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儿结局。在连续接受检查的925名妇女中，有22人被诊断为妊娠期糖尿病。110例正常妊娠妇女作为对照。用2小时75g口服葡萄糖耐量试验评价血糖水平和胰岛素反应。测定免疫反应性胰岛素(IRI)、血糖曲线下面积(AUCG)、胰岛素曲线下面积(AUC)和胰岛素生成指数(II=ΔIRI30‘/ΔBS30’)。根据正常对照组的Auci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结果。GDM患者表现出对葡萄糖刺激的胰岛素分泌受损，在75g OGTT早期血浆胰岛素水平(30‘)低，胰岛素/葡萄糖比值(30’和60‘)降低。妊娠期糖尿病患者的II和AUCI/AUCG值均低于正常对照组。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GDM患者中显著，但在高胰岛素血症GDM患者中检测不到。正常和低胰岛素血症的GDM患者的大胎儿率明显高于高胰岛素血症的GDM患者和对照组。高胰岛素血症的妊娠期糖尿病患者妊娠高血压综合征发生率高(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患者和正常对照组。结果表明，GDM各亚组间不仅胰岛素分泌不同，而且围产期临床特征也不同。从而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.