The Association Between Glucose Variability and Insulin Parameters in Gestational Diabetes Diagnosed After 24 Gestational Weeks

Overview

Journal Nutrients

Date 2025 Feb 13

PMID 39940296

Authors

Yoshifumi Kasuga

Kaoru Kajikawa

Naotsugu Ishikawa

Yasuhiko Ogata

Marina Takahashi

Keisuke Akita

Junko Tamai

Yuka Fukuma

Yuya Tanaka

Toshimitsu Otani

Marie Fukutake

Satoru Ikenoue

Mamoru Tanaka

Affiliations

Soon will be listed here.

Abstract

: Recently, it was reported that glucose variability (GV) calculated using the 75 g oral glucose tolerance test (OGTT) is associated with adverse perinatal outcomes. However, its role in gestational diabetes mellitus (GDM) remains unclear. We investigated the association between GV and insulin parameters in Japanese women diagnosed with GDM after 24 weeks of gestation (late GDM). : A total of 280 mothers with late GDM cared for at Keio University Hospital were included in this study. Using 75 g OGTT, the initial increase and subsequent decrease were calculated as the GV. : The initial increase was significantly positively associated with 1 h plasma glucose level (PG) and 2 h PG with 75 g OGTT ( < 0.001), but fasting PG, insulinogenic index (IGI), and homeostasis model assessment-insulin resistance were negatively associated with the initial increase (all < 0.001). The subsequent decrease was significantly positively correlated with 1 h PG ( < 0.001) but negatively correlated with 2 h PG ( < 0.001), IGI ( = 0.009), and the whole-body insulin sensitivity index derived from the OGTT ( = 0.02). Insulin Secretion-Sensitivity Index-2 was not associated with an initial increase or subsequent decrease. : Since the initial increase might reflect insulin secretion and the subsequent decrease might reflect insulin sensitivity in Japanese women with late GDM, GV could alter several insulin parameters. Further studies are required to investigate the usefulness of GV in the management of GDM.

References

Mahajan G, Mukhopadhyay K, Attri S, Kumar P . Neurodevelopmental Outcome of Asymptomatic Hypoglycemia Compared With Symptomatic Hypoglycemia and Euglycemia in High-Risk Neonates. Pediatr Neurol. 2017; 74:74-79. DOI: 10.1016/j.pediatrneurol.2017.05.028. View

Inoue S, Kozuma Y, Miyahara M, Yoshizato T, Tajiri Y, Hori D . Pathophysiology of gestational diabetes mellitus in lean Japanese pregnant women in relation to insulin secretion or insulin resistance. Diabetol Int. 2020; 11(3):269-273. PMC: 7387397. DOI: 10.1007/s13340-020-00425-x. View

Lewandowska M, Wieckowska B, Sajdak S . Pre-Pregnancy Obesity, Excessive Gestational Weight Gain, and the Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus. J Clin Med. 2020; 9(6). PMC: 7355601. DOI: 10.3390/jcm9061980. View

Tano S, Kotani T, Ushida T, Yoshihara M, Imai K, Nakamura N . Evaluating glucose variability through OGTT in early pregnancy and its association with hypertensive disorders of pregnancy in non-diabetic pregnancies: a large-scale multi-center retrospective study. Diabetol Metab Syndr. 2023; 15(1):123. PMC: 10251636. DOI: 10.1186/s13098-023-01103-z. View

Munang Y, Noubiap J, Danwang C, Sama J, Azabji-Kenfack M, Mbanya J . Reproducibility of the 75 g oral glucose tolerance test for the diagnosis of gestational diabetes mellitus in a sub-Saharan African population. BMC Res Notes. 2017; 10(1):622. PMC: 5704589. DOI: 10.1186/s13104-017-2944-7. View

Retnakaran R, Qi Y, Goran M, Hamilton J . Evaluation of proposed oral disposition index measures in relation to the actual disposition index. Diabet Med. 2009; 26(12):1198-203. DOI: 10.1111/j.1464-5491.2009.02841.x. View

Kasuga Y, Kawai T, Miyakoshi K, Hori A, Tamagawa M, Hasegawa K . DNA methylation analysis of cord blood samples in neonates born to gestational diabetes mothers diagnosed before 24 gestational weeks. BMJ Open Diabetes Res Care. 2022; 10(1). PMC: 8772407. DOI: 10.1136/bmjdrc-2021-002539. View

Kasuga Y, Hata K, Tajima A, Ochiai D, Saisho Y, Matsumoto T . Association of common polymorphisms with gestational diabetes mellitus in Japanese women: A case-control study. Endocr J. 2017; 64(4):463-475. DOI: 10.1507/endocrj.EJ16-0431. View

Burns C, Rutherford M, Boardman J, Cowan F . Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics. 2008; 122(1):65-74. DOI: 10.1542/peds.2007-2822. View

10.

Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7):412-9. DOI: 10.1007/BF00280883. View

11.

Kasuga Y, Kawai T, Miyakoshi K, Saisho Y, Tamagawa M, Hasegawa K . Epigenetic Changes in Neonates Born to Mothers With Gestational Diabetes Mellitus May Be Associated With Neonatal Hypoglycaemia. Front Endocrinol (Lausanne). 2021; 12:690648. PMC: 8276691. DOI: 10.3389/fendo.2021.690648. View

12.

Feghali M, Abebe K, Comer D, Caritis S, Catov J, Scifres C . Pregnancy outcomes in women with an early diagnosis of gestational diabetes mellitus. Diabetes Res Clin Pract. 2018; 138:177-186. PMC: 5910191. DOI: 10.1016/j.diabres.2018.02.004. View

13.

Kasuga Y, Takahashi M, Kajikawa K, Akita K, Tamai J, Fukuma Y . Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks. J Diabetes Investig. 2024; 15(12):1803-1808. PMC: 11615686. DOI: 10.1111/jdi.14318. View

14.

Metzger B, Lowe L, Dyer A, Trimble E, Chaovarindr U, Coustan D . Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19):1991-2002. DOI: 10.1056/NEJMoa0707943. View

15.

Sweeting A, Ross G, Hyett J, Molyneaux L, Constantino M, Harding A . Gestational Diabetes Mellitus in Early Pregnancy: Evidence for Poor Pregnancy Outcomes Despite Treatment. Diabetes Care. 2015; 39(1):75-81. DOI: 10.2337/dc15-0433. View

16.

Harlass F, Brady K, Read J . Reproducibility of the oral glucose tolerance test in pregnancy. Am J Obstet Gynecol. 1991; 164(2):564-8. DOI: 10.1016/s0002-9378(11)80021-9. View

17.

Sato M, Tamura Y, Kaga H, Yamasaki N, Kadowaki S, Sugimoto D . Adipose tissue insulin resistance in young Japanese women is associated with metabolic abnormalities and dehydroepiandrosterone-sulfate. Front Endocrinol (Lausanne). 2024; 15:1390778. PMC: 11456452. DOI: 10.3389/fendo.2024.1390778. View

18.

Mikkelsen M, Nielsen S, Stage E, Mathiesen E, Damm P . High maternal HbA1c is associated with overweight in neonates. Dan Med Bull. 2011; 58(9):A4309. View

19.

Dori-Dayan N, Cukierman-Yaffe T, Kedar N, Zemet R, Cohen O, Mazaki-Tovi S . Maternal glucose variability during pregnancy & birthweight percentile in women with pre-gestational diabetes. Gynecol Endocrinol. 2021; 37(12):1116-1120. DOI: 10.1080/09513590.2021.1993814. View

20.

Fukatsu M, Takai Y, Matsunaga S, Era S, Ono Y, Saito M . Diagnosis and potential management of gestational diabetes mellitus using the International association of diabetes and pregnancy study groups criteria. J Obstet Gynaecol Res. 2016; 43(2):272-280. DOI: 10.1111/jog.13223. View