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Assessment of insulin resistance and insulin secretion function of patients with gestational diabetes mellitus

WANG Feng-huan, LI Hua-ping   

  1. Department of Gynecology and Obstetrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2015-03-28 Published:2015-03-26
  • Supported by:

    Foundation of Science and Technology Commission of Shanghai Municipality,12ZR1422200; Science and Technology Foundation of Shanghai Jiao Tong University School of Medicine, 11XJ21059

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Abstract:

Objective To explore the insulin resistance and variations of the secretory function of pancreas β-cells of women with gestational diabetes mellitus (GDM). Methods A total of 1 825 pregnant women who underwent prenatal examinations and 75 g oral glucose tolerance test (OGTT) during 24-28 weeks of gestation were selected. Indicators relevant to the insulin resistance and secretory function of pancreatic β-cells were detected. Results According to the results of 75 g OGTT, pregnant women were divided into the normal glucose tolerance (NGT) group (n=1 291) and GDM group (n=534). Patients of the GDM group were further divided into the GDM1 group (n=322), GDM2 group (n=160), and GDM3 (n=52) group according to the severity of disease. The blood glucose level of the NGT group reached the peak 0.5-1 h after the 75 g OGTT and the blood glucose level of the GDM group reached the peak 1 h after the 75 g OGTT. The blood glucose level of the GDM group at each time point was higher than that of the NGT group and the blood glucose level of the GDM group increased with the severity of disease (P<0.05). The insulin level of the NGT group reached the peak 1 h after the 75 g OGTT. The insulin level of the GDM group reached the peak 2 h after the 75 g OGTT and was significantly higher than that of other time points. The insulin level of the GDM group increased with the severity of disease (P<0.05). Compared with the NGT group, HOMA-IR, AUCG after glucose load, and AUCI after glucose load of the GDM group were significantly higher and gradually increased with the severity of disease (P<0.05); ISIcomp was lower (P<0.05); function index of pancreas β-cells (HOMA-β), ratio of net increase of insulin to net increase of glucose 30 min after glucose load (ΔI30/ΔG30), and modified beta-cell function index (MBCI) decreased. The differences were statistically significant (P<0.05). Stumvoll 1 phase and 2 phase insulin secretion indexes of the GDM group were lower than those of the NGT group and gradually decreased with the severity of disease. Conclusion The insulin resistant of pregnant women with GDM is severe and early phase insulin secretion is impaired, which are relevant to the severity of disease.

Key words: gestational diabetes mellitus, insulin, insulin resistance, pancreatic β-cell function