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Kerstin Berntorp

Kerstin Berntorp

Adjunct professor

Kerstin Berntorp

The impact of ethnicity on glucose homeostasis after gestational diabetes mellitus

Author

  • Claes Ignell
  • Nael Shaat
  • Magnus Ekelund
  • Kerstin Berntorp

Summary, in English

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.

Department/s

  • Genomics, Diabetes and Endocrinology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Department of Clinical Sciences, Malmö

Publishing year

2012

Language

English

Pages

440-441

Publication/Series

Diabetologia

Volume

55

Issue

Suppl 1

Document type

Conference paper: abstract

Publisher

Springer

Topic

  • Endocrinology and Diabetes

Conference name

48th European Association for the Study of Diabetes Annual Meeting

Conference date

2012-10-01 - 2012-10-05

Conference place

Berlin, Germany

Status

Published

Research group

  • Genomics, Diabetes and Endocrinology

ISBN/ISSN/Other

  • ISSN: 1432-0428