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Arora GP, Åkerlund M, Brøns C, Moen GH, Wasenius NS, Sommer C, Jenum AK, Almgren P, Thaman RG, Orho-Melander M, Eriksson J, Qvigstad E, Birkeland K, Berntorp K, Vaag AA, Groop L, Prasad RB. Phenotypic and genotypic differences between Indian and Scandinavian women with gestational diabetes mellitus. J Intern Med 2019; 286:192-206. [PMID: 30919529 DOI: 10.1111/joim.12903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a transient form of diabetes characterized by impaired insulin secretion and action during pregnancy. Population-based differences in prevalence exist which could be explained by phenotypic and genetic differences. The aim of this study was to examine these differences in pregnant women from Punjab, India and Scandinavia. METHODS Eighty-five GDM/T2D loci in European and/or Indian populations from previous studies were assessed for association with GDM based on Swedish GDM criteria in 4018 Punjabi Indian and 507 Swedish pregnant women. Selected loci were replicated in Scandinavian cohorts, Radiel (N = 398, Finnish) and STORK/STORK-G (N = 780, Norwegian). RESULTS Punjabi Indian women had higher GDM prevalence, lower insulin secretion and better insulin sensitivity than Swedish women. There were significant frequency differences of GDM/T2D risk alleles between both populations. rs7178572 at HMG20A, previously associated with GDM in South Indian and European women, was replicated in North Indian women. The T2D risk SNP rs11605924 in the CRY2 gene was associated with increased GDM risk in Scandinavian but decreased GDM risk in Punjabi Indian women. No other overlap was seen between GDM loci in both populations. CONCLUSIONS Gestational diabetes mellitus is more common in Indian than Swedish women, which partially can be attributed to differences in insulin secretion and action. There was marked heterogeneity in the GDM phenotypes between the populations which could only partially be explained by genetic differences.
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Affiliation(s)
- G P Arora
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Deep Hospital, Ludhiana, Punjab, India
| | - M Åkerlund
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - C Brøns
- Department of Endocrinology (Diabetes and Metabolism), Rigshospitalet, Copenhagen, Denmark
| | - G-H Moen
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - N S Wasenius
- Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, Diabetes and Obesity Research Program Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - C Sommer
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - A K Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - P Almgren
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | | | - M Orho-Melander
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - J Eriksson
- Department of General Practice and Primary Health Care, Diabetes and Obesity Research Program Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - E Qvigstad
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - K Birkeland
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K Berntorp
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - A A Vaag
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Department of Endocrinology (Diabetes and Metabolism), Rigshospitalet, Copenhagen, Denmark.,Cardiovascular, Renal and Metabolism (CVRM) Translational Medicine Unit, Early Clinical development, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - L Groop
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Finnish Institute of Molecular Medicine (FIMM), Helsinki University, Helsinki, Finland
| | - R B Prasad
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
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Arora GP, Almgren P, Thaman RG, Pal A, Groop L, Vaag A, Prasad RB, Brøns C. Insulin secretion and action in North Indian women during pregnancy. Diabet Med 2017; 34:1477-1482. [PMID: 28731584 DOI: 10.1111/dme.13428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 01/06/2023]
Abstract
AIM The relative roles(s) of impaired insulin secretion vs. insulin resistance in the development of gestational diabetes mellitus depend upon multiple risk factors and diagnostic criteria. Here, we explored their relative contribution to gestational diabetes as defined by the WHO 1999 (GDM1999) and adapted WHO 2013 (GDM2013) criteria, excluding the 1-h glucose value, in a high-risk Indian population from Punjab. METHODS Insulin secretion (HOMA2-B) and insulin action (HOMA2-IR) were assessed in 4665 Indian women with or without gestational diabetes defined by the GDM1999 or adapted GDM2013 criteria. RESULTS Gestational diabetes defined using both criteria was associated with decreased insulin secretion compared with pregnant women with normal glucose tolerance. Women with gestational diabetes defined by the adapted GDM2013, but not GDM1999 criteria, were more insulin resistant than pregnant women with normal glucose tolerance, and furthermore displayed lower insulin secretion than GDM1999 women. Urban habitat, illiteracy, high age and low BMI were independently associated with reduced insulin secretion, whereas Sikh religion, increasing age and BMI, as well as a family history of diabetes were independently associated with increased insulin resistance. CONCLUSIONS Gestational diabetes risk factors influence insulin secretion and action in North Indian women in a differential manner. Gestational diabetes classified using the adapted GDM2013 compared with GDM1999 criteria is associated with more severe impairments of insulin secretion and action.
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Affiliation(s)
- G P Arora
- Deep Hospital, Ludhiana, Punjab, India
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - P Almgren
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - R G Thaman
- Deep Hospital, Ludhiana, Punjab, India
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - A Pal
- Punjab Agriculture University, Ludhiana, India
| | - L Groop
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
- Finnish Institute of Molecular Medicine (FIMM), Helsinki University, Helsinki, Finland
| | - A Vaag
- Department of Endocrinology (Diabetes and Metabolism), Rigshospitalet, Denmark
- Astrazeneca, Gothenburg, Sweden
| | - R B Prasad
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - C Brøns
- Department of Endocrinology (Diabetes and Metabolism), Rigshospitalet, Denmark
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Abstract
Twenty years ago, Hales and Barker along with their co-workers published some of their pioneering papers proposing the 'thrifty phenotype hypothesis' in Diabetologia (4;35:595-601 and 3;36:62-67). Their postulate that fetal programming could represent an important player in the origin of type 2 diabetes, the metabolic syndrome and cardiovascular disease (CVD) was met with great scepticism.More recently, their observations have been confirmed and expanded in many epidemiological and animal experimental studies, and human integrative physiological studies have provided insights into some of the underlying molecular mechanisms. Type 2 diabetes is a multiple-organ disease, and developmental programming, with its idea of organ plasticity, is a plausible hypothesis for a common basis for the widespread organ dysfunctions in type 2 diabetes and the metabolic syndrome. Only two among the 45 known type 2 diabetes susceptibility genes are associated with low birthweight, indicating that the association between low birthweight and type 2 diabetes is mainly non-genetic. Prevention programmes targeting adult lifestyle factors seems unable to stop the global propagation of type 2 diabetes, and intensive glucose control is inadequate to reduce the excess CVD mortality in type 2 diabetic patients. Today, the thrifty phenotype hypothesis has been established as a promising conceptual framework for a more sustainable intergenerational prevention of type 2 diabetes.
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Affiliation(s)
- A A Vaag
- Department of Endocrinology, Rigshospitalet (7652), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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