Antepartum predictors of the development of type 2 diabetes in Latino women 11-26 months after pregnancies complicated by gestational diabetes

In this study, we sought to identify antepartum characteristics that predic t the de novo development diabetes 11-26 months after the index pregnancy i n a carefully characterized cohort of women with gestational diabetes melli tus (GDM). Oral and frequently sampled intravenous glucose tolerance tests (OGTTs and FSIGTs), hyperinsulinemic-euglycemic clamps with labeled glucose , and body composition studies were performed on 91 islet cell antibody-neg ative Latino women with GDM during the third trimester of pregnancy. The wo men were documented to be diabetes-free within 6 months postpartum. Their d iabetes status was ascertained again between 11 and 26 months postpartum. L ogistic regression analysis was used to identify independent predictors of the development of diabetes within that interval. Fourteen of the women dev eloped diabetes by World Health Organization criteria 11-26 months after de livery of the index pregnancy. Three antepartum variables were independent predictors of diabetes: the 1-h postchallenge plasma glucose concentration from the 100-g OGTT at which GDM was diagnosed (higher = increased risk; P = 0.003); an index of pancreatic beta-cell compensation for insulin resista nce, defined as the product of the 30-min incremental plasma insulin:glucos e ratio on a 75-g OGTT and the insulin sensitivity index from a hyperinsuli nemic-euglycemic clamp (lower = increased risk, P = 0.009); and the basal g lucose production rate after an overnight fast (higher = increased risk; P = 0.04). We conclude that postchallen,be hyperglycemia, poor pancreatic bet a-cell compensation for insulin resistance, and elevated endogenous glucose production during pregnancy precede the development of type 2 diabetes in young Latino women by at least 1-2 years.