
  year         = {{2012}},
}