1084-P: Cesarean Delivery and Insulin Sensitivity in the Older Adult: The Microbiome and Insulin Longitudinal Evaluation Study

Cesarean delivery has been associated with increased risk of obesity and type 2 diabetes. While the mechanism for this is unknown, it is hypothesized to be a result of alterations in the gut microbiome in early life that may lead to obesity, metabolic derangement and, ultimately, impaired glucose homeostasis. In a racially-diverse, prospective cohort of nondiabetic, older adults (≥40 years), we assessed the crude and adjusted association between cesarean delivery and glucose and insulin homeostasis traits. Participants completed a comprehensive clinical assessment, including an oral glucose tolerance test (with glucose, C-peptide, insulin measures at 0, 30, 120 minutes) and health and demographic questionnaires, from which self-reported mode of delivery was recorded. A total of 353 participants were enrolled, with a mean (std) age of 59 (9.0) years, 61.8% female, 36.5% Non-Hispanic Black. Of these, 15 (4.2%) were missing delivery status at birth. As expected for this older cohort, cesarean delivery was relatively uncommon (5.0%). Still, relative to vaginal delivery, cesarean delivery was associated with a significantly higher BMI (aβ: 3.53; 95% CI: 0.15, 6.91) and fasting glucose (aβ: 5.12; 95% CI: 0.01, 10.23), a 14% decrease in insulin sensitivity (aβ: -0.14; 95% CI: -0.28, -0.01), and a 58% increased risk (aRR: 1.58; 95% CI: 1.08, 2.31) for prediabetes/diabetes (Table).

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