Gestasyonel diabeti olan ve olmayan gebe kadınlarda serum leptin konsantrasyonlarıyla vücut yağ oranı değerlerinin kıyaslanması ve insülin direnci ile insülin duyarlılığı ile ilişkisi

Amaç: Gestasyonel diabet ile obesite gebelikte sık görülen metabolik bozukluklar arasında yer almaktadır. Leptin başlıca yağ dokusu hücreleri tarafından üretilerek dolaşıma salınan bir peptiddir. Leptin’in karbonhidrat metabolizması ve insülin direnci üzerine tanımlanmiş birçok etkileri bildirilmiştir; ancak gestasyonel diabet ile arasındaki ilişkiye ait veriler kısıtlıdır. Bundan ötürü bu çalışmada sağlıklı ve gestasyonel diabetli gebelerdeki vücut yağ yüzdesi, serum insülin ve leptin düzeylerinin kıyaslanarak gestasyonel diabet üzerine olası etkilerinin değerlendirilmesi amaçlanmıştır. Yöntem: Bu çalışmada 26 ile 36. gebelik haftaları arasındaki 49 gestasyonel diabetli ve 37 sağlıklı gebe incelendi. Vücut kitle indeksi ve cilt kıvrım kalınlıkları ölçüldü. Vücut yağ yüzdesi Siri formülüyle hesaplandı. Serum açlık glukoz, insülin ve leptin seviyeleri ölçüldü. İnsülin duyarlılığının değerlendirilmesinde QUICKI-IS, insülin direncinin değerlendirilmesinde ise HOMA-IR indeksleri kullanıldı. Bulgular: Gebelik haftası, yaş ve vücut kitle indeksi bakımından her iki grup arasında anlamlı fark bulunmadı (p>0.05). Gestasyonel diabetli gebelerde Vücut yağ yüzdesi (p=0.007), serum insülin (p=0.004) , leptin düzeyleri (p=0.044) ve HOMA–IR (p<0.001) sağlıklı gebelere kıyasla daha yüksek saptanırken; QUICKI-IS ise anlamlı derecede düşük bulundu (p<0.001). Korelasyon analizinde vücut yağ oranı ile serum leptin (p<0.001), insülin (p=0.04) ve HOMA-IR arasında (p=0.04) anlamlı pozitif korelasyon; QUICKI-IS ile ise (p<0.001) anlamlı ters korelasyon bulundu. Sonuç: Gestasyonel diabetli gebelerde sağlıklı gebelere kıyasla artmış olan vücut yağ oranı; leptin düzeylerinin ve insülin direncinin artmasına, insülin duyarlılığının ise azalmasına yol açabileceği düşünülmüştür. Cilt kıvrım kalınlığı ölçülerek vücut yağ yüzdesinin hesaplanması, günlük klinik uygulamalarda gebeler için güvenilir, ucuz ve uygun bir yöntem gibi görünmektedir.

Anahtar Kelimeler:

Gestasyonel Diabetes Mellitus, Leptin, İnsülin Direnci, insülin duyarlılığı, vücut yağ yüzdesi

Comparison of both insulin resistance and insulin sensitivity and their relations with serum leptin concentrations and body fat percentage in a pregnant women with and without gestational diabetes

Aim: Gestational diabetes and obesity are the common metabolic disorders during pregnancy. Leptin primarily produced by fat cells, has been shown to regulate energy metabolism. There is limited data regarding to this subject in gestational diabetes. In this study it was aimed that the comparison of body fat percentage and leptin levels in pregnant women with or without gestational diabetes. Method: 49 pregnant women with gestational diabetes and 37 healty pregnant women between 26.–36. gestational weeks have been evaluated. Body mass index and skinfold thickness have been calculated antropometrically. Body fat percantage has been calculated from skinfold thickness according to Siri formula. Serum insulin and leptin levels have been mesaured. For evalution of insulin sensitivity, QUICKI-IS; for evalution of insulin resistance, HOMA-IR indexes have been used. Results: Both groups were similar according to gestational weeks and BMI (p>0.05). Body fat percantage (p=0.007), insulin (p=0.004) and HOMA–IR (p<0.001) have found higher; while QUICKI-IS (p<0.001) lower in pregnant women with Gestational diabetes than control group. Significantly positive correlation has been found between body fat percantage and leptin(p< 0.001) insulin (p=0.04) and HOMA-IR (p=0.04), but negative correlated with QUICKI-IS (p<0.001). Conclusion: Consequently, increased body fat percantage in gestational diabetes, increases serum leptin levels and insulin resistance, but decreases the insulin sensitivity. Calculate of body fat percantage by measurement of skinfold thickness has been seen as suitable, inexpensive and save method in pregnant women.

Keywords:

Gestational diabetes mellitus, leptin, insulin resistance, insulin sensistivity,

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