Declining β-Cell Compensation for Insulin Resistance in Hispanic Women With Recent Gestational Diabetes Mellitus
Association with changes in weight, adiponectin, and C-reactive protein
- Anny H. Xiang, PHD1,
- Miwa Kawakubo, MS1,
- Enrique Trigo, MD2,
- Siri L. Kjos, MD3 and
- Thomas A. Buchanan, MD2,3
- 1Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, California;
- 2Department of Medicine, University of Southern California School of Medicine, Los Angeles, California;
- 3Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California.
- Corresponding author: Anny H. Xiang, xiang{at}usc.edu.
Abstract
OBJECTIVE To identify factors associated with declining β-cell compensation for insulin resistance.
RESEARCH DESIGN AND METHODS In a cohort of Hispanic women with recent gestational diabetes mellitus, oral glucose tolerance tests (OGTTs), intravenous glucose tolerance tests (IVGTTs), and bioelectrical impedance measurements were performed at 15-month intervals for up to 5 years, or until fasting plasma glucose exceeded 140 mg/dl (7.8 mmol/l). Data were analyzed to identify predictors of declining β-cell compensation for insulin resistance (the disposition index [DI]) and to examine the mechanism of weight gain and changes in circulating levels of selected adipokines and inflammatory markers on β-cell compensation decline.
RESULTS A total of 60 nondiabetic women had a median of four sets of OGTT + IVGTT during a median follow-up of 52 months. Fourteen of the women developed diabetes. None of the baseline characteristics were significantly predictive of a decline in DI. There were significant univariate associations between declining DI and weight gain (specifically fat gain), declining adiponectin and rising C-reactive protein. Multivariate analysis showed that the weight gain was the most significant factor associated with declining DI. The amount of association between weight gain and declining DI was explained 31% by changes in adiponectin and C-reactive protein and 40% by changes in insulin resistance.
CONCLUSIONS These results identify weight gain as the strongest factor associated with declining β-cell compensation for insulin resistance in Hispanic women at high risk for type 2 diabetes. Such effect may be mediated through at least two effects: alterations in adipokine levels and increasing insulin resistance.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received August 11, 2009.
- Accepted November 9, 2009.
- © 2010 by the American Diabetes Association.
