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Epidemiology/Health services research
β-Cell function or insulin resistance was associated with the risk of type 2 diabetes among women with or without obesity and a history of gestational diabetes
  1. Yuxin Fan1,2,
  2. Leishen Wang3,
  3. Huikun Liu3,
  4. Shuang Zhang3,
  5. Huiguang Tian3,
  6. Yun Shen2,4,
  7. Jaakko Tuomilehto5,
  8. Zhijie Yu6,
  9. Xilin Yang7,
  10. Gang Hu2,
  11. Ming Liu1
  1. 1Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
  2. 2Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  3. 3Tianjin Women’s and Children’s Health Center, Tianjin, China
  4. 4Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Six People’s Hospital, Shanghai, China
  5. 5Department of Public Health, University of Helsinki, Helsinki, Finland
  6. 6Population Cancer Research Program, Dalhousie University, Halifax, Nova Scotia, Canada
  7. 7Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
  1. Correspondence to Dr Gang Hu; gang.hu{at}pbrc.edu; Dr Ming Liu; mingliu{at}tmu.edu.cn

Abstract

Introduction To evaluate the single association of postpartum β-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum β-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk.

Research design and methods The study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of β-cell secretory function (HOMA-%β) and homeostatic model assessment of insulin resistance (HOMA-IR).

Results Multivariable-adjusted ORs of diabetes across quartiles of HOMA-%β and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (ptrend <0.001), and 1.00, 2.11, 5.59, and 9.36 (ptrend <0.001), respectively. Women with IR only had the same diabetes risk as women with β-cell dysfunction only. Obesity, together with IR or β-cell dysfunction, had a stronger effect on diabetes risk. This stronger effect was also found for a history of GDM with IR or β-cell dysfunction. Women with three risk factors, including obesity, a history of GDM and β-cell dysfunction/IR, showed the highest ORs of diabetes.

Conclusions β-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and β-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.

  • obesity
  • non-insulin-treated type 2 diabetes
  • insulin resistance
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-001060

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    Footnotes

    • Contributors LW, HL, SZ and HT researched data. YF, ML and GH conceptualized and designed the study, performed the statistical analyses, interpreted the results, and drafted the manuscript. LW, HL, SZ, HT, YS, JT, ZY and XY reviewed and revised the manuscript. All authors critically reviewed the scientific content and approved the final manuscript. GH is the guarantor of this work and, as such, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This work was supported by the European Foundation for the Study of Diabetes/Chinese Diabetes Society/Lilly program for Collaborative Research between China and Europe. GH was partly supported by the grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790) and the National Institute of General Medical Sciences (U54GM104940) of the National Institutes of Health. YF and ML were partly supported by the grants from the National Key R&D Programme of China 2019 (YFA 0802502), National Natural Science Foundation of China (81 830 025 and 81620108004), and the Tianjin Municipal Science and Technology Commission (17ZXMFSY00150).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Tianjin Gestational Diabetes Mellitus Prevention Program was approved by the Human Subjects Committee of the Tianjin Women’s and Children’s Health Center and the reference numbers are 2009–01 and 2013-03-01. Each participant signed the informed consent form.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.