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Former gestational diabetes: mathematical modeling of intravenous glucose tolerance test for the assessment of insulin clearance and its determinants. (English) Zbl 1470.92152

Summary: Women with a previous history of gestational diabetes mellitus (GDM) have increased risk of developing GDM in future pregnancies (i.e. recurrent GDM) and also type 2 diabetes (T2D). Insulin clearance represents one of the processes regulating glucose tolerance but has been scarcely investigated for its possible impairment in high-risk subjects. The aim of this study was to identify possible determinants of insulin clearance in women with a previous history of GDM. A detailed model-based analysis of a regular 3-hour, insulin-modified intravenous glucose tolerance test (IM-IVGTT) has been performed in women with a previous history of GDM (pGDM, \(n = 115\)) and in women who had a healthy pregnancy (CNT, \(n = 41\)) to assess total, first-phase and second-phase insulin clearance (\(\mathrm{Cl}_{\mathrm{INS-TOT}}, \mathrm{Cl}_{\mathrm{INS-FP}}\) and \(\mathrm{Cl}_{\mathrm{INS-SP}}\)) and other metabolic parameters (insulin sensitivity \(\mathrm{S}_{\mathrm{I}}\), glucose effectiveness \(\mathrm{S}_{\mathrm{G}}\), beta-cell function and disposition index DI). \(\mathrm{Cl}_{\mathrm{INS-SP}}\) was found increased in pGDM with respect to CNT and was found significantly inversely linearly correlated with \(\mathrm{S}_{\mathrm{G}}\) (\(r = -0.20\), \(p = 0.03\), slope: -16.2, 95% CI -30.9 to -1.4, intercept: 1.1, 95% CI 0.7-1.4) and also with DI (\(r = -0.22\), \(p = 0.02\), slope: -10.0, 95% CI -18.5 to -1.6, intercept: 0.9, 95% CI 0.7-1.3). Disposition index, accounting for the combined contribution of insulin sensitivity and beta-cell function, and glucose effectiveness were identified as possible determinants of insulin clearance in women with a previous history of GDM. This may be of relevance for more accurate estimation and prevention of the risk for recurrent GDM and T2D.

MSC:

92C50 Medical applications (general)
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