Reach further, in an Open Access Journal Endocrinology, Diabetes & Metabolism Case Reports

ISSN 1470-3947 (print)
ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology

Published by BioScientifica
Endocrine Abstracts (2017) 50 OC2.6 
| DOI:10.1530/endoabs.50.OC2.6
|

Reduced early GLP-1 response in gestational diabetes is associated with hyperinsulinaemia and insulin resistance: a prospective case-control study

Nithya Sukumar1, Christos Bagias1, Ilona Goljan2, Seley Gharanei1, Bee Tan1, Jens Juls Holst3 & Ponnusamy Sa1,2

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Background: Glucagon-like peptide-1 (GLP-1) concentrations are reduced by 20–50% in type 2 diabetes but studies in women with gestational diabetes mellitus (GDM) are inconclusive. Our aim was to study the GLP-1 profile during a glucose tolerance test (GTT) at GDM diagnosis and its relationship with insulin levels.

Methods: A prospective study of selectively screened women was conducted. Plasma GLP-1, insulin and glucose were measured at 30-minute intervals during a 2-hour 75 g GTT. GDM was diagnosed according to UK NICE guidelines (glucose0min ≥5.6 mmol/l or glucose120min ≥7.8 mmol/l) and the parameters were additionally considered as continuous variables in linear regression models.

Results: Hundred and forty-five women were recruited and 19 developed GDM (glucose120min range 7.8–12.1 mmol/l). 19 controls, with the lowest glucose120min values in our cohort (range 4.0–4.5 mmol/l), were identified. GLP30min concentrations were significantly lower in GDM women than controls after adjusting for covariates (Table 1). GLP-1 total area under the curve (AUC) was reduced by 13% in GDM (adjusted P<0.05) but mean GLP-1 and incremental AUC were similar. Serum insulin levels from 0 to 90 min were similar in the two groups but GDM women had over two times higher insulin120min (481 vs 211 pmol/l, adjusted P=0.001). GLP0min and GLP30min were negatively correlated with insulin120min. GLP30min also independently predicted insulin sensitivity index, measured by Stumvoll formula (β-coefficient=0.152, P=0.038), thus contributing to post-prandial hyperglycaemia. There were no associations between GLP-1 levels at other time-points and any glucose or insulin parameters.

GLP levels (pmol/l)GDMControlsAdj p-valueBMI, age, ethnicity, smoking
GLP0min13.6±4.4615.7±4.08NS
GLP30min15.9±3.8919.8±4.520.041
GLP60min18.1±4.9620.6±4.44NS
GLP90min18.3±4.4920.2±4.84NS
GLP120min18.2±4.6118.8±4.66NS

Conclusion: Total and early (GLP30min) GLP-1 response are reduced by 13–20% in GDM women respectively. Lower GLP30min levels are independently linked to lower insulin sensitivity, thus suggesting a novel mechanism to explain the pathogenesis of GDM.

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