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High Calorie Consumption after GDM Leads to Increased Insulin Resistance in Hispanic Women

The women also experienced reduced beta cell function….

Researchers from the University of Southern California, Los Angeles, assessed associations between dietary intake and rates of change in insulin resistance and β-cell function in Hispanic women with prior gestational diabetes mellitus (GDM).

Sixty-two nondiabetic Hispanic women with pregnancies complicated by GDM completed oral and intravenous glucose tolerance tests and bioelectrical impedance measurements of body fat every 12–15 months postpartum for up to 12 years. Self-reported dietary intake was collected at all visits by structured food frequency questionnaires developed for Hispanics. Mixed-effects models were used to assess the relationship between dietary intake and rates of change in metabolic outcomes during follow-up.

The median length of follow-up from the first postpartum evaluation was 8.0 years (interquartile range 4.5–10.8 years). At baseline, women were 32 ± 5.7 years old and had a median calorie intake of 2,091 kcal/day. Over the course of follow-up, dietary intake did not change significantly. Higher baseline calorie intake was associated with a faster decline in insulin sensitivity, measured by the insulin sensitivity index (SI) (P = 0.029), and β-cell compensation, measured by the disposition index (DI) (P = 0.027), over time. These associations remained after adjustment for baseline characteristics; changes in BMI, calorie intake, levels of physical activity; and additional pregnancies during the follow-up period. The median rates were −0.06 vs. −0.02 units/year for SI and −810 vs. −692 units/year for DI for women with baseline calorie intake above versus below the cohort median.

The researchers concluded that, “High calorie intake is associated with a faster decline in insulin sensitivity and β-cell compensation in Hispanic women who are at high risk for type 2 diabetes, independent of adiposity.”

Practice Pearls:

  • In this study, Hispanic women demonstrated declining insulin sensitivity and beta function with high daily calorie intake
  • This study provided more realistic information about long-term dietary intake in a free-living environment
  • Pregnant women who are at risk of gestational diabetes mellitus should always discuss with their physician about controlling daily calorie intake during and after pregnancy

Chen Z, Watanabe R, Stram D, Buchanan T, Xiang A, et al. High calorie intake is associated with worsening insulin resistance and B-cell function in Hispanic after gestational diabetes mellitus. Diabetes Care. 2014; 37:3294-3300.