Gülşah YENİDÜNYA YALIN, Bülent CAN, Sema ÇİFTÇİ, Nevin DİNÇÇAĞ

Risk factors predicting the development of diabetes mellitus and metabolic syndrome following gestational diabetes mellitus

Background/aim: To determine risk factors associated with the development of insulin resistance, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) in gestational diabetes mellitus (GDM) patients 10 years after giving birth. Materials and methods: Medical records of patients with former GDM were screened. Eligible patients were invited to the hospital to obtain information about their present health status. Patients with pregestational diabetes and patients with multiple pregnancies were excluded. A total of 67 women formed the study group. American Diabetes Association (ADA) and International Diabetes Federation (IDF) criteria were used to define T2DM and MetS, respectively. Results: A total of 27 patients developed diabetes (40.3%) and 35 patients (52%) developed MetS. T2DM developed, on average, 4.8 years after delivery. There was a significant difference between diabetic and nondiabetic patients in terms of insulin use during pregnancy (P < 0.001). Women who developed diabetes within 10 years after giving birth were observed to have significantly higher fasting plasma glucose on oral glucose tolerance test during their pregnancy (P = 0.007). Current and pregestational body mass indices had a significant effect on the development of MetS (P = 0.003 and P = 0.027, respectively). Conclusion: In this long-term study, we found that patients with high fasting plasma glucose (FPG) and insulin requirement during pregnancy are at an increased risk of developing T2DM, while pregestational obesity is predictive of progression to MetS. Identifying and targeting high-risk individuals may delay and possibly prevent T2DM and MetS.Key words: Diabetes, metabolic syndrome, gestational diabetes, insulin resistance

PDF

___

1. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N et al. Gestational diabetes: a clinical update. World Journal of Diabetes 2015; 6: 1065-1072. doi: 10.4239/wjd.v6.i8.1065
2. Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP et al. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the coronary artery risk development in young adults study. Journal of the American Heart Association 2014; 3: e000490. doi: 10.1161/ JAHA.113.000490
3. Retnakaran R, Shah BR. Role of type 2 diabetes in determining retinal, renal and cardiovascular outcomes in women with previous gestational diabetes mellitus. Diabetes Care 2017; 40: 101-108. doi: 10.2337/dc16-1400
4. Archambault C, Arel R, Filion KB. Gestational diabetes and risk of cardiovascular disease: a scoping review. Open Medicine 2014; 8: e1-e9.
5. Tamás G, Kerényi Z. Gestational diabetes: current aspects on pathogenesis and treatment. Experimental and Clinical Endocrinology and Diabetes 2001; 109: 400-411. doi: 10.1055/ s-2001-18598
6. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA, USA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2020.
7. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683-689. doi: 10.2337/diacare.24.4.683
8. World Health Organization (2011). Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11 December 2008. Geneva, Switzerland: World Health Organization; 2011.
9. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42: 13-28. doi: 10.2337/dc19-S002
10. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome-a new worldwide definition. The Lancet 2005; 366: 1059-1062. doi: 10.1016/ S0140-6736(05)67402-8
11. Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A et al. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care 2003; 26: 3320-3325. doi: 10.2337/diacare.26.12.3320
12. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25 (10): 1862-1868. doi: 10.2337/diacare.25.10.1862
13. Bentley-Lewis R, Levkoff S, Stuebe A, Seely EW. Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus. Nature Clinical Practice Endocrinology & Metabolism 2008; 4 (10): 552-558. doi: 10.1038/ncpendmet0965
14. Lauenborg J, Mathiesen E, Hansen T, Glümer C, Jørgensen T et al. The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population. The Journal of Clinical Endocrinology & Metabolism 2005; 90 (7): 4004-4010. doi: 10.1210/jc.2004-1713
15. Hakkarainen H, Huopio H, Cederberg H, Pääkkönen M, Voutilainen R et al. The risk of metabolic syndrome in women with previous GDM in a long-term follow-up. Gynecological Endocrinology 2016; 32 (11): 920-925. doi: 10.1080/09513590.2016.1198764
16. American Diabetes Association Diabetes Care 2019; 42 (Supplement 1): 165-172. doi: 10.2337/dc19-S014
17. Nicholson WK, Wilson LM, Witkop CT, Baptiste-Roberts K, Bennett WL et al. Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evidence Report/Technology Assessment 2008; (162): 1-96.
18. Baptiste-Roberts K, Barone BB, Gary TL, Golden SH, Wilson LM et al. Risk factors for type 2 diabetes among women with gestational diabetes: a systematic review. The American Journal of Medicine 2009; 122 (3): 207-214. doi: 10.1016/j. amjmed.2008.09.034
19. Herath H, Herath R, Wickremasinghe R. Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women-A community based retrospective cohort study. PLoS One 2017; 12 (6): e0179647. doi: 10.1371/journal.pone.0179647
20. Tam WH, Yang XL, Chan JC, Ko GT, Tong PC et al. Progression to impaired glucose regulation, diabetes and metabolic syndrome in Chinese women with a past history of gestational diabetes. Diabetes/Metabolism Research and Reviews 2007; 23 (6): 485-489. doi: 10.1002/dmrr.741
21. Kjos SL, Peters RK, Xiang A, Henry OA, Montoro M et al. Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing. Diabetes 1995; 44 (5): 586-591. doi: 10.2337/diab.44.5.586
22. Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH et al. Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. The Journal of Clinical Endocrinology & Metabolism 2008; 93 (12): 4774-4779. doi: 10.1210/jc.2008-0772
23. Kim C, McEwen LN, Piette JD, Goewey J, Ferrara A et al. Risk perception for diabetes among women with histories of gestational diabetes mellitus. Diabetes Care 2007; 30 (9): 2281- 2286. doi: 10.2337/dc07-0618
24. Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA et al. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia 2016; 59 (7): 1403-1411. doi: 10.1007/s00125-016-3927-2
25. Barker J, Su F, Alwan NA. Risk factors for type 2 diabetes after gestational diabetes: a population-based cohort study. The Lancet 2017; 390: S21. doi: 10.1016/S0140-6736(17)32956-2
26. Cheung BM, Li C. Diabetes and hypertension: is there a common metabolic pathway? Current Atherosclerosis Reports 2012; 14 (2): 160-166. doi: 10.1007/s11883-012-0227-2
27. Albareda M, Caballero A, Badell G, Rodriguez-Espinosa J, Ordonez-Llanos J et al. Metabolic syndrome at follow-up in women with and without gestational diabetes mellitus in index pregnancy. Metabolism: Clinical and Experimental 2005; 54: 1115-1121. doi: 10.1016/j.metabol.2005.03.017
28. Verma A, Boney CM, Tucker R, Vohr BR. Insulin resistance syndrome in women with prior history of gestational diabetes mellitus. The Journal of Clinical Endocrinology & Metabolism 2002; 87: 3227-3235. doi: 10.1210/jcem.87.7.8684
29. Xu Y, Shen S, Sun L, Yang H, Jin B et al. Metabolic syndrome risk after gestational diabetes: a systematic review and metaanalysis. PLoS One 2014; 9 (1): e87863. doi: 10.1371/journal. pone.0087863
30. Gonzalez-Mejia ME, Porchia LM, Torres-Rasgado E, RuizVivanco G, Pulido-Pérez P et al. C-peptide is a sensitive indicator for the diagnosis of metabolic syndrome in subjects from Central Mexico. Metabolic Syndrome and Related Disorders 2016; 14: 210-216.doi: 10.1089/met.2015.0067
31. Wahren J, Larsson C. C-peptide: new findings and therapeutic possibilities. Diabetes Research and Clinical Practice 2015; 107: 309-319. doi: 10.1016/j.diabres.2015.01.016
32. De Souza LR, Ray JG, Retnakaran R. Gestational diabetes and the metabolic syndrome. In: Radenkovic M (editor). Gestational Diabetes. 2nd ed. London, UK: IntechOpen; 2011. pp. 141-168. doi: 10.5772/22119
33. Ekelund M, Shaat N, Almgren P, Groop L, Berntorp K. Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia 2010; 53 (3): 452-457.doi: 10.1007/s00125-009-1621-3
34. Taveras EM, Rifas-Shiman SL, Rich-Edwards JW, Gunderson EP, Stuebe AM et al. Association of maternal short sleep duration with adiposity and cardiometabolic status at 3 years postpartum. Obesity 2011; 19 (1): 171-178. doi: 10.1038/ oby.2010.117