Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period

AIMS/HYPOTHESIS

This study aimed to determine, in women with gestational diabetes (GDM), the changes in insulin sensitivity (Matsuda Insulin Sensitivity Index; IS_OGTT), insulin response and disposition index (DI) from late pregnancy (34-37 weeks gestation, T1), to early postpartum (1-5 days, T2) and late postpartum (6-12 weeks, T3). A secondary aim was to correlate the longitudinal changes in maternal lipids, adipokines, cytokines and weight in relation to the changes in IS_OGTT, insulin response and DI.

METHODS

IS_OGTT, insulin response and DI were calculated at the three time points (T1, T2 and T3) using the results of a 75 g OGTT. Adipokines, cytokines and lipids were measured prior to each OGTT. Linear mixed-effects models were used to compare changes across each time point. Changes in IS_OGTT, insulin response and DI were correlated with changes in maternal adipokines, cytokines and lipids at each time point.

RESULTS

A total of 27 women completed all assessments. Compared with T1, IS_OGTT was 11.20 (95% CI 8.09, 14.31) units higher at 1-5 days postpartum (p < 0.001) and was 5.49 (95% CI 2.38, 8.60) units higher at 6-12 weeks postpartum (p < 0.001). Compared with T1, insulin response values were 699.6 (95% CI 957.5, 441.6) units lower at T2 (p < 0.001) and were 356.3 (95% CI 614.3, 98.3) units lower at T3 (p = 0.004). Compared with T1, the DI was 6434.1 (95% CI 2486.2, 10,381.0) units higher at T2 (p = 0.001) and was 4262.0 (95% CI 314.6, 8209.3) units higher at T3 (p = 0.03). There was a decrease in mean cholesterol, triacylglycerol, LDL-cholesterol and VLDL-cholesterol from T1 to T2 (all p < 0.001), and an increase in mean C-reactive protein, IL-6 and IL-8 from T1 to T2 (all p < 0.001). Mean leptin decreased from T1 to T2 (p = 0.001). There was no significant change in mean adiponectin (p = 0.99) or TNF-α (p = 0.81) from T1 to T2. The mean maternal BMI decreased from T1 to T2 (p = 0.001) and T3 (p < 0.001). There were no significant correlations between any measure of change in IS_OGTT, insulin response and DI and change in maternal cytokines, adipokines, lipids or weight from T1 to T2.

CONCLUSIONS/INTERPRETATION

In women with GDM, delivery was associated with improvement in both insulin sensitivity and insulin production within the first few days. Improvement in insulin production persisted for 6-12 weeks, but insulin sensitivity deteriorated slightly. These changes in glucose metabolism were not associated to changes in lipids, leptin, inflammation markers or body weight.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02082301.

Studies on the effect of diadenlyated nucleotides on calcium mobilization and prostacyclin synthesis in bovine aortic endothelial cells

Extracellular adenine dinucleotides are modulators of blood vessel tone. We have previously demonstrated that Ap(2)A and Ap(4)A induce the synthesis of nitric oxide (NO) from bovine aortic endothelial cells (BAEC) while Ap(3)A and Ap(5)A do not [FEBS Lett. 427 (1998) 320; Arch. Biochem. Biophys. 364 (1999) 280.]. In this communication we determine the effect of Ap(x)As (x=2-5) on prostacyclin (PGI(2)) synthesis and Ca(2+) mobilization in BAEC. Ap(2)A and Ap(4)A significantly enhanced the synthesis of PGI(2) while Ap(3)A and Ap(5)A do not. These data support the notion that Ap(2)A and Ap(4)A are vasodilators. All four dinucleotides significantly enhanced Ca(2+) mobilization over basal levels. Ap(5)A and Ap(3)A enhanced 2.0 and 1.6 times more Ca(2+) release than Ap(4)A, respectively. Since neither Ap(5)A nor Ap(3)A enhanced the synthesis of either PGI(2) or NO but did mobilize Ca(2+), these data support the hypothesis that in BAEC Ca(2+) release is localized or compartmentalized.