Endocrinol Metab.  2024 Oct;39(5):701-710. 10.3803/EnM.2024.1974.

Amelioration of Insulin Resistance after Delivery Is Associated with Reduced Risk of Postpartum Diabetes in Women with Gestational Diabetes Mellitus

• Son H
• Moon JH
• Choi SH
• Cho NH
• Kwak SH
• Jang HC

• KMID: 2560279
• DOI: http://doi.org/10.3803/EnM.2024.1974

Abstract

Background
Identifying risk factors for postpartum type 2 diabetes in women with gestational diabetes mellitus (GDM) is crucial for effective interventions. We examined whether changes in insulin sensitivity after delivery affects the risk of type 2 diabetes in women with GDM.
Methods
This prospective cohort study included 347 women with GDM or gestational impaired glucose tolerance, who attended the follow-up visits at 2 months postpartum and annually thereafter. Changes in insulin sensitivity were calculated using the Matsuda index at GDM diagnosis and at 2 months postpartum (ΔMatsuda index). After excluding women with pregestational diabetes or those followed up only once, we analyzed the risk of postpartum type 2 diabetes based on the ΔMatsuda index tertiles.
Results
The incidence of type 2 diabetes at the two-month postpartum visit decreased with increasing ΔMatsuda index tertiles (16.4%, 9.5%, and 1.8%, P=0.001). During a 4.1-year follow-up, 26 out of 230 women who attended more than two follow-up visits (11.3%) developed type 2 diabetes. Compared to the lowest tertile, subjects in the highest ΔMatsuda index tertile showed a significantly reduced risk of type 2 diabetes (hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.93; P=0.036) after adjusting for confounders.
Conclusion
Improvement in insulin sensitivity after delivery is associated with a reduced risk of postpartum type 2 diabetes in women with GDM. Postpartum changes in insulin sensitivity could be a useful prediction for future type 2 diabetes development in women with GDM.

Keyword

Diabetes, gestational; Diabetes mellitus, type 2; Insulin resistance; Insulin sensitivity

Figure

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  Fig. 1. Cumulative incidence of type 2 diabetes according to ∆Matsuda index. ∆Matsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. Lowest tertiles ranged from –10.9 to –0.9, middle tertile from –0.8 to 1.2, highest tertile ranged from 1.2 to 8.8. Hazard ratio (HR) of postpartum type 2 diabetes are calculated using Cox proportional model including ∆Matsuda index and variables associated with postpartum type 2 diabetes (gestational fasting blood glucose, postpartum BMI, age at birth, familial history of diabetes, parity). CI, confidence interval.

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