Diabetes Metab J.  2011 Feb;35(1):58-64. 10.4093/dmj.2011.35.1.58.

Insulin Secretion and Incretin Hormone Concentration in Women with Previous Gestational Diabetes Mellitus

• Yu SH
• Cho B
• Lee Y
• Kim E
• Choi SH
• Lim S
• Yi KH
• Park YJ
• Park KS
• Jang HC

• KMID: 2281493
• DOI: http://doi.org/10.4093/dmj.2011.35.1.58

Abstract

BACKGROUND
We examined the change in the levels of incretin hormone and effects of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) on insulin secretion in women with previous gestational diabetes (pGDM).
METHODS
A 75-g oral glucose tolerance test (OGTT) was conducted on 34 women with pGDM. In addition, 11 women with normal glucose tolerance, matched for age, height and weight, were also tested. The insulin, GIP, GLP-1, and glucagon concentrations were measured, and their anthropometric and biochemical markers were also measured.
RESULTS
Among 34 women with pGDM, 18 had normal glucose tolerance, 13 had impaired glucose tolerance (IGT) and 1 had diabetes. No significant differences were found in GLP-1 concentration between the pGDM and control group. However, a significantly high level of glucagon was present in the pGDM group at 30 minutes into the OGTT. The GIP concentration was elevated at 30 minutes and 60 minutes in the pGDM group. With the exception of the 30-minute timepoint, women with IGT had significantly high blood glucose from 0 to 120 minutes. However, there was no significant difference in insulin or GLP-1 concentration. The GIP level was significantly high from 0 to 90 minutes in patients diagnosed with IGT.
CONCLUSION
GLP-1 secretion does not differ between pGDM patients and normal women. GIP was elevated, but that does not seem to induce in increase in insulin secretion. Therefore, we conclude that other factors such as heredity and environment play important roles in the development of type 2 diabetes.

Keyword

Gestational diabetes mellitus; Glucagon; Glucagon-like peptide 1; Glucose-dependent insulinotropic polypeptide; Insulin secretion

MeSH Terms

Biomarkers
Blood Glucose
Diabetes, Gestational
Female
Glucagon
Glucagon-Like Peptide 1
Glucose
Glucose Tolerance Test
Heredity
Humans
Incretins
Insulin
Pregnancy
Blood Glucose
Glucagon
Glucagon-Like Peptide 1
Glucose
Incretins
Insulin

Figure

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  Fig. 1 Plasma concentrations of glucose (A), insulin (B), glucagon like pepide1 (GLP-1) (C), glucose-dependent insulinotropic polypeptide (GIP) (D), and glucagon (E) after the ingestion of 75-g oral glucose in 34 women with a history of previous gestational diabetes mellitus (pGDM) (square symbols) and 11 control women (round symbols). Data are presented as means±standard deviation; P values were calculated using repeated measures ANOVA. aSignificant differences at individual time points (P<0.05 by one-way ANOVA).

• 

  Fig. 2 Plasma concentrations of glucose (A), insulin (B), glucagon like pepide1 (GLP-1) (C), glucose-dependent insulinotropic polypeptide (GIP) (D), and glucagon (E) after the ingestion of 75-g oral glucose in 13 women with impaired glucose tolerance (IGT) (square symbols) and 11 control women (round symbols). Data are presented as means±standard deviation; P values were calculated using repeated measures ANOVA. aSignificant differences at individual time points (P<0.05 by one-way ANOVA).

Reference

1. Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes. 1991. 40:Suppl 2. 197–201.

2. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005. 115:485–491.

3. Hong ES, Lee HJ, Hong YS, Sung EA, Jang YJ. Pospartum assessment of insulin secretion and sensitivity in women with gestational diabetes mellitus (GDM). J Korean Diabetes Assoc. 2002. 26:319–327.

4. Lim S, Choi SH, Park YJ, Park KS, Lee HK, Jang HC, Cho NH, Metzger BE. Visceral fatness and insulin sensitivity in women with a previous history of gestational diabetes mellitus. Diabetes Care. 2007. 30:348–353.

5. Ebert R, Creutzfeldt W. Gastrointestinal peptides and insulin secretion. Diabetes Metab Rev. 1987. 3:1–26.

6. Unger RH, Eisentraut AM. Entero-insular axis. Arch Intern Med. 1969. 123:261–266.

7. Gerich JE. The genetic basis of type 2 diabetes mellitus: impaired insulin secretion versus impaired insulin sensitivity. Endocr Rev. 1998. 19:491–503.

8. Nauck M, Stockmann F, Ebert R, Creutzfeldt W. Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1986. 29:46–52.

9. Vilsboll T, Krarup T, Madsbad S, Holst JJ. Defective amplification of the late phase insulin response to glucose by GIP in obese type II diabetic patients. Diabetologia. 2002. 45:1111–1119.

10. Cypryk K, Vilsboll T, Nadel I, Smyczynska J, Holst JJ, Lewinski A. Normal secretion of the incretin hormones glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 during gestational diabetes mellitus. Gynecol Endocrinol. 2007. 23:58–62.

11. Forbes S, Moonan M, Robinson S, Anyaoku V, Patterson M, Murphy KG, Ghatei MA, Bloom SR, Johnston DG. Impaired circulating glucagon-like peptide-1 response to oral glucose in women with previous gestational diabetes. Clin Endocrinol (Oxf). 2005. 62:51–55.

12. Jang HC, Yim CH, Han KO, Yoon HK, Han IK, Kim MY, Yang JH, Cho NH. Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum. Diabetes Res Clin Pract. 2003. 61:117–124.

13. Jang HC, Cho YM, Park KS, Kim SY, Lee HK, Kim MY, Yang JH, Shin SM. Pregnancy outcome in Korean women with gestational diabetes mellitus diagnosed by the carpenter-coustan criteria. J Korean Diabetes Assoc. 2004. 28:122–130.

14. Katsuki A, Sumida Y, Gabazza EC, Murashima S, Furuta M, Araki-Sasaki R, Hori Y, Yano Y, Adachi Y. Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes. Diabetes Care. 2001. 24:362–365.

15. Jensen SL, Nielsen OV, Kuhl C. The enteral insulin-stimulation after pancreas transplantation in the pig. Diabetologia. 1976. 12:617–620.

16. Meier JJ, Gallwitz B, Askenas M, Vollmer K, Deacon CF, Holst JJ, Schmidt WE, Nauck MA. Secretion of incretin hormones and the insulinotropic effect of gastric inhibitory polypeptide in women with a history of gestational diabetes. Diabetologia. 2005. 48:1872–1881.

17. Nauck MA, El-Ouaghlidi A, Gabrys B, Hucking K, Holst JJ, Deacon CF, Gallwitz B, Schmidt WE, Meier JJ. Secretion of incretin hormones (GIP and GLP-1) and incretin effect after oral glucose in first-degree relatives of patients with type 2 diabetes. Regul Pept. 2004. 122:209–217.

18. Nyholm B, Walker M, Gravholt CH, Shearing PA, Sturis J, Alberti KG, Holst JJ, Schmitz O. Twenty-four-hour insulin secretion rates, circulating concentrations of fuel substrates and gut incretin hormones in healthy offspring of type II (non-insulin-dependent) diabetic parents: evidence of several aberrations. Diabetologia. 1999. 42:1314–1323.

19. Hansotia T, Drucker DJ. GIP and GLP-1 as incretin hormones: lessons from single and double incretin receptor knockout mice. Regul Pept. 2005. 128:125–134.