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Normal Glucose Tolerance and Gestational Diabetes Mellitus

What is in between?

¹ Department of Endocrinology and Metabolism, Section of Diabetes, University of Pisa, Pisa, Italy
² Department of Internal Medicine, Spedali Riuniti, Pistoia, Italy

Address correspondence and reprint requests to Dr. Graziano Di Cianni, Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, Ospedale di Cisanello, Via Paradisa, 2, 56126 Pisa, Italy. E-mail: dicianni{at}immr.med.unipi.it

OBJECTIVE— The aim of this article was to define the metabolic phenotype of pregnant women with one abnormal value (OAV) during an oral glucose tolerance test (OGTT) and to test whether OAV could be considered metabolically comparable to gestational diabetes mellitus (GDM) or a specific entity between GDM and normal pregnancy.

RESEARCH DESIGN AND METHODS— After 100-g 3-h OGTTs, 4,053 pregnant women were classified as having GDM, OAV, or normal glucose tolerance (NGT). Those with OAV were subdivided into three subgroups: fasting hyperglycemia (one abnormal value at fasting during an OGTT), 1-h hyperglycemia (one abnormal value at 1 h during an OGTT [1h-OAV]), or 2- or 3-h hyperglycemia (one abnormal value at 2 or 3 h during an OGTT). As derived from the OGTT, we measured insulin sensitivity (insulin sensitivity index [ISI] Matsuda) and insulin secretion (homeostasis model assessment for the estimation of ß-cell secretion [HOMA-B], first- and second-phase insulin secretion). The product of the first-phase index and the ISI was calculated to obtain the insulin secretion–sensitivity index (ISSI).

RESULTS— GDM was diagnosed in 17.9% and OAV in 18.7% of pregnant women; women with GDM and OAV were older and had higher BMI and serum triglyceride levels than those with NGT (all P < 0.05). Women with NGT had the highest ISI followed by those with OAV (–21.7%) and GDM (–32.1%). HOMA-B results were comparable with those for OAV and GDM but significantly (P < 0.01) lower than those for NGT; first- and second-phase insulin secretion appeared progressively reduced from that in women with NGT to that in women with OAV and GDM (P < 0.01). ISSI was higher in women with NGT than in women with either OAV (–34%) or GDM (–51.7%) (P < 0.001). Among OAV subgroups, the 1h-OAV subgroup showed the lowest ISSI (P < 0.05).

CONCLUSIONS— OAV and GDM are clinically indistinguishable, and both groups are different from women with NGT. Women with GDM and OAV showed impaired insulin secretion and insulin sensitivity, although these defects are more pronounced in women with GDM. Compared with other OAV subgroups, 1h-OAV could be considered a more severe condition.

Abbreviations: AUC_Gluc, incremental area under the glucose curve • AUC_Ins, incremental area under the insulin curve • F-OAV, one abnormal value at fasting during an oral glucose tolerance test • GCT, glucose challenge test • GDM, gestational diabetes mellitus • HOMA-B, homeostasis model assessment for the estimation of ß-cell secretion • ISI, insulin sensitivity index • ISSI, insulin secretion–sensitivity index • L-OAV, one abnormal value at 2 or 3 h during an oral glucose tolerance test • NGT, normal glucose tolerance • OGTT, oral glucose tolerance test • 1h-OAV, one abnormal value at 1-h during an OGTT • OAV, one abnormal value during an OGTT

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