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Songwon Lecture 2025
Diabetes, obesity and metabolism
Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
Endocrinol Metab. 2026;41(1):26-33.   Published online February 3, 2026
DOI: https://doi.org/10.3803/EnM.2025.2852
  • 1,742 View
  • 68 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFPubReader   ePub   
Gestational diabetes mellitus (GDM) is increasing in prevalence worldwide, and postpartum glucose intolerance represents one of the major complications after delivery in women with GDM. A wide range of risk factors for postpartum glucose intolerance have been identified, including ethnicity, genetic predisposition, age, obesity, pre-pregnancy body mass index, gestational weight gain, history of GDM, family history of diabetes, degree of hyperglycemia, insulin treatment, lipid profiles, and other metabolic factors. Lifestyle interventions, including weight loss, are thought to reduce the risk of postpartum glucose intolerance. Careful attention should be paid to the screening of postpartum glucose intolerance in women with GDM, and concerted efforts should be made to prevent or delay the development of diabetes and other metabolic disorders.

Citations

Citations to this article as recorded by  
  • Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities
    Joon Ho Moon, Han Na Jung, Bongseong Kim, Seung-Hyun Ko, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
    Diabetes & Metabolism Journal.2026; 50(2): 280.     CrossRef
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Songwon Lecture 2024
Diabetes, obesity and metabolism
Gestational Diabetes Mellitus: Mechanisms Underlying Maternal and Fetal Complications
Jooyeop Lee, Na Keum Lee, Joon Ho Moon
Endocrinol Metab. 2025;40(1):10-25.   Published online January 23, 2025
DOI: https://doi.org/10.3803/EnM.2024.2264
  • 28,097 View
  • 1,014 Download
  • 34 Web of Science
  • 40 Crossref
AbstractAbstract PDFPubReader   ePub   
Gestational diabetes mellitus (GDM) affects over 10% of all pregnancies, both in Korea and worldwide. GDM not only increases the risk of adverse pregnancy outcomes such as preeclampsia, preterm birth, macrosomia, neonatal hypoglycemia, and shoulder dystocia, but it also significantly increases the risk of developing postpartum type 2 diabetes mellitus and cardiovascular disease in the mother. Additionally, GDM is linked to a higher risk of childhood obesity and diabetes in offspring, as well as neurodevelopmental disorders, including autistic spectrum disorder. This review offers a comprehensive summary of clinical epidemiological studies concerning maternal and fetal complications and explores mechanistic investigations that reveal the underlying pathophysiology.

Citations

Citations to this article as recorded by  
  • Impact of Maternal Obesity on Neonatal TSH Levels: A Prospective Study on the Influence of BMI
    Gökçe Çıplak, Gülsüm Kadıoğlu Şimşek, Özhan Akyol, Aylin Kayalı Akyol, Hayriye Gözde Kanmaz Kutman, Fuat Emre Canpolat
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    Current Obesity Reports.2026;[Epub]     CrossRef
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    Viktoria Xega, Jun-Li Liu
    Metabolism and Diseases.2026; 1(1): 100002.     CrossRef
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    Yeping Wang, Zhanwei Liang, Haixia Xu, Ye Wang, Weiwei Qu, Yanjun Hu, Kaixin Chen, Tao Peng, Xiaoqing Li, Lidong Wu
    Talanta.2026; 303: 129484.     CrossRef
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    Manman Zhu, Hao Yang, Bo Feng, Yi Jiang, Yaoyao Zhang
    Psychiatry Research.2026; 358: 116987.     CrossRef
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    Discover Applied Sciences.2026;[Epub]     CrossRef
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    Polina V. Popova, Elena A. Vasukova, Alexandra S. Tkachuk, Anna D. Anopova, Irina S. Nemikina, Elena V. Verbitskaya, Angelina I. Eriskovskaya, Elena Y. Vasilieva, Irina E. Zazerskaya, Ofeliia A. Bettikher, Olga A. Li, Tatiana M. Pervunina, Viswanathan Moh
    Diabetes Research and Clinical Practice.2026; 234: 113151.     CrossRef
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    Mai Ahmed, Dada Oluwaseyi Temilola, Mushi Matjila, Manogari Chetty
    Periodontal and Implant Research.2026;[Epub]     CrossRef
  • Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
    Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
    Endocrinology and Metabolism.2026; 41(1): 26.     CrossRef
  • Dose-response relationship between early pregnancy blood pressure and gestational diabetes mellitus based on propensity score matching: a retrospective study
    Rongrong Han, Yanqiang Guo, Minqiang Zhang, Jinhua Pan
    BMC Pregnancy and Childbirth.2026;[Epub]     CrossRef
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    Zenia Safwan, Emaan Ijaz, Hafsa Shamim, Arooj Fatima, Ashfaq Ahmad, Ahmed Murtaz Khalid
    Brain and Development.2026; 48(2): 104521.     CrossRef
  • Long-term risk of offspring type 1 and type 2 diabetes following maternal gestational diabetes mellitus: a nationwide birth cohort study with 10-year follow-up
    Joon Ho Moon, Han Na Jung, Bongseong Kim, Jaehyun Kim, Young Mi Jung, Hyeon Ji Kim, Jee Yoon Park, Tae Jung Oh, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
    BMC Medicine.2026;[Epub]     CrossRef
  • Umbilical cord asprosin and subfatin levels in relation to neonatal metabolic outcomes in gestational diabetes mellitus: a cross-sectional study
    Figen Efe Camili, Ozlem Kemer Aycan, Merve Akis Yilmaz, Bayram Burak Ceviz, Selim Afsar, Gurhan Guney, Mine Islimye Taskin
    BMC Endocrine Disorders.2026;[Epub]     CrossRef
  • Small Extracellular Vesicles in Gestational Diabetes Mellitus: Current Landscape and Emerging Diagnostic Horizons
    Mai Ahmed, Dada Oluwaseyi Temilola, Mushi Matjila, Manogari Chetty
    Journal of Extracellular Biology.2026;[Epub]     CrossRef
  • The Economic Burden of Gestational Diabetes and Body Mass Index Changes Between Pregnancies: A Retrospective Cohort Study
    Rashidul Alam Mahumud, Glynis Pauline Ross, Adam Mackie, Rachael L. Morton, Kirsten I. Black
    BJOG: An International Journal of Obstetrics & Gynaecology.2026;[Epub]     CrossRef
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    Lili Shi, Claudia I. García Zorba, Miller A. Dickerson, Carolyn L. Bayer
    Placenta.2026;[Epub]     CrossRef
  • Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities
    Joon Ho Moon, Han Na Jung, Bongseong Kim, Seung-Hyun Ko, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
    Diabetes & Metabolism Journal.2026; 50(2): 280.     CrossRef
  • The correlation between triglyceride-glucose index in early pregnancy (<20 weeks) and pregnancy complications and adverse pregnancy outcomes: a systematic review and meta-analysis
    Wenli Zhang, Junzhi Wang, Liangliang Chu, Xinyu Pi, Guochun Zhang
    Frontiers in Medicine.2026;[Epub]     CrossRef
  • Mixed Heavy Metal Exposure During Pregnancy Induces GDM-like Metabolic Dysfunction Associated with Glycer-Ophospholipid Metabolic Reprogramming and Altered Insig1 Expression: A Multi-Omics Study in Rats
    Tianao Sun, Zhanyue Zheng, Yongjie Ma, Minglian Pan, Yingjie Zhou, Jingxia Wei, Xinyu Yuan, Jinhao Wan, You Li, Yan Sun
    Toxics.2026; 14(4): 351.     CrossRef
  • Neutrophils and neutrophil extracellular traps in diabetes mellitus and its complications: Mechanisms and therapeutic implications
    Li Lei, Jiaying Liu, Yunrong Li, Bo Huang, Zhenzhuang Zou
    iScience.2026; 29(5): 115585.     CrossRef
  • Antenatal Screening Compliance for Gestational Diabetes and Its Effect on Maternal-Fetal Outcomes: A Pre- and Post-Intervention Clinical Audit
    Shumaila Jabeen, Hina Mumtaz, Maryam Hafeez
    Biological and Clinical Sciences Research Journal.2026; 7(3): 34.     CrossRef
  • Mogrosides as Dual-Function Sweeteners: A Comprehensive Review of Extraction, Metabolism, Antidiabetic Mechanisms, and Food Applications
    Qiqi Feng, Tao Wang, Qing Wang, Hongyu Pan, Yujie Zhong, Yongliang Zhuang
    Nutrients.2026; 18(9): 1342.     CrossRef
  • Association and discriminative value of early-pregnancy neck circumference for gestational diabetes mellitus: A prospective study based on logistic regression and machine learning models
    Feng Wang, Xiaohua Li, Huanliu He, Weidi Guo, Jiali Huang, Dan Li
    International Journal of Diabetes in Developing Countries.2026;[Epub]     CrossRef
  • Transient fetal hyperglycemia reprograms adipogenesis, lipogenesis, and insulin signaling in zebrafish
    Bridget Konadu, Madelyn K. Logan, Carol K. Cox, Kristin S. Edwards, Joshua S. Speed, Yann Gibert
    Biomedicine & Pharmacotherapy.2026; 199: 119445.     CrossRef
  • Metabolic obesity phenotypes and adverse pregnancy outcomes: a National Cross-Sectional study
    Tongxin Wang, Yuehua Tang, Qimeng Zhu, Wei Wang, Haoyang Xiang, Xinyue Chu, Xiude Fan, Ling Gao
    European Journal of Obstetrics & Gynecology and Reproductive Biology.2026; : 115215.     CrossRef
  • Unveiling Gestational Diabetes: An Overview of Pathophysiology and Management
    Rahul Mittal, Karan Prasad, Joana R. N. Lemos, Giuliana Arevalo, Khemraj Hirani
    International Journal of Molecular Sciences.2025; 26(5): 2320.     CrossRef
  • Advancing Early Prediction of Gestational Diabetes Mellitus with Circular RNA Biomarkers
    Joon Ho Moon, Sung Hee Choi
    Diabetes & Metabolism Journal.2025; 49(3): 403.     CrossRef
  • Exploring the Vertical Transmission of Exosomes in Diagnostic and Therapeutic Targets for Pregnancy Complications
    Shrikrishna Bhagat, Rakshith Hanumanthappa, Ketki Bhokare, Neelabh Datta, Nidhi Vastrad, M. David, N. Maharaj, Krishnan Anand
    ACS Biomaterials Science & Engineering.2025; 11(9): 5157.     CrossRef
  • Prevalence of Cardiovascular Functional Anomalies in Large-for-Gestational-Age (LGA) Fetuses by Fetal Echocardiography
    Łucja Hanna Biały, Oskar Sylwestrzak, Julia Murlewska, Łukasz Sokołowski, Iwona Strzelecka, Maria Respondek-Liberska
    Journal of Clinical Medicine.2025; 14(13): 4500.     CrossRef
  • The Relationship Between Gestational Diabetes, Emotional Eating, and Clinical Indicators
    Tuğçe Taşar Yıldırım, Çiğdem Akçabay, Sevler Yıldız, Gülşen Kutluer
    Medicina.2025; 61(8): 1447.     CrossRef
  • Characteristics of the gut microbiota in gestational diabetes mellitus associated with poor dietary habits: An observational study
    Linhua Hu, Hongli Liu, Fengbing Liang, Zhi Du, Shudan Jiang, Guoxia Chen, Xiaoting Fang, Lixia Bi
    Medicine.2025; 104(33): e43752.     CrossRef
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    Jing Peng, Huazhang Miao, Li Zhang, Jing Jin, Lirong He, Dongdong Xue, Yong Guo, Guocheng Liu
    Frontiers in Endocrinology.2025;[Epub]     CrossRef
  • Activation of GPR39 Ameliorates Placental Dysfunction by Inhibiting Activation of NLRP1 Inflammasome in Gestational Diabetes Mellitus
    Xiaohua Zhou, Hong Sun
    Clinical and Experimental Pharmacology and Physiology.2025;[Epub]     CrossRef
  • Early spontaneous movements in full-term infants exposed to gestational diabetes mellitus
    Büşra Kepenek-Varol, Osman Baştuğ, Ahmet Özdemi̇r, Özlem Menevşe
    Infant Behavior and Development.2025; 81: 102156.     CrossRef
  • Diagnostic performance of PAPP-A and β-hCG in early detection of gestational diabetes mellitus: a meta-analysis
    Maryam Rahimi, Ladan Haghighi, Mostafa Majidnia, Babak Ghadirzadeh, Yousef Moradi
    Acta Diabetologica.2025; 63(3): 435.     CrossRef
  • Chrononutrition in Gestational Diabetes: Toward Precision Timing in Maternal Care
    Viktoria Xega, Jun-Li Liu
    Journal of Personalized Medicine.2025; 15(11): 534.     CrossRef
  • Protective effects of berberine-loaded chitosan/solid lipid nanoparticles in streptozotocin-induced gestational diabetes mellitus rats
    Yu Liu, Shaik Althaf Hussain, Hua Yue
    Experimental Biology and Medicine.2025;[Epub]     CrossRef
  • The Characteristics of Course of Pregnancy and Perinatal Outcomes in Women with Gestation Diabetes Mellitus (The Results of Ten-Years Research)
    N. V. Batrak, I. V. Ivanova
    Problems of Social Hygiene, Public Health and History of Medicine.2025; 33(6): 1414.     CrossRef
  • Is metformin therapy in conjunction with lifestyle modifications more effective than lifestyle modifications alone in lowering the risk of gestational diabetes mellitus in pregnant women with metabolic dysfunction-associated steatotic liver disease (MASLD
    Venkatachalam Jayaseelan, Murali Subbaiah, Kalaiselvy Arikrishnan, Ramkumar Govindarajalu, Sabita Pulavarthi, Nivedita Nanda, Khadeeja Nasreen Vadakkepeediyakkal, Pazhanivel Mohan, Gayathri Murugesan Sivagurunathan, Mohammed Kais Musthafa, Mahadevan Durai
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    Hanna Salivon
    InterConf.2025; (62(268)): 130.     CrossRef
Close layer
Original Article
Diabetes, obesity and metabolism
Metabolic Phenotypes of Women with Gestational Diabetes Mellitus Affect the Risk of Adverse Pregnancy Outcomes
Joon Ho Moon, Sookyung Won, Hojeong Won, Heejun Son, Tae Jung Oh, Soo Heon Kwak, Sung Hee Choi, Hak Chul Jang
Endocrinol Metab. 2025;40(2):247-257.   Published online November 28, 2024
DOI: https://doi.org/10.3803/EnM.2024.2089
  • 5,205 View
  • 159 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
Gestational diabetes mellitus (GDM) affects women with diverse pathological phenotypes, but little is known about the effects of this variation on perinatal outcomes. We explored the metabolic phenotypes of GDM and their impact on adverse pregnancy outcomes.
Methods
Women diagnosed with gestational glucose intolerance or GDM were categorized into subgroups according to their prepregnancy body mass index (BMI) and the median values of the gestational Matsuda and Stumvoll indices. Logistic regression analysis was employed to assess the odds of adverse pregnancy outcomes, such as large-for-gestational age (LGA), small-for-gestational age, preterm birth, low Apgar score, and cesarean section.
Results
A total of 309 women were included, with a median age of 31 years and a median BMI of 22.3 kg/m2. Women with a higher pre-pregnancy BMI had a higher risk of LGA newborns (adjusted odds ratio [aOR] for pre-pregnancy BMI ≥25 kg/m2 compared to 20–23 kg/m2, 4.26; 95% confidence interval [CI], 1.99 to 9.12; P<0.001; P for trend=0.001), but the risk of other adverse pregnancy outcomes did not differ according to pre-pregnancy BMI. Women with insulin resistance had a higher risk of LGA (aOR, 1.88; 95% CI, 1.02 to 3.47; P=0.043) and cesarean section (aOR, 2.12; 95% CI, 1.29 to 3.50; P=0.003) than women in the insulin-sensitive group. In contrast, defective β-cell function did not affect adverse pregnancy outcomes.
Conclusion
Different metabolic phenotypes of GDM were associated with heterogeneous pregnancy outcomes. Women with obesity and those with insulin resistance are at greater risk of adverse outcomes and might need strict glycemic management during pregnancy.

Citations

Citations to this article as recorded by  
  • Long-term risk of offspring type 1 and type 2 diabetes following maternal gestational diabetes mellitus: a nationwide birth cohort study with 10-year follow-up
    Joon Ho Moon, Han Na Jung, Bongseong Kim, Jaehyun Kim, Young Mi Jung, Hyeon Ji Kim, Jee Yoon Park, Tae Jung Oh, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
    BMC Medicine.2026;[Epub]     CrossRef
  • Novel inflammatory markers for predicting adverse pregnancy outcomes in pregnant women with polycystic ovary syndrome: a retrospective case‒control study
    Na Pan, Jing Zhang, Ning Zhu, Mengting Liu, Shuying Yang, Zhanshuai Song, Haibo Song
    BMC Pregnancy and Childbirth.2026;[Epub]     CrossRef
  • Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
    Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
    Endocrinology and Metabolism.2026; 41(1): 26.     CrossRef
  • Placental transport dysfunction in omega-3 and omega-6 fatty acid in patients with gestational diabetes mellitus
    Wei Long, Fang Guo, Jun Yao, Qinjun Wei, Lizhong Yin, Jiawen Xu, Xin Cao
    Annals of Medicine.2026;[Epub]     CrossRef
  • Gestational Diabetes Mellitus: Mechanisms Underlying Maternal and Fetal Complications
    Jooyeop Lee, Na Keum Lee, Joon Ho Moon
    Endocrinology and Metabolism.2025; 40(1): 10.     CrossRef
  • The Characteristics of Course of Pregnancy and Perinatal Outcomes in Women with Gestation Diabetes Mellitus (The Results of Ten-Years Research)
    N. V. Batrak, I. V. Ivanova
    Problems of Social Hygiene, Public Health and History of Medicine.2025; 33(6): 1414.     CrossRef
Close layer
Review Article
Diabetes, obesity and metabolism
Changes in the Epidemiological Landscape of Diabetes in South Korea: Trends in Prevalence, Incidence, and Healthcare Expenditures
Kyoung Hwa Ha, Dae Jung Kim
Endocrinol Metab. 2024;39(5):669-677.   Published online September 25, 2024
DOI: https://doi.org/10.3803/EnM.2024.2073
  • 17,800 View
  • 301 Download
  • 13 Web of Science
  • 14 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Diabetes is a serious public health concern that significantly contributes to the global burden of disease. In Korea, the prevalence of diabetes is 12.5% among individuals aged 19 and older, and 14.8% among individuals aged 30 and older as of 2022. The total number of people with diabetes among those aged 19 and older is estimated to be 5.4 million. The incidence of diabetes decreased from 8.1 per 1,000 persons in 2006 to 6.3 per 1,000 persons in 2014, before rising again to 7.5 per 1,000 persons in 2019. Meanwhile, the incidence of type 1 diabetes increased significantly, from 1.1 per 100,000 persons in 1995 to 4.8 per 100,000 persons in 2016, with the prevalence reaching 41.0 per 100,000 persons in 2017. Additionally, the prevalence of gestational diabetes saw a substantial rise from 4.1% in 2007 to 22.3% in 2023. These changes have resulted in increases in the total medical costs for diabetes, covering both outpatient and inpatient services. Therefore, effective diabetes prevention strategies are urgently needed.

Citations

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  • Age-stratified comorbidity transitions and interconnected mapping of nine allergic diseases
    Ju Hee Kim, Eun Lee, Jeewon Shin, Eunkyo Ha, Hana Yoo, Soonchul Lee, Man Yong Han
    Allergology International.2026; 75(2): 252.     CrossRef
  • Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
    Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
    Endocrinology and Metabolism.2026; 41(1): 26.     CrossRef
  • Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities
    Joon Ho Moon, Han Na Jung, Bongseong Kim, Seung-Hyun Ko, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
    Diabetes & Metabolism Journal.2026; 50(2): 280.     CrossRef
  • Prevalence, Diagnostic Role, and Clinical Features of Zinc Transporter 8 Autoantibody in Korean Children and Adolescents With Diabetes Mellitus
    Sohyun Shin, Hyun Ah Woo, Hakyung Lee, Yun Jeong Lee, Hwa Young Kim, Young Ah Lee, Choong Ho Shin, Ho Young Lee, Jaehyun Kim
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Trends in prescribing sodium‐glucose cotransporter 2 inhibitors for individuals with type 2 diabetes with and without cardiovascular‐renal disease in South Korea, 2015–2021
    Kyoung Hwa Ha, Soyoung Shin, EunJi Na, Dae Jung Kim
    Journal of Diabetes Investigation.2025; 16(2): 215.     CrossRef
  • Effects of Black Cumin Seed Extract on Pancreatic Islet β-Cell Proliferation and Hypoglycemic Activity in Streptozotocin-Induced Diabetic Rats
    Jongkyu Kim, Yoon-Seok Chun, Namkyu Yoon, Byungkwon Kim, Kiin Choi, Sae-Kwang Ku, Namju Lee
    Antioxidants.2025; 14(2): 174.     CrossRef
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    Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
    Diabetes & Metabolism Journal.2025; 49(2): 183.     CrossRef
  • Elevated triglyceride-glucose index is a risk factor for cardiovascular events in adults with type 1 diabetes: a cohort study
    Rosa Oh, Seohyun Kim, Sang Ho Park, Myunghwa Jang, So Hyun Cho, Ji Yoon Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim
    Cardiovascular Diabetology.2025;[Epub]     CrossRef
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    Minsang Kim, Jung Koh, Jeong Cho, Semin Cho, Soojin Lee, Hyuk Huh, Seong Kim, Sehyun Jung, Eunjeong Kang, Sehoon Park, Jin Paek, Woo Park, Kyubok Jin, Seungyeup Han, Kwon Joo, Kyungdo Han, Dong Kim, Yaerim Kim
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    Kyoung Hwa Ha, Dae Jung Kim
    Diabetes & Metabolism Journal.2025; 49(5): 987.     CrossRef
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    Jong Han Choi, Shinae Kang, Soo-Kyung Kim, Won Jun Kim, Ji Min Kim, Jaehyun Bae, Jae-Seung Yun, Eonju Jeon, Young-Eun Kim, Jae Hyun Bae, Hun Jee Choe, Young Min Cho, Seung-Hyun Ko, Sang Yong Kim, Hae Jin Kim, You-Cheol Hwang, Min Kyong Moon, Suk Chon, Seo
    Diabetes & Metabolism Journal.2025; 49(6): 1155.     CrossRef
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    Ju-young Lee, Youngeun Yoo, Sanghun Lee
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    Shiva Raj Acharya, Sudarshan Subedi, Diwash Timilsina
    Scientific Reports.2025;[Epub]     CrossRef
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    In Hwa Jeong, Kyung-Won Hong, Ja-Eun Choi, Bo-Kyung Shine
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Close layer
Original Article
Diabetes, obesity and metabolism
Amelioration of Insulin Resistance after Delivery Is Associated with Reduced Risk of Postpartum Diabetes in Women with Gestational Diabetes Mellitus
Heejun Son, Joon Ho Moon, Sung Hee Choi, Nam H. Cho, Soo Heon Kwak, Hak Chul Jang
Endocrinol Metab. 2024;39(5):701-710.   Published online August 21, 2024
DOI: https://doi.org/10.3803/EnM.2024.1974
  • 6,280 View
  • 90 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Identifying risk factors for postpartum type 2 diabetes in women with gestational diabetes mellitus (GDM) is crucial for effective interventions. We examined whether changes in insulin sensitivity after delivery affects the risk of type 2 diabetes in women with GDM.
Methods
This prospective cohort study included 347 women with GDM or gestational impaired glucose tolerance, who attended the follow-up visits at 2 months postpartum and annually thereafter. Changes in insulin sensitivity were calculated using the Matsuda index at GDM diagnosis and at 2 months postpartum (ΔMatsuda index). After excluding women with pregestational diabetes or those followed up only once, we analyzed the risk of postpartum type 2 diabetes based on the ΔMatsuda index tertiles.
Results
The incidence of type 2 diabetes at the two-month postpartum visit decreased with increasing ΔMatsuda index tertiles (16.4%, 9.5%, and 1.8%, P=0.001). During a 4.1-year follow-up, 26 out of 230 women who attended more than two follow-up visits (11.3%) developed type 2 diabetes. Compared to the lowest tertile, subjects in the highest ΔMatsuda index tertile showed a significantly reduced risk of type 2 diabetes (hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.93; P=0.036) after adjusting for confounders.
Conclusion
Improvement in insulin sensitivity after delivery is associated with a reduced risk of postpartum type 2 diabetes in women with GDM. Postpartum changes in insulin sensitivity could be a useful prediction for future type 2 diabetes development in women with GDM.

Citations

Citations to this article as recorded by  
  • Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
    Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
    Endocrinology and Metabolism.2026; 41(1): 26.     CrossRef
  • Gestational Diabetes Mellitus: Mechanisms Underlying Maternal and Fetal Complications
    Jooyeop Lee, Na Keum Lee, Joon Ho Moon
    Endocrinology and Metabolism.2025; 40(1): 10.     CrossRef
  • Evaluation of Maternal Factors Affecting Postpartum Insulin Resistance Markers in Mothers with Gestational Diabetes—A Case–Control Study
    Karolina Karcz, Paulina Gaweł, Barbara Królak-Olejnik
    Nutrients.2024; 16(22): 3871.     CrossRef
Close layer
Review Article
Diabetes, obesity and metabolism
The Benefits Of Continuous Glucose Monitoring In Pregnancy
Jee Hee Yoo, Jae Hyeon Kim
Endocrinol Metab. 2023;38(5):472-481.   Published online October 11, 2023
DOI: https://doi.org/10.3803/EnM.2023.1805
  • 19,719 View
  • 582 Download
  • 13 Web of Science
  • 16 Crossref
AbstractAbstract PDFPubReader   ePub   
Previous studies have consistently demonstrated the positive effects of continuous glucose monitoring (CGM) on glycemic outcomes and complications of diabetes in people with type 1 diabetes. Guidelines now consider CGM to be an essential and cost-effective device for managing type 1 diabetes. As a result, insurance coverage for it is available. Evidence supporting CGM continues to grow and expand to broader populations, such as pregnant people with type 1 diabetes, people with type 2 diabetes treated only with basal insulin therapy, and even type 2 diabetes that does not require insulin treatment. However, despite the significant risk of hyperglycemia in pregnancy, which leads to complications in more than half of affected newborns, CGM indications and insurance coverage for those patients are unresolved. In this review article, we discuss the latest evidence for using CGM to offer glycemic control and reduce perinatal complications, along with its cost-effectiveness in pregestational type 1 and type 2 diabetes and gestational diabetes mellitus. In addition, we discuss future prospects for CGM coverage and indications based on this evidence.

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Original Articles
Diabetes, Obesity and Metabolism
Big Data Articles (National Health Insurance Service Database)
Predicting the Risk of Insulin-Requiring Gestational Diabetes before Pregnancy: A Model Generated from a Nationwide Population-Based Cohort Study in Korea
Seung-Hwan Lee, Jin Yu, Kyungdo Han, Seung Woo Lee, Sang Youn You, Hun-Sung Kim, Jae-Hyoung Cho, Kun-Ho Yoon, Mee Kyoung Kim
Endocrinol Metab. 2023;38(1):129-138.   Published online January 27, 2023
DOI: https://doi.org/10.3803/EnM.2022.1609
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AbstractAbstract PDFPubReader   ePub   
Background
The severity of gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. We aimed to generate a risk model for predicting insulin-requiring GDM before pregnancy in Korean women.
Methods
A total of 417,210 women who received a health examination within 52 weeks before pregnancy and delivered between 2011 and 2015 were recruited from the Korean National Health Insurance database. The risk prediction model was created using a sample of 70% of the participants, while the remaining 30% were used for internal validation. Risk scores were assigned based on the hazard ratios for each risk factor in the multivariable Cox proportional hazards regression model. Six risk variables were selected, and a risk nomogram was created to estimate the risk of insulin-requiring GDM.
Results
A total of 2,891 (0.69%) women developed insulin-requiring GDM. Age, body mass index (BMI), current smoking, fasting blood glucose (FBG), total cholesterol, and γ-glutamyl transferase were significant risk factors for insulin-requiring GDM and were incorporated into the risk model. Among the variables, old age, high BMI, and high FBG level were the main contributors to an increased risk of insulin-requiring GDM. The concordance index of the risk model for predicting insulin-requiring GDM was 0.783 (95% confidence interval, 0.766 to 0.799). The validation cohort’s incidence rates for insulin-requiring GDM were consistent with the risk model’s predictions.
Conclusion
A novel risk engine was generated to predict insulin-requiring GDM among Korean women. This model may provide helpful information for identifying high-risk women and enhancing prepregnancy care.

Citations

Citations to this article as recorded by  
  • Nationwide Big Data Studies of Endocrine Diseases Using the Korean National Health Information Database: Research Trends and Standardization of Operational Definitions
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  • Developing a Risk Stratification Tool to Predict Patients with Gestational Diabetes Mellitus at Risk of Insulin Treatment: A Cohort Study
    Xi Yang, Hannah L. Nathan, Ebruba E. Oyekan, Tim I. M. Korevaar, Doaa Ahmed, Katherine Pacifico, Aisha Hameed, Manju Chandiramani, Anita Banerjee, Caroline Ovadia
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    Friederike Weschenfelder, Barbara Dusek, Heinke Adamczewski, Dietmar Weber, Matthias Kaltheuner, Yvonne Heimann, Tanja Groten
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Diabetes, Obesity and Metabolism
Big Data Articles (National Health Insurance Service Database)
Risk and Risk Factors for Postpartum Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Korean Nationwide Cohort Study
Mi Jin Choi, Jimi Choi, Chae Weon Chung
Endocrinol Metab. 2022;37(1):112-123.   Published online February 28, 2022
DOI: https://doi.org/10.3803/EnM.2021.1276
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  • 10 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies.
Methods
This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models.
Results
The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m2) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy.
Conclusion
This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

Citations

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  • Metabolic trajectory from gestational to type 2 diabetes mellitus: a systematic review and meta-analysis
    Tsegaamlak Kumelachew Derse, Desalegn Mitiku Kide, Addisu Simachew Asgai, Jenberu Mekurianew Kelkay
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    Nilajkumar Bagde, Madhuri Bagde, Vijayalakshmi Shanbhag, Pragati Trigunait, Nagma Sheikh, Sarita Agrawal
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    Kyoung Hwa Ha, Dae Jung Kim
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    Danielle Cristina Honorio França, Eduardo Luzía França, Luis Sobrevia, Angélica Mércia Pascon Barbosa, Adenilda Cristina Honorio-França, Marilza Vieira Cunha Rudge
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Clinical Study
Vitamin D Deficiency at Mid-Pregnancy Is Associated with a Higher Risk of Postpartum Glucose Intolerance in Women with Gestational Diabetes Mellitus
Kyung-Soo Kim, Seok Won Park, Yong-Wook Cho, Soo-Kyung Kim
Endocrinol Metab. 2020;35(1):97-105.   Published online March 19, 2020
DOI: https://doi.org/10.3803/EnM.2020.35.1.97
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AbstractAbstract PDFPubReader   ePub   
Background

To evaluate the association between serum 25-hydroxyvitamin D (25(OH)D) at mid-pregnancy and postpartum glucose intolerance in women with gestational diabetes mellitus (GDM).

Methods

We enrolled 348 pregnant women diagnosed with GDM from August 2012 to October 2016. We measured serum 25(OH)D levels at mid-pregnancy and carried out a 75-g oral glucose tolerance test at 6 to 12 weeks after delivery. Vitamin D deficiency was defined as serum 25(OH)D <20 ng/mL.

Results

The prevalence of vitamin D deficiency was 76.7% (n=267). Women with vitamin D deficiency had a higher prevalence of postpartum glucose intolerance than did those without vitamin D deficiency (48.7% vs. 32.1%, P=0.011). Serum 25(OH)D level was negatively correlated with hemoglobin A1c at antepartum and postpartum period (antepartum: r=−0.186, P=0.001; postpartum: r=−0.129, P=0.047). Homeostasis model assessment of β-cell function was positively correlated with serum 25(OH)D level only postpartum (r=0.138, P=0.035). The risk of postpartum glucose intolerance was 2.00 times (95% confidence interval, 1.13 to 3.55) higher in women with vitamin D deficiency than in those without vitamin D deficiency (P=0.018).

Conclusion

In women with GDM, vitamin D deficiency at mid-pregnancy is associated with an elevated risk of postpartum glucose intolerance.

Citations

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    Milena Martello Cristófalo, Júlio Oliva de Almeida Garcia, José Fernando Santos Aldrighi, Renan Martello Cristófalo, Maria Laura Marconi França, Liania Alves Luzia, Suleima Pedroza Vasconcelos, José Mendes Aldrighi
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    Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
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    Rakesh Kumar Gupta, Sonal Tiwari, Sakshi Agarwal, Amita Diwakar, Pawan K. Dubey
    Diabetology & Metabolic Syndrome.2025;[Epub]     CrossRef
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    Saneela Saleem, Zahra Khan, Imtiaz Hussain, Faran Khan, Fahad Al-Asmari, Faima Atta Khan, Alyan Ali Zafar, Muhammad Abdul Rahim, Zongo Eliasse, Mohamed Fawzy Ramadan
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Case Report
Obesity and Metabolism
Two Cases of Allergy to Insulin in Gestational Diabetes
Gi Jun Kim, Shin Bum Kim, Seong Il Jo, Jin Kyeong Shin, Hee Sun Kwon, Heekyung Jeong, Jang Won Son, Seong Su Lee, Sung Rae Kim, Byung Kee Kim, Soon Jib Yoo
Endocrinol Metab. 2015;30(3):402-407.   Published online May 18, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.3.402
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AbstractAbstract PDFPubReader   

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Citations

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  • Insulin Allergy: The Allergist’s Updated Approach to Evaluation and Management
    Jessica Oh, Evelyn Capellan Vasquez, Santiago Alvarez-Arango, Manish Ramesh, Mariana C. Castells
    The Journal of Allergy and Clinical Immunology: In Practice.2025; 13(5): 990.     CrossRef
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    Alissa M. Guarneri , Robert P. Hoffman
    Current Diabetes Reviews.2022;[Epub]     CrossRef
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    Partha Pratim Chakraborty, Sugata Narayan Biswas, Shinjan Patra
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Original Article
Obesity and Metabolism
A Novel Mutation in the Von Hippel-Lindau Tumor Suppressor Gene Identified in a Patient Presenting with Gestational Diabetes Mellitus
Yun Hyi Ku, Chang Ho Ahn, Chan-Hyeon Jung, Jie Eun Lee, Lee-Kyung Kim, Soo Heon Kwak, Hye Seung Jung, Kyong Soo Park, Young Min Cho
Endocrinol Metab. 2013;28(4):320-325.   Published online December 12, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.4.320
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  • 30 Download
  • 6 Crossref
AbstractAbstract PDFPubReader   
Background

Von Hippel-Lindau (VHL) disease is an autosomal dominantly inherited, multisystemic tumor syndrome caused by mutations in the VHL gene. To date, more than 1,000 germline and somatic mutations of the VHL gene have been reported. We present a novel mutation in the VHL tumor suppressor gene that presented with gestational diabetes mellitus.

Methods

A 30-year-old woman presented with gestational diabetes mellitus. She sequentially showed multiple pancreatic cysts, spinal cord hemangioblastoma, cerebellar hemangioblastoma, and clear cell type renal cell carcinomas. Also, her father and brother had brain hemangioblastomas. Each of the three exons of the VHL gene was individually amplified by polymerase chain reaction and direct sequencing was performed using an ABI 3730 DNA analyzer.

Results

DNA sequence analysis to determine the presence of VHL mutation in her family revealed del291C, a novel frameshift mutation.

Conclusion

We found a novel mutation in the VHL tumor suppressor gene that presented with gestational diabetes mellitus.

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    Ying Wang, Junfeng Li, Yan Wang, Yingxue Guo
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    Alma Nelly Diaz-Herreros, Alberto Granados-Galeana, Isaí Martínez-Torres, Elba Reyes-Maldonado, Erika Rosales-Cruz, Fernando Gómez-Chávez, Gabriel Betanzos-Cabrera, Amaranta Sarai Valdez-Guerrero, Juan Carlos Cancino-Diaz, Mario Eugenio Cancino-Diaz
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    Claudia von Arx, Monica Capozzi, Elena López-Jiménez, Alessandro Ottaiano, Fabiana Tatangelo, Annabella Di Mauro, Guglielmo Nasti, Maria Lina Tornesello, Salvatore Tafuto
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