Progressive metabolic derangement of glucose tolerance first detected during pregnancy mimics the pathogenesis of type 2 diabetes

In a large Dutch multiethnic cohort, 2031 consecutive pregnant women were stratified by a 2-step testing procedure into 4 groups according to American Diabetes Association criteria: normal glucose tolerance (NGT), mild gestational hyperglycaemia (MGH), gestational diabetes mellitus without early postpartum diabetes within 6 months of delivery (GDM1) and gestational diabetes mellitus with early postpartum diabetes mellitus (GDM2). Progressive metabolic derangement of glucose tolerance first detected during pregnancy was similar to that found in type 2 diabetics: fasting plasma glucose concentration, 100-g oral glucose tolerance test (OGTT) were under the curve, and mean glucose concentration during the OGTT increased progressively among the 4 groups. Furthermore, fasting C-peptide concentration displayed an inverted-U pattern, with a maximum at a mean plasma glucose concentration during the OGTT of 9.6 mmol/L in the transition from GDM1 to GDM2. Compared with NGT subjects, the fasting C-peptide/glucose concentration ratio decreased by 42% in GDM patients whilst the ratios were similar in MGH patients.

Abstract