AIMS/HYPOTHESIS This study aimed to determine, in women with gestational diabetes (GDM), the changes in insulin sensitivity (Matsuda Insulin Sensitivity Index; ISOGTT), insulin response and disposition index (DI) from late pregnancy (34-37 weeks gestation, T1), to early postpartum (1-5 days, T2) and late postpartum (6-12 weeks, T3). A secondary aim was to correlate the longitudinal changes in maternal lipids, adipokines, cytokines and weight in relation to the changes in ISOGTT, insulin response and DI. METHODS ISOGTT, insulin response and DI were calculated at the three time points (T1, T2 and T3) using the results of a 75 g OGTT. Adipokines, cytokines and lipids were measured prior to each OGTT. Linear mixed-effects models were used to compare changes across each time point. Changes in ISOGTT, insulin response and DI were correlated with changes in maternal adipokines, cytokines and lipids at each time point. RESULTS A total of 27 women completed all assessments. Compared with T1, ISOGTT was 11.20 (95% CI 8.09, 14.31) units higher at 1-5 days postpartum (p < 0.001) and was 5.49 (95% CI 2.38, 8.60) units higher at 6-12 weeks postpartum (p < 0.001). Compared with T1, insulin response values were 699.6 (95% CI 957.5, 441.6) units lower at T2 (p < 0.001) and were 356.3 (95% CI 614.3, 98.3) units lower at T3 (p = 0.004). Compared with T1, the DI was 6434.1 (95% CI 2486.2, 10,381.0) units higher at T2 (p = 0.001) and was 4262.0 (95% CI 314.6, 8209.3) units higher at T3 (p = 0.03). There was a decrease in mean cholesterol, triacylglycerol, LDL-cholesterol and VLDL-cholesterol from T1 to T2 (all p < 0.001), and an increase in mean C-reactive protein, IL-6 and IL-8 from T1 to T2 (all p < 0.001). Mean leptin decreased from T1 to T2 (p = 0.001). There was no significant change in mean adiponectin (p = 0.99) or TNF-α (p = 0.81) from T1 to T2. The mean maternal BMI decreased from T1 to T2 (p = 0.001) and T3 (p < 0.001). There were no significant correlations between any measure of change in ISOGTT, insulin response and DI and change in maternal cytokines, adipokines, lipids or weight from T1 to T2. CONCLUSIONS/INTERPRETATION In women with GDM, delivery was associated with improvement in both insulin sensitivity and insulin production within the first few days. Improvement in insulin production persisted for 6-12 weeks, but insulin sensitivity deteriorated slightly. These changes in glucose metabolism were not associated to changes in lipids, leptin, inflammation markers or body weight. TRIAL REGISTRATION ClinicalTrials.gov NCT02082301.

中文翻译：

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从妊娠晚期到产后，妊娠糖尿病妇女的糖代谢纵向变化。

目的/假设这项研究旨在确定妊娠糖尿病（GDM）妇女的妊娠晚期（妊娠34-37周）的胰岛素敏感性（Matsuda胰岛素敏感性指数； ISOGTT），胰岛素反应和处置指数（DI）的变化。 T1），产后早期（1-5天，T2）和产后晚期（6-12周，T3）。第二个目的是将母体脂质，脂肪因子，细胞因子和体重的纵向变化与ISOGTT，胰岛素反应和DI的变化相关联。方法使用75 g OGTT的结果在三个时间点（T1，T2和T3）计算ISOGTT，胰岛素反应和DI。每次OGTT前都要测量脂肪因子，细胞因子和脂质。线性混合效应模型用于比较每个时间点的变化。ISOGTT的变化，在每个时间点，胰岛素反应和DI与母体脂肪因子，细胞因子和脂质的变化相关。结果共有27名妇女完成了所有评估。与T1相比，ISOGTT在产后1-5天升高了11.20（95％CI 8.09，14.31）个单位（p <0.001），在产后6-12周升高了5.49（95％CI 2.38，8.60）个单位（p <0.001） 0.001）。与T1相比，在T2时胰岛素反应值降低了699.6（95％CI 957.5，441.6）个单位（p <0.001），在T3时胰岛素反应值降低了356.3（95％CI 614.3，98.3）个单位（p = 0.004）。与T1相比，DI在T2时增加6434.1（95％CI 2486.2，10,381.0）个单位（p = 0.001），在T3时增加4262.0（95％CI 314.6，8209.3）个单位（p = 0.03）。从T1到T2，平均胆固醇，三酰基甘油，LDL-胆固醇和VLDL-胆固醇均降低（所有p <0.001），从T1到T2的平均C反应蛋白，IL-6和IL-8均增加（所有p <0.001）。瘦素平均水平从T1降至T2（p = 0.001）。从T1到T2，平均脂联素（p = 0.99）或TNF-α（p = 0.81）没有显着变化。孕妇平均BMI从T1降至T2（p = 0.001）和T3（p <0.001）。从T1到T2，ISOGTT，胰岛素反应和DI的任何变化与母体细胞因子，脂肪因子，脂质或体重的变化之间均无显着相关性。结论/解释对于患有GDM的女性，分娩与头几天内胰岛素敏感性和胰岛素产生的改善有关。胰岛素产生的改善持续了6-12周，但胰岛素敏感性略有下降。葡萄糖代谢的这些变化与脂质的变化无关，瘦素，炎症标志物或体重。试验注册ClinicalTrials.gov NCT02082301。