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OBJECTIVE-Women with gestational diabetes mellitus (GDM) show reduced insulin sensitivity and markedly elevated glucose excursions. After delivery, GDM mostly reverts to normal glucose tolerance (NGT), although leaving an increased risk of type 2 diabetes. Because gastrointestinal function changes during pregnancy causing vomiting, constipation, or reduced motility, we thought that gut glucose absorption in GDM or pregnancy might be altered to affect circulating glucose excursions.
RESEARCH DESIGN AND METHODS-By undergoing 180-min oral glucose tolerance tests (OGTTs), pregnant women with GDM (GDM^sub preg^; n = 15, BMI = 32 ± 2 kg/m^sup 2^, aged 33 ± 1 years) were compared with NGT women (NGT^sub preg;^ n = 7, BMl = 28 ± 1 kg/m^sup 2^, aged 34 ± 2 years), matching for major anthropometric characteristics (each P > 0.2). After delivery (6-7 months later), both groups were studied the same way. We computed and mathematically modeled gut glucose absorption from insulin-mediated glucose disappearance and endogenous glucose production (EGP). Whole-body insulin sensitivity was calculated using the Clamp-like Index.
RESULTS-GDM^sub preg^ showed 16-25% higher plasma glucose concentrations (P < 0.04) during the final 2 h of OGTT, similar EGP, but lower (P < 0.01) insulin sensitivity (2.7 ± 0.2 mg . kg^sup -1^ * min^sup -1^ vs. NGT^sub preg^: 4.5 ± 0.8 mg . kg^sup -1^ . min^sup -1^). In GDM^sub preg^, gut glucose absorption rates were ≤52% lower from 30 to 120 min (P < 0.03 vs. conditions after delivery or NGT^sub preg^). In contrast, glucose absorption rates in NGT^sub preg^ were comparable during and after pregnancy. None of the studied women developed diabetes after delivery.
CONCLUSIONS-In GDM^sub preg^, OGTT gut glucose absorption is markedly lower during hyperglycemia, whereas both glycemia and glucose absorption in NGT^sub preg^ are comparable between pregnant and postpartum states. Thus, hyperglycemia in GDM does not seem to result from too rapid or increased glucose absorption.
Diabetes Care 34:1475-1480, 2011
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Women with gestational diabetes mellitus (GDM) display both impaired ß-cell function and reduced sensitivity to insulin, bearing an elevated risk to develop type 2 diabetes in the future (1-3). Because GDM may result in newborn macrosomia and other disorders (4), the World Health Organization and the International Association of Diabetes and Pregnancy Study Groups recommend the standardized, 75-g...