38
39
method for quantifying insulin secretion and resistance. The American journal of physiology. 1979;237(3):E214-23. Epub 1979/09/01.
9. Seltzer HS, Allen EW, Herron AL, Jr., Brennan MT. Insulin secretion in response to glycemic stimulus: relation of delayed initial release to carbohydrate intolerance in mild diabetes mellitus. The Journal of clinical investigation. 1967;46(3):323-35. Epub 1967/03/01.
10. Buchanan TA, Xiang AH, Kjos SL, Trigo E, Lee WP, Peters RK.
Antepartum predictors of the development of type 2 diabetes in Latino women 11-26 months after pregnancies complicated by gestational diabetes. Diabetes. 1999;48(12):2430-6. Epub 1999/12/02.
11. Golden SH, Bennett WL, Baptist-Roberts K, Wilson LM, Barone B, Gary TL, et al. Antepartum glucose tolerance test results as predictors of type 2 diabetes mellitus in women with a history of gestational diabetes mellitus: a systematic review. Gender medicine.
2009;6 Suppl 1:109-22. Epub 2009/06/12.
12. Jang HC, Yim CH, Han KO, Yoon HK, Han IK, Kim MY, et al.
Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum. Diabetes research and clinical practice. 2003;61(2):117-24. Epub 2003/09/03.
13. Xiang AH, Kjos SL, Takayanagi M, Trigo E, Buchanan TA.
Detailed physiological characterization of the development of type 2 diabetes in Hispanic women with prior gestational diabetes mellitus.
Diabetes. 2010;59(10):2625-30. Epub 2010/08/05.
14. Xiang AH, Kawakubo M, Trigo E, Kjos SL, Buchanan TA.
Declining beta-cell compensation for insulin resistance in Hispanic women with recent gestational diabetes mellitus: association with changes in weight, adiponectin, and C-reactive protein. Diabetes care.
40 2010;33(2):396-401. Epub 2009/11/26.
15. Tura A, Grassi A, Winhofer Y, Guolo A, Pacini G, Mari A, et al.
Progression to type 2 diabetes in women with former gestational diabetes: time trajectories of metabolic parameters. PloS one.
2012;7(11):e50419. Epub 2012/11/28.
16. Ekelund M, Shaat N, Almgren P, Anderberg E, Landin-Olsson M, Lyssenko V, et al. Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetes research and clinical practice. 2012;97(3):394-8. Epub 2012/05/18.
17. Standards of medical care in diabetes--2010. Diabetes care.
2010;33 Suppl 1:S11-61. Epub 2010/01/29.
18. Standards of medical care in diabetes--2012. Diabetes care.
2012;35 Suppl 1:S11-63. Epub 2012/01/04.
19. Committee opinion no. 504: screening and diagnosis of gestational diabetes mellitus. Obstetrics and gynecology.
2011;118(3):751-3. Epub 2011/08/24.
20. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes care. 1998;21 Suppl 2:B161-7. Epub 1998/08/15.
21. Bergman RN, Ider YZ, Bowden CR, Cobelli C. Quantitative estimation of insulin sensitivity. The American journal of physiology.
1979;236(6):E667-77. Epub 1979/06/01.
22. Boston RC, Stefanovski D, Moate PJ, Sumner AE, Watanabe RM, Bergman RN. MINMOD Millennium: a computer program to calculate glucose effectiveness and insulin sensitivity from the frequently sampled intravenous glucose tolerance test. Diabetes technology & therapeutics.
41 2003;5(6):1003-15. Epub 2004/01/08.
23. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta- cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9. Epub 1985/07/01.
24. Hermans MP, Levy JC, Morris RJ, Turner RC. Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes. Diabetologia. 1999;42(6):678-87. Epub 1999/06/26.
25. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. The Journal of clinical endocrinology and metabolism.
1998;83(8):2694-8. Epub 1998/08/26.
26. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. The Journal of clinical endocrinology and metabolism. 2000;85(7):2402-10. Epub 2000/07/21.
27. Stumvoll M, Mitrakou A, Pimenta W, Jenssen T, Yki-Jarvinen H, Van Haeften T, et al. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes care. 2000;23(3):295- 301. Epub 2000/06/27.
28. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes care. 1999;22(9):1462-70. Epub 1999/09/10.
42
Abstract
Prediction of future development of diabetes mellitus using postpartum oral glucose tolerance test in Korean
women with previous gestational diabetes mellitus
Yeong Gi Kim College of Medicine Seoul National University
Introduction: Gestational diabetes mellitus is an important risk factor of diabetes mellitus in women. In this study, our first purpose was analysis of correlation among postpartum oral glucose tolerance test(OGTT) indices and postpartum frequently sampled intravenous glucose tolerance test(FSIVGTT) indices in Korean women with gestational diabetes mellitus. Our second
43
purpose was development of prediction model for long term occurrence of diabetes mellitus using postpartum oral glucose tolerance test indices and clinically important anthropometric measures and comparing with previous studies.
Methods: One hundred and fifty-eight women with gestational diabetes mellitus underwent 75 g OGTT at postpartum 6 week, 1 year, 2 year and 3 year. They also underwent FSIVGTT at postpartum 1 year. Indices of insulin secretion and insulin sensitivity obtained by 75 g OGTT were converted to normal distribution by Box-Cox transformation. Acute insulin response to glucose (AIRg) and insulin sensitivity index (SI) obtained by FSIVGTT were also transformed the same way. Correlations among them were proved by Pearson’s correlation. The group of women who had occurred postpartum diabetes mellitus was compared to the group of women who did not occurred postpartum diabetes mellitus by Student’s t-test to discover risk factors of postpartum diabetes mellitus. Again, univariate logistic regression analysis was performed using initial clinical characteristics, anthropometric measures, indices obtained by 75 g OGTT and indices obtained by FSIVGTT. Later, multivariate logistic regressions were conducted using risk factors confirmed during previous steps to develop prediction models for postpartum occurrence of diabetes mellitus. Usefulness of the prediction models was evaluated by ROC curves.
Results: AIRg obtained by FSIVGTT at postpartum 1 year was related (r=0.707, p<0.01) to insulinogenic index (IGI) 30. SI obtained by FSIVGTT was related to several indices of insulin sensitivity obtained by 75 g OGTT at
44
postpartum 1 year and was related to Matsuda index with largest correlation coefficient (r=0.496, p<0.01). A model to predict occurrence of diabetes mellitus in 3 years of postpartum was developed using BMI before pregnancy, weight gain during pregnancy, HOMA β and 120 minute plasma glucose obtained by 75 g OGTT at postpartum 6 week. AUC of ROC curve was 0.867 (p<0.001).
Conclusions: Correlation was proved among postpartum OGTT indices and postpartum IVGTT indices. Based on this, prediction model for occurrence of diabetes mellitus in 3 years postpartum using postpartum OGTT indices and simple anthropometric measures was developed. Our model is clinically useful compared to previous studies and predict long term occurrence of diabetes mellitus.
--- Keywords: gestational diabetes mellitus, oral glucose tolerance test, diabetes mellitus, prediction model
Student number : 2011 – 21971