Diabetes during pregnancy (GDM) increases type 2 diabetes (T2DM) risk after delivery. Insulin deficiency postpartum may play a greater role in T2DM development than insulin resistance in South Asian populations due to early life undernutrition and lack of excessive weight gain. We studied insulin pathophysiology after pregnancy in Indian women with GDM. Women were enrolled at delivery and followed until 6 months postpartum at an Indian public hospital serving lower socioeconomic strata. Fasting oral glucose tolerance testing (75 g) with insulin levels at 0, 30, and 120 min at 6 weeks (baseline) and 6 months postpartum were used to assess insulin resistance (by HOMA-IR) and insulin deficiency (by insulinogenic index (IGI) and fasting insulin oral disposition index (oDI)). Prediabetes and T2DM were defined per ADA criteria. Among 49 women at baseline, median age was 28 yrs (IQR 25-32). By 6 months postpartum, 9/49 women (18.4%) had T2DM and an additional 13/49 (26.5%) had prediabetes. IGI and oDI at 6 weeks postpartum were significantly lower in women who had prediabetes/T2DM by 6 months postpartum compared to women with normal glucose tolerance ([0.21 vs 0.48, p=0.03] and [0.03 vs 0.06, p<0.01], respectively), whereas there was no difference in HOMA-IR. Insulin deficiency postpartum may be more predictive of future T2DM than insulin resistance in South Asian women. Larger longitudinal studies are needed to further examine this association.
V. Kulkarni: None. M. Alexander: None. S. Naik: None. A. Kole: None. S. Tambe: None. P. Deshpande: None. T. Brown: Consultant; Merck & Co., Inc., Janssen Pharmaceuticals, Inc., ViiV. J.S. Mathad: None. P. Chebrolu: None.
Weill Cornell Fund for the Future Grant (R01A162235)
