Progression to Type 2 Diabetes in Women with Former Gestational Diabetes Time Trajectories of Metabolic Parameters 英文参考文献.docVIP

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Progression to Type 2 Diabetes in Women with Former Gestational Diabetes Time Trajectories of Metabolic Parameters 英文参考文献.doc

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Progression to Type 2 Diabetes in Women with Former Gestational Diabetes Time Trajectories of Metabolic Parameters 英文参考文献

ProgressiontoType2DiabetesinWomenwithFormer GestationalDiabetes:TimeTrajectoriesofMetabolic Parameters AndreaTura1*,AngelaGrassi1,YvonneWinhofer2,AnnamariaGuolo3,GiovanniPacini1,AndreaMari1, AlexandraKautzky-Willer2 1MetabolicUnit,InstituteofBiomedicalEngineering,NationalResearchCouncil,Padova,Italy, 2Unit ofGenderMedicine,DivisionofEndocrinologyandMetabolism, ClinicofInternalMedicineIII,MedicalUniversityofVienna,Vienna,Austria,3DepartmentofEconomics,UniversityofVerona,Verona,Italy Abstract Aim of this study was analyzing the time trajectories of the metabolic parameters in European women with former gestational diabetes (fGDM), and determining predictors of type 2 diabetes onset. A group of seventy-six fGDM women werestudiedattheoutpatientdepartmentoftheUniversityClinicofVienna.Theywereevaluatedyearlywitha3h-oral glucose tolerance test (OGTT) up to 7-years from delivery. At baseline, women also underwent an intravenous glucose tolerance test (IVGTT). Insulin sensitivity and beta-cell function were assessed by both OGTT and IVGTT. Women were dividedintoprogressors(PROG)todiabetes(n=19)andnon-progressors(n=57).Timetrajectoriesofglycemiaandother parameters were analyzed after synchronization to time of diabetes onset or last OGTT. Then, Cox proportional hazard regressionanalysiswasperformedtoassessthepredictivepowerofstudiedvariablesfordiabetesonset.Wefoundthat,in PROG,timetrajectoriesofglycemiawereflatuntildiabetesonset,whentheyshowedamarkedincrease(P,0.0001).Insulin sensitivity showed similar marked decrease (P,0.0001) at diabetes onset, together with a tendency to continuous slow decline in the previous years. At contrast, beta-cell function showed only continuous slow decline. Major predictors of diabetesonsetwereglycemiclevels,BMI,insulinresistance,andconditionofimpairedglucosetolerance.Inconclusion,in fGDM,markeddeteriorationofinsulinsensitivityisassociatedwithdiabetesonset.Preventionstrategiesaimedatopposing totheinsulinsensitivityderangementmaybepartic