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1Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
2Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
3Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
4Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2024 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conception or design: H.S., J.H.M., S.H.K., H.C.J. Acquisition, analysis, or interpretation of data: H.S., J.H.M., S.H.K., H.C.J. Drafting the work or revising: H.S., J.H.M., S.H.C., N.H.C., S.H.K., H.C.J. Final approval of the manuscript: H.S., J.H.M., S.H.C., N.H.C., S.H.K., H.C.J.
Characteristic | Did not develop T2DM (n=288) | Progression to T2DM (n=59) | P value |
---|---|---|---|
Age at delivery, yr | 31.6±4.1 | 32.1±4.4 | 0.396 |
Body mass index, pregestational, kg/m2 | 21.9±3.1 | 24.5±3.5 | <0.001 |
BMI change, kg/m2 | –0.1±1.3 | 0.0±1.2 | 0.978 |
Parity, n | 2.1±1.6 | 1.9±1.7 | 0.369 |
Exercise | 99 (34.4) | 25 (41.7) | 0.283 |
Breastfeeding | 102 (35.4) | 9 (15.0) | 0.002 |
100-g OGTT at mid-gestation | |||
Glucose (fasting), mg/dL | 87.9±11.2 | 100.5±14.1 | <0.001 |
Glucose (1-hour), mg/dL | 185.9±28.4 | 203.7±36.6 | <0.001 |
Glucose (2-hour), mg/dL | 172.7±27.1 | 195.8±33.9 | <0.001 |
Glucose (3-hour), mg/dL | 145.6±25.8 | 165.3±31.8 | <0.001 |
Insulin (fasting), μIU/mL | 8.7±6.8 | 9.3±3.8 | 0.023 |
Insulin (1-hour), μIU/mL | 65.2±49.0 | 45.9±37.8 | 0.004 |
Insulin (2-hour), μIU/mL | 88.1±61.7 | 64.3±50.8 | 0.005 |
Insulin (3-hour), μIU/mL | 75.7±52.2 | 60.9±38.6 | 0.033 |
75-g OGTT at initial postpartum visit (postpartum 2 months) | |||
Glucose (fasting), mg/dL | 90.2±8.9 | 121.1±46.2 | <0.001 |
Glucose (30-minute), mg/dL | 154.9±25.7 | 200.4±57.9 | <0.001 |
Glucose (60-minute), mg/dL | 160.2±36.4 | 241.5±82.8 | <0.001 |
Glucose (90-minute), mg/dL | 138.4±33.3 | 231.7±78.2 | <0.001 |
Glucose (120-minute), mg/dL | 122.5±28.4 | 208.4±86.1 | <0.001 |
Insulin (fasting), μIU/mL | 10.2±5.3 | 12.0±6.2 | 0.026 |
Insulin (30-minute), μIU/mL | 42.3±25.6 | 32.0±19.1 | 0.003 |
Insulin (60-minute), μIU/mL | 52.0±34.5 | 42.1±24.9 | 0.035 |
Insulin (90-minute), μIU/mL | 48.5±33.3 | 53.8±40.2 | 0.288 |
Insulin (120-minute), μIU/mL | 43.4±31.3 | 53.3±46.5 | 0.042 |
Longitudinal changes in glycemic measures | |||
Matsuda index | |||
Antepartum | 5.2±2.7 | 5.0±2.8 | 0.524 |
Postpartum | 5.3±2.3 | 3.9±2.2 | <0.001 |
P valuea | 0.717 | 0.010 | |
Mean difference | 0.1±3.0 | –1.0±3.3 | 0.011 |
HOMA-IR | |||
Antepartum | 1.9±1.1 | 2.3±1.0 | 0.002 |
Postpartum | 2.3±1.3 | 3.8±3.5 | <0.001 |
P valuea | <0.001 | 0.003 | |
Mean difference | 0.4±1.4 | 1.4±3.5 | <0.001 |
Insulinogenic index | |||
Antepartum | 0.7±1.9 | 0.4±0.3 | 0.195 |
Postpartum | 0.6±0.4 | 0.3±0.2 | <0.001 |
P valuea | 0.201 | 0.028 | |
Mean difference | –0.1±1.8 | –0.1±0.3 | 0.872 |
HOMA-β | |||
Antepartum | 141.7±98.3 | 109.6±98.4 | 0.023 |
Postpartum | 150.8±112.4 | 100.7±63.8 | 0.001 |
P valuea | 0.288 | 0.531 | |
Mean difference | 9.1±145.4 | –8.9±107.9 | 0.369 |
Disposition index | |||
Antepartum | 2.6±3.3 | 1.6±1.1 | 0.023 |
Postpartum | 2.7±2.3 | 1.0±1.0 | <0.001 |
P valuea | 0.646 | 0.002 | |
Mean difference | 0.1±3.9 | –0.6±1.3 | 0.195 |
Values are expressed as mean±standard deviation or number (%). ΔMatsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. P values are for the t test or chi-square test to compare subjects with and without the occurrence of type 2 diabetes.
T2DM, type 2 diabetes; OGTT, oral glucose tolerance test; HOMA-IR, homeostasis model assessment of insulin resistance; HOMA-β, homeostasis model assessment of β-cell function.
a Paired t test from antepartum to postpartum values within each group.
Values are expressed as number (%). ΔMatsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. Lowest tertiles ranged from –10.9 to –1.1, middle tertile from –1.0 to 1.0, highest tertile ranged from 1.0 to 8.5. P values are for the chisquare test to compare the occurrence of postpartum T2DM and combined with postpartum prediabetes across the tertiles.
T2DM, type 2 diabetes.
Variable |
Univariatea |
Multivariateb |
||
---|---|---|---|---|
HR (95% CI) | P value | HR (95% CI) | P value | |
∆Matsuda index tertile | ||||
Lowest tertile | 1 (reference) | 1 (reference) | ||
Middle tertile | 0.72 (0.29–1.79) | 0.484 | 0.52 (0.21–1.33) | 0.175 |
Highest tertile | 0.59 (0.22–1.59) | 0.293 | 0.33 (0.12–0.93) | 0.036 |
Fasting plasma glucose | 1.05 (1.03–1.08) | <0.001 | 1.06 (1.03–1.09) | <0.001 |
Postpartum body mass index | 1.18 (1.06–1.32) | <0.001 | 1.16 (1.03–1.30) | 0.015 |
Age at birth | 0.99 (0.90–1.09) | 0.869 | 0.93 (0.84–1.04) | 0.203 |
Family history of diabetes | 1.00 (0.47–2.17) | 0.992 | 0.98 (0.43–2.19) | 0.950 |
Parity | 0.90 (0.69–1.16) | 0.414 | 0.87 (0.67–1.13) | 0.305 |
HR of postpartum type 2 diabetes are calculated using Cox proportional model including ΔMatsuda index and variables associated with postpartum type 2 diabetes. ΔMatsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. Lowest tertiles ranged from –10.9 to –0.9, middle tertile from –0.8 to 1.2, highest tertile ranged from 1.2 to 8.8.
HR, hazard ratio; CI, confidence interval.
a ΔMatsuda index and factors associated with postpartum type 2 diabetes (gestational fasting blood glucose, postpartum body mass index, age at birth, familial history of diabetes, parity) were included in the multivariate Cox model;
b ΔMatsuda index tertile was included as a covariate in addition to factors associated with postpartum type 2 diabetes in the multivariate Cox model.
Characteristic | Did not develop T2DM (n=288) | Progression to T2DM (n=59) | P value |
---|---|---|---|
Age at delivery, yr | 31.6±4.1 | 32.1±4.4 | 0.396 |
Body mass index, pregestational, kg/m2 | 21.9±3.1 | 24.5±3.5 | <0.001 |
BMI change, kg/m2 | –0.1±1.3 | 0.0±1.2 | 0.978 |
Parity, n | 2.1±1.6 | 1.9±1.7 | 0.369 |
Exercise | 99 (34.4) | 25 (41.7) | 0.283 |
Breastfeeding | 102 (35.4) | 9 (15.0) | 0.002 |
100-g OGTT at mid-gestation | |||
Glucose (fasting), mg/dL | 87.9±11.2 | 100.5±14.1 | <0.001 |
Glucose (1-hour), mg/dL | 185.9±28.4 | 203.7±36.6 | <0.001 |
Glucose (2-hour), mg/dL | 172.7±27.1 | 195.8±33.9 | <0.001 |
Glucose (3-hour), mg/dL | 145.6±25.8 | 165.3±31.8 | <0.001 |
Insulin (fasting), μIU/mL | 8.7±6.8 | 9.3±3.8 | 0.023 |
Insulin (1-hour), μIU/mL | 65.2±49.0 | 45.9±37.8 | 0.004 |
Insulin (2-hour), μIU/mL | 88.1±61.7 | 64.3±50.8 | 0.005 |
Insulin (3-hour), μIU/mL | 75.7±52.2 | 60.9±38.6 | 0.033 |
75-g OGTT at initial postpartum visit (postpartum 2 months) | |||
Glucose (fasting), mg/dL | 90.2±8.9 | 121.1±46.2 | <0.001 |
Glucose (30-minute), mg/dL | 154.9±25.7 | 200.4±57.9 | <0.001 |
Glucose (60-minute), mg/dL | 160.2±36.4 | 241.5±82.8 | <0.001 |
Glucose (90-minute), mg/dL | 138.4±33.3 | 231.7±78.2 | <0.001 |
Glucose (120-minute), mg/dL | 122.5±28.4 | 208.4±86.1 | <0.001 |
Insulin (fasting), μIU/mL | 10.2±5.3 | 12.0±6.2 | 0.026 |
Insulin (30-minute), μIU/mL | 42.3±25.6 | 32.0±19.1 | 0.003 |
Insulin (60-minute), μIU/mL | 52.0±34.5 | 42.1±24.9 | 0.035 |
Insulin (90-minute), μIU/mL | 48.5±33.3 | 53.8±40.2 | 0.288 |
Insulin (120-minute), μIU/mL | 43.4±31.3 | 53.3±46.5 | 0.042 |
Longitudinal changes in glycemic measures | |||
Matsuda index | |||
Antepartum | 5.2±2.7 | 5.0±2.8 | 0.524 |
Postpartum | 5.3±2.3 | 3.9±2.2 | <0.001 |
P value |
0.717 | 0.010 | |
Mean difference | 0.1±3.0 | –1.0±3.3 | 0.011 |
HOMA-IR | |||
Antepartum | 1.9±1.1 | 2.3±1.0 | 0.002 |
Postpartum | 2.3±1.3 | 3.8±3.5 | <0.001 |
P value |
<0.001 | 0.003 | |
Mean difference | 0.4±1.4 | 1.4±3.5 | <0.001 |
Insulinogenic index | |||
Antepartum | 0.7±1.9 | 0.4±0.3 | 0.195 |
Postpartum | 0.6±0.4 | 0.3±0.2 | <0.001 |
P value |
0.201 | 0.028 | |
Mean difference | –0.1±1.8 | –0.1±0.3 | 0.872 |
HOMA-β | |||
Antepartum | 141.7±98.3 | 109.6±98.4 | 0.023 |
Postpartum | 150.8±112.4 | 100.7±63.8 | 0.001 |
P value |
0.288 | 0.531 | |
Mean difference | 9.1±145.4 | –8.9±107.9 | 0.369 |
Disposition index | |||
Antepartum | 2.6±3.3 | 1.6±1.1 | 0.023 |
Postpartum | 2.7±2.3 | 1.0±1.0 | <0.001 |
P value |
0.646 | 0.002 | |
Mean difference | 0.1±3.9 | –0.6±1.3 | 0.195 |
Variable | ∆Matsuda index |
Total (n=347) | P value | ||
---|---|---|---|---|---|
Lowest tertile (n=116) | Middle tertile (n=116) | Highest tertile (n=115) | |||
Postpartum T2DM | 19 (16.4) | 11 (9.5) | 2 (1.8) | 32 (9.2) | 0.001 |
Postpartum prediabetes and T2DM | 67 (57.8) | 52 (44.8) | 32 (28.1) | 151 (43.6) | <0.001 |
Variable | Univariate |
Multivariate |
||
---|---|---|---|---|
HR (95% CI) | P value | HR (95% CI) | P value | |
∆Matsuda index tertile | ||||
Lowest tertile | 1 (reference) | 1 (reference) | ||
Middle tertile | 0.72 (0.29–1.79) | 0.484 | 0.52 (0.21–1.33) | 0.175 |
Highest tertile | 0.59 (0.22–1.59) | 0.293 | 0.33 (0.12–0.93) | 0.036 |
Fasting plasma glucose | 1.05 (1.03–1.08) | <0.001 | 1.06 (1.03–1.09) | <0.001 |
Postpartum body mass index | 1.18 (1.06–1.32) | <0.001 | 1.16 (1.03–1.30) | 0.015 |
Age at birth | 0.99 (0.90–1.09) | 0.869 | 0.93 (0.84–1.04) | 0.203 |
Family history of diabetes | 1.00 (0.47–2.17) | 0.992 | 0.98 (0.43–2.19) | 0.950 |
Parity | 0.90 (0.69–1.16) | 0.414 | 0.87 (0.67–1.13) | 0.305 |
Values are expressed as mean±standard deviation or number (%). ΔMatsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. T2DM, type 2 diabetes; OGTT, oral glucose tolerance test; HOMA-IR, homeostasis model assessment of insulin resistance; HOMA-β, homeostasis model assessment of β-cell function. Paired
Values are expressed as number (%). ΔMatsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. Lowest tertiles ranged from –10.9 to –1.1, middle tertile from –1.0 to 1.0, highest tertile ranged from 1.0 to 8.5. T2DM, type 2 diabetes.
HR of postpartum type 2 diabetes are calculated using Cox proportional model including ΔMatsuda index and variables associated with postpartum type 2 diabetes. ΔMatsuda index was defined as the difference between the initial postpartum Matsuda index and the gestational Matsuda index. Lowest tertiles ranged from –10.9 to –0.9, middle tertile from –0.8 to 1.2, highest tertile ranged from 1.2 to 8.8. HR, hazard ratio; CI, confidence interval. ΔMatsuda index and factors associated with postpartum type 2 diabetes (gestational fasting blood glucose, postpartum body mass index, age at birth, familial history of diabetes, parity) were included in the multivariate Cox model; ΔMatsuda index tertile was included as a covariate in addition to factors associated with postpartum type 2 diabetes in the multivariate Cox model.