Analysis of Insulin Secretion and Resistance in Gestational Diabetes

本研究的目的是评估妊娠期糖尿病（GDM）患者的胰岛素动力学，并根据胰岛素反应模式比较围产期结局。连续925名妇女中有22名被诊断为GDM。110例正常妊娠妇女作为对照。通过2小时75 g OGTT评价血糖水平和胰岛素反应。测定免疫反应性胰岛素（IRI）、葡萄糖曲线下面积（AUC）（AUCg）、胰岛素AUC（AUCi）和胰岛素生成指数（II=ΔIRI 30 '/Δ BS 30'）。根据正常对照组AUCi的平均值± 2SD，将GDM患者分为高胰岛素血症组、正常胰岛素血症组和低胰岛素血症组。比较GDM亚组和对照组的临床和实验室检查结果。GDM患者在75 g OGTT早期表现出对葡萄糖刺激的胰岛素分泌受损，血浆胰岛素水平低（30“）和胰岛素/葡萄糖比率降低（30”和60“）。GDM患者的II值和AUCi/AUCg值较对照组降低。这些降低的胰岛素反应在低胰岛素血症和正常胰岛素血症的GDM患者中是显著的，但在高胰岛素血症的GDM患者中未检测到。正常和低胰岛素血症的GDM患者的大于胎龄儿发生率显著高于高胰岛素血症的GDM患者或对照组。高胰岛素血症GDM患者妊娠高血压发生率高（40%）.高胰岛素血症GDM患者孕前体重指数显著高于正常胰岛素血症GDM患者和对照组。结果表明，不仅胰岛素分泌，而且围产期的临床特征GDM亚组之间的差异。由此证实了该病的异质性。

The aim of this study was to evaluate the insulin dynamics of patients with gestational diabetes mellitus (GDM) and to compare perinatal outcomes according to the insulin response patterns. Twenty-two of consecutive 925 women examined were diagnosed as having GDM. One hundred ten women who experienced normal pregnancy were used as controls. Plasma glucose levels and insulin responses were evaluated by 2-hours 75 g OGTT. Immunoreactive insulin (IRI), area under the curves (AUC) of glucose (AUCg), AUC of insulin (AUCi), and insulinogenic index (II=ΔIRI 30'/ΔBS30') were measured. The GDM patients were divided into three subgroups, consisting of a hyper-, normo-, and hypoinsulinemia group, according to the mean ± 2SD of AUCi obtained from the controls. Clinical and laboratory findings were compared among the GDM subgroups and controls. The GDM patients showed impaired insulin secretion to glucose stimuli, with low plasma insulin levels (30') and reduced insulin/glucose ratios (30' and 60') early in 75 g OGTT. The II and AUCi/AUCg values of GDM patients were reduced as compared with those of controls. These reduced insulin responses were remarkable in hypo- and normoinsulinemic GDM patients, but were not detected in hyperinsulinemic GDM patients. The rate of large for gestational age baby in normo- and hypoinsulinemic GDM patients was significantly higher than that of hyperinsulinemic GDM patients or controls. Hyperinsulinemic GDM patients had a high frequency of pregnancy induced hypertension (40 %). Body mass index prior to pregnancy of hyperinsulinemic GDM Patients was significantly higher than that of normoinsulinemic GDM patients or controls. It was demonstrated that not only insulin secretion but also perinatal clinical characteristics differed among the GDM subgroups. The heterogeneity of the disease was thus confirmed.