Exp Clin Endocrinol Diabetes 2006; 114(1): 11-17
DOI: 10.1055/s-2005-873015
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Prevalence of Impaired Glucose Tolerance 6 Years after Gestational Diabetes

W. Hunger-Dathe1 , N. Mosebach2 , A. Sämann1 , G. Wolf1 , U. A. Müller1
  • 1Friedrich-Schiller University of Jena, Department of Internal Medicine III (Head: Prof. Dr. med. G. Wolf), Jena, Germany
  • 2Hufeland-Hospital GmbH, Bad Langensalza, Germany
Further Information

Publication History

Received: May 25, 2005 First decision: September 23, 2005

Accepted: October 28, 2005

Publication Date:
01 February 2006 (online)

Abstract

Aim: Prevalence of glucose metabolism disorders in women six years after gestational diabetes in the index pregnancy (GDM). Method: 227 Caucasian women who developed GDM between 1995 and 1996 were investigated; 173 women (BMI 27.5 ± 6.0 kg/m2) received 75 g oGGT on average 5.8 ± 2.0 years after delivery. Results: Impaired glucose metabolism was found in 31.2 %, IGT or IFG 19.1 %, diabetes mellitus type 2 (DM2) 9.2 %, diabetes mellitus type 1 (DM1) 2.3 %, second GDM 0.6 %. 27.2 % (BMI 25 - 29.9 kg/m2) were overweight, 23.1 % suffered from obesity (BMI 30 - 39.9 kg/m2) and 5.2 % morbid obesity (BMI ≥ 40 kg/m2). In comparison to a healthy control group, women with DM2 at re-examination were: older in age (32.1 ± 5.9 vs. 29.1 ± 4.8 years, p < 0.05), had higher BMI (29.4 ± 6.9 vs. 24.6 ± 4.8 kg/m2, p < 0.05), higher fasting blood glucose (6.5 ± 1.9 vs. 5.2 ± 0.9 mmol/l, p < 0.05), earlier diagnosis of GDM (25 ± 8 vs. 29 ± 5 SSW, p < 0.05), more frequent insulin therapy during pregnancy (75 vs. 24 %) and had significantly higher insulin- and C-peptide for all measures of the oGTT, whereas HbA1c was not different (4.9 ± 0.5 vs. 4.8 ± 0.3 %, n. s.). Conclusion: In an average of 5.8 years after the diagnosis of GDM, the majority of women still have chronic insulin resistance. One third has either IGT, IFG or diabetes mellitus. Therefore, a long term follow-up is strongly recommended for women diagnosed with GDM.

Literature

  • 1 Aberg A E, Jonsson K J, Eskilsson I, Landin-Olsson M, Frid A H. Predictive factors of developing diabetes mellitus in women with gestational diabetes.  Acta Obstet Gynecol Scand. 2002;  81 11-16
  • 2 Albareda M, Caballero A, Badell G, Piquer S, Ortiz A, De Leiva A. et al . Diabetes and abnormal glucose tolerance in women with previous gestational diabetes.  Diabetes Care. 2003 a;  26 1199-1205
  • 3 Albareda M, Caballero A, Badell G, Piquer S, Ortiz A, de Leiva A. et al . Diabetes and abnormal glucose tolerance in women with previous gestational diabetes.  Diabetes Care. 2003 b;  26 1199-1205
  • 4 Ali Z, Alexis S D. Occurrence of diabetes mellitus after gestational diabetes mellitus in Trinidad.  Diabetes Care. 1990;  13 527-529
  • 5 Azen S P, Peters R K, Berkowitz K, Kjos S, Xiang A, Buchanan T A. TRIPOD (Troglitazone In the Prevention Of Diabetes): a randomized, placebo-controlled trial of troglitazone in women with prior gestational diabetes mellitus.  Control Clin Trials. 1998;  19 217-231
  • 6 Beischer N A, Oats J N, Henry O A, Sheedy M T, Walstab J E. Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia.  Diabetes. 1991;  40 (Suppl 2) 35-38
  • 7 Bergstrom R W, Newell-Morris L L, Leonetti D L. Association of elevated fasting C-peptide level and increased intraabdominal fat distribution with development of NIDDM in Japanese.  American Men Diabetes. 1990;  39 104-111
  • 8 Buchanan T A. Pancreatic B-cell defects in gestational diabetes: implications for the pathogenesis and prevention of type 2 diabetes.  J Clin Endocrinol Metab. 2001;  86 989-993
  • 9 Burke J P, Williams K, Narayan V, Leibson C, Haffner S M, Stern M P. A population perspective on diabetes prevention. Whom should we target for preventing weight gain?.  Diabetes Care. 2003;  26 1999-2004
  • 10 Catalano P M, Kirwan J P, Haugel-de Mouzon S, King J. Gestational diabetes and insulin resistance: Role in short- and long-term implications for mother and fetus.  J Nutr. 2003;  133 1674-1683
  • 11 Catalano P M, Vargo K M, Bernstein I M, Amini S B. Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes.  Am J Obstet Gynecol. 1991;  165 914-919
  • 12 Cheung N W, Byth K. Population health significance of gestational diabetes.  Diabetes Care. 2003;  26 2005-2009
  • 13 Chiasson J L, Josse R G, Gomis R, Hanefeld M, Karasik V, Laakso M. STOP-NIDDM Trail Research Group . Acarbose for prevention of type 2 diabetes mellitus: the STOPNIDDM randomised trial.  Lancet. 2002;  359 2072-2077
  • 14 Chou P, Li C L, Wu G S, Tsai S T. Progression to type 2 diabetes among high-risk groups in Kin-Chen, Kinmen: Exploring the natural history of type 2 diabetes.  Diabetes Care. 1998;  21 1183-1187
  • 15 Coustan D R, Carpenter M W, O'Sullivan P S, Carr S R. Gestational diabetes: predictors of subsequent disordered glucose metabolism.  Am J Obstet Gynecol. 1993;  168 1139-1144 1144-1145 (discussion)
  • 16 Damm P. Gestational diabetes mellitus and subsequent development of overt diabetes mellitus.  Dan Med Bull. 1998;  45 495-509
  • 17 Damm P, Kuhl C, Bertelsen A, Molsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus.  Am J Obstet Gynecol. 1992;  167 607-616
  • 18 Damm P, Vestergaard H, Kuhl C, Pedersen O. Impaired insulin-stimulated nonoxidative glucose metabolism in glucose-tolerant women with previous gestational diabetes.  Am J Obstet Gynecol. 1996;  174 722-729
  • 19 Dawson S I, Smith W CS, Watson M S, Wilson B J, Prescott G J, Campbell D. et al . A cohort study of reproductive risk factors, weight and weight change and the developement of diabetes mellitus.  Diabetes, Obesity and Metabolism. 2003;  5 244-250
  • 20 De Fronzo R A, Bonadonna R C, Ferrannini E. Pathogenesis of NIDDM: a balanced overview.  Diabetes Care. 1992;  15 318-368
  • 21 Deutsche Diabetes Gesellschaft .Diagnostik und Therapie des Gestationsdiabetes: Stellungnahme der Arbeitsgemeinschaft Diabetes und Schwangerschaft der DDG 2001. 2001
  • 22 Deutsche Diabetes Gesellschaft . Praxis-Leitlinien der Deutschen Diabetes Gesellschaft (DDG).  Diabetes und Stoffwechsel. 2002;  11 1-39
  • 23 Diabetes Prevention Program Research Group . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med. 2002;  346 393-403
  • 24 Eriksson K F, Lindgarde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study.  Diabetologia. 1991;  34 891-898
  • 26 Füchtenbusch M, Ferber K, Standl E, Ziegler A G. Prediction of type 1 diabetes postpartum in patients with gestational diabetes mellitus by combined islet cell autoantibody screening: a prospective multicenter study.  Diabetes. 1997;  46 1459-1467
  • 27 Grant P T, Oats J N, Beischer N A. The long-term follow-up of women with gestational diabetes.  Aust NZJ Obstet Gynaecol. 1986;  26 17-22
  • 28 Greenberg L R, Moore T R, Murphy H. Gestational diabetes mellitus: antenatal variables as predictors of postpartum glucose intolerance.  Obstet Gynecol. 1995;  86 97-101
  • 29 Henry O A, Beischer N A. Long-term implications of gestational diabetes for the mother.  Baillieres Clin Obstet Gynaecol. 1991;  5 461-483
  • 31 Hu F B, Manson J E, Stampfer M J, Colditz G A, Liu S, Solomon C G. et al . Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.  N Engl J Med. 2001;  345 790-797
  • 32 Kim C, Newton K M, Knopp R H. Gestational Diabetes and the Incidence of Type 2 Diabetes.  Diabetes Care. 2002;  25 1862-1868
  • 33 Kjos S L, Buchanan T A, Greenspoon J S, Montoro M, Bernstein G S, Mestman J H. Gestational diabetes mellitus: the prevalence of glucose intolerance and diabetes mellitus in the first two months post partum.  Am J Obstet Gynecol. 1990;  163 93-98
  • 34 Kjos S L, Peters R K, Xiang A, Henry O A, Montoro M, Buchanan T A. Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing.  Diabetes. 1995;  44 586-591
  • 35 Kousta E, Lawrence N J, Godsland I F, Penny A, Anyaoku V, Millauer B A. et al . Insulin resistance and beta-cell dysfunction in normoglycaemic European women with a history of gestational diabetes.  Clin Endocrinol (Oxf). 2003;  59 289-297
  • 36 Laakso M. How good a marker is insulin level for insulin resistance?.  Am J Epidemiol. 1993;  137 959-965
  • 37 Lam K S, Li D F, Lauder I J, Lee C P, Kung A W, Ma J T. Prediction of persistent carbohydrate intolerance in patients with gestational diabetes.  Diabetes Res Clin Pract. 1991;  12 181-186
  • 38 Lauenborg J, Hansen T, Jensen D M, Vestergaard H, Molsted-Pedersen L, Hornnes P. et al . Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population.  Diabetes Care. 2004;  27 1194-1199
  • 39 Lehtovirta M, Forsen B, Gullstrom M, Haggblom M, Eriksson J G, Taskinen M R. et al . Metabolic effects of metformin in patients with impaired glucose tolerance.  Diabet Med. 2001;  18 578-583
  • 40 Metzger B E, Cho N H, Roston S M, Radvany R. Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus.  Diabetes Care. 1993;  16 1598-1605
  • 41 Nijpels G, Popp-Snijders C, Kostense P J, Bouter L M, Heine R J. Fasting proinsulin and 2-h post-load glucose levels predict the conversion to NIDDM in subjects with impaired glucose tolerance: The Hoorn Study.  Diabetologia. 1996;  39 113-118
  • 42 O'Sullivan J B. The Boston gestational diabetes studies: review and prospectives. Pearson DWM Carbohydrate Metabolism in Pregnancy and the Newborn. Berlin, Heidelberg, New York; Springer 1989: 287-294
  • 43 Pallardo F, Herranz L, Garcia-Ingelmo T, Grande C, Martin-Vaquero P, Janez M. et al . Early postpartum metabolic assessment in women with prior gestational diabetes.  Diabetes Care. 1999;  22 1053-1058
  • 44 Pan X R, Li G W, Hu Y H, Wang J X, Yang W Y, An Z X. et al . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.  Diabetes Care. 1997;  20 537-544
  • 45 Pendergrass M, Fazioni E, De Fronzo R A. Non-insulin-dependent diabetes mellitus and gestational diabetes mellitus: same disease, another name?.  Diabetes Rev. 1995;  3 566-583
  • 46 Persson B, Hanson U, Hartling S G, Binder C. Follow-up of women with previous GDM: insulin, C-peptide, and proinsulin responses to oral glucose load.  Diabetes. 1991;  40 (Suppl 2) 136-141
  • 47 Pettitt D J, Knowler W C, Baird H R, Bennett P H. Gestational diabetes: infant and maternal complications of pregnancy in relation to third-trimester glucose tolerance in the Pima Indians.  Diabetes Care. 1980;  3 458-464
  • 48 Pradhan A D, Manson J E, Meigs J B, Rifai N, Buring J E, Liu S. et al . Insulin, proinsulin, proinsulin : insulin ratio, and the risk of developing type 2 diabetes mellitus in women.  Am J Med. 2003;  114 438-444
  • 49 Reaven G M. Banting lecture 1988. Role of Insulin Resistance in Human Disease.  Diabetes. 1988;  37 1595-1607
  • 50 Sinha B, Brydon P, Taylor R S, Hollins A, Munro A, Jenkins D J. et al . Maternal antenatal parameters as predictors of persistent postnatal glucose intolerance: a comparative study between Afro-Caribbeans, Asians and Caucasians.  Diabet Med. 2003;  20 382-386
  • 51 Stage E, Ronneby H, Damm P. Lifestyle change after gestational diabetes.  Diabetes Res Clin Pract. 2004;  63 67-72
  • 52 Thefeld W. Prävalenz des Diabetes mellitus in der erwachsenen Bevölkerung Deutschlands.  Gesundheitswesen. 1999;  61 S85-S89
  • 53 Tuomilehto J, Lindstrom J, Eriksson J, Valle T T, Hamalainen H. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance (The Finnish Diabetes Prevention Study Group).  N Engl J Med. 2001;  344 1343-1350
  • 54 Uusitupa M, Lindi V, Louheranta A, Salopuro T, Lindstrom J, Tuomilehto J. Long-term improvement in insulin sensitivity by changing lifestyles of people with impaired glucose tolerance: 4-year results from the Finnish Diabetes Prevention Study.  Diabetes. 2003;  52 2532-2538
  • 55 Weiss P AM, Walcher W, Scholz H S. Der vernachlässigte Gestationsdiabetes: Risiken und Folgen.  Geburtsh Frauenheilk. 1999;  59 535-544
  • 56 World Health Organization . Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee.  World Health Organ Tech Rep Ser. 1995;  854 1-452
  • 57 Zimmet P, Dowse G, Bennett P H. Hyperinsulinaemia is a predictor of non-insulin-dependent diabetes mellitus.  Diabete Metab. 1991;  17 101-108

Dr. med. Wilgard Hunger-Dathe

University of Jena Medical School
Department of Internal Medicine III

07740 Jena

Germany

Phone: + 4936419324323

Fax: + 49 364 19 32 43 22

Email: wilgard.hunger-dathe@med.uni-jena.de

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