Study of Possible Relation between Fasting Plasma Glucagon, Gestational Diabetes and Development of Type 2 DM

Author(s): Ashraf Okba, Salwa Seddik Hosny, Alyaa Elsherbeny*, Manal Mohsin Kamal.

Journal Name: Current Diabetes Reviews

Volume 16 , Issue 2 , 2020

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Abstract:

Background and Aims: Women who develop GDM (gestational diabetes mellitus) have a relative insulin secretion deficiency, the severity of which may be predictive for later development of diabetes. This study aimed to investigate the role of fasting plasma glucagon in the prediction of later development of diabetes in pregnant women with GDM.

Materials and Methods: The study was conducted on 150 pregnant women with GDM after giving informed oral and written consents and being approved by the research ethical committee according to the declaration of Helsinki. The study was conducted in two phases, first phase during pregnancy and the second one was 6 months post-partum, as we measured fasting plasma glucagon before and after delivery together with fasting and 2 hour post-prandial plasma sugar.

Results: Our findings suggested that glucagon levels significantly increased after delivery in the majority 14/25 (56%) of GDM women who developed type 2 DM within 6 months after delivery compared to 6/20 (30%) patients with impaired fasting plasma glucose (IFG) and only 22/105 (20%) non DM women, as the median glucagon levels were 80,76, 55, respectively. Also, there was a high statistical difference between fasting plasma glucagon post-delivery among diabetic and non-diabetic women (p ≤ 0.001). These results indicated the useful role of assessing fasting plasma glucagon before and after delivery in patients with GDM to predict the possibility of type 2 DM.

Conclusion: There is a relatively high glucagon level in GDM patients, which is a significant pathogenic factor in the incidence of subsequent diabetes in women with a history of GDM. This could be important in the design of follow-up programs for women with previous GDM.

Keywords: Gestational diabetes mellitus, glucagons, fasting, plasma, IFG, post-prandial.

[1]
Lencioni C, Resi V, Romero F, et al. Glucagon-like peptide-1 secretion in women with gestational diabetes mellitus during and after pregnancy Department of Endocrinology and Metabolism-Section of Diabetes, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy. J Endocrinol Invest 2011; 34: e287-90.
[PMID: 21666414]
[2]
Kuhl C, Holst JJ. Plasma glucagon and the insulin:glucagon ratio in gestational diabetes. Diabetes 1976; 25(1): 16-23.
[http://dx.doi.org/dx.doi. org/10.2337/diab.25.1.16] [PMID: 1245265]
[3]
American Diabetes Association. Preconception care of women with diabetes. Diabetes Care 2003; 26(Suppl. 1): S91-3.
[http://dx.doi.org/10.2337/diacare.26.2007.S91] [PMID: 12502628]
[4]
Bonora E, Formentini G, Calaterra F, et al. HOM-estimated insulin resistance is independent predictor of cardiovascular disease in type 2 diabetic subjects. Diabetes Care 2002; 25: 1135-41.
[http://dx.doi.org/10.2337/diacare.25.7.1135] [PMID: 12087010]
[5]
Qu HQ, Li Q, Rentfro AR, Fisher-Hoch SP, McCormick JB. The definition of insulin resistance using HOMA-IR for Americans of Mexican descent using machine learning. PLoS One 2011; 6(6)e21041
[http://dx.doi.org/10.1371/journal.pone.0021041] [PMID: 21695082]
[6]
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28(7): 412-9.
[http://dx.doi.org/10.1007/BF00280883] [PMID: 3899825]
[7]
Hædersdal S, Lund A, Knop FK, Vilsbøll T. The role of glucagon in the pathophysiology and treatment of type 2 diabetes. Mayo Clin Proc 2018; 93(2): 217-39.
[http://dx.doi.org/10.1016/j.mayocp. 2017.12.003] [PMID: 293075 53]
[8]
National Diabetes Clearinghouse 2011. national diabetes statistics US department of health and human services Retrieved 222014.
[9]
Jiang G1. Zhang BB. Glucagon regulation of metabolic fuel supply. Proceedings VIII Congress of the International Diabetes Federation. Am J Physiol Endocrinol Metab 2003; 284(4): E671-8.
[PMID: 12626323]
[10]
Day JL, Tattersall RB. Glucagon secretion in unaffected monozygotic twins of juvenile diabetics. Metabolism 1975; 24(2): 145-51.
[http://dx.doi.org/10.1016/0026-0495(75)90015-3] [PMID: 11676 15]
[11]
Metzger BE, Cho NH, Roston SM, Radvany R. Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus. Diabetes Care 1993; 16(12): 1598-605.
[http://dx.doi.org/10.2337/diacare.16.12.1598] [PMID: 8299456]
[12]
Damm P, Kühl C, Bertelsen A, Mølsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol 1992; 167(3): 607-16.
[http://dx.doi.org/10.1016/S0002-9378(11)91559-2] [PMID: 1530012]
[13]
Lam KS, Li DF, Lauder IJ, Lee CP, Kung AW, Ma JT. Prediction of persistent carbohydrate intolerance in patients with gestational diabetes. Diabetes Res Clin Pract 1991; 12(3): 181-6.
[http://dx.doi.org/10.1016/0168-8227(91)90075-O] [PMID: 18893 47]


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Article Details

VOLUME: 16
ISSUE: 2
Year: 2020
Page: [148 - 155]
Pages: 8
DOI: 10.2174/1573399815666190405171907
Price: $65

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