Gestational diabetes & diabetes in pregnancy
A critique of measurement of defective insulin secretion and insulin sensitivity as a precision approach to gestational diabetes
Authors' conclusion
Precision categorisation of GDM using HOMA2-S and HOMA2-B does not provide useful diagnostic or prognostic information, but did distinguish a novel subgroup of patients with GDM, characterised by an isolated postprandial defect in insulin sensitivity.
Study context
- Population
- Pregnant women with ≥1 risk factor for gestational diabetes mellitus (GDM) undergoing 75 g OGTT at nine hospital sites; GDM diagnosis per NICE guidance
- Participants
- 1,308 women
- Exposure
- Pathophysiological GDM subtypes vs NGT
- NGTn = 1,027reference
- Insulin-resistant GDMn = 135
- Insulin-insufficient GDMn = 73
- Bothn = 2
- GDM-neithern = 71
- Outcome
- Classification by enhanced specimen handling
Methodological detailsmulticentre, nine hospital sites
- Multicentre
- Nine hospital sites
Main finding
As reported in the abstract
- Classified as GDM
- 281/1308 (21.5%)
Observational data: associations, not effects.
Further findings
GDM-neither phenotype
- Relatively insulin-sensitive fasting but marked post-load hyperglycaemia and hyperinsulinaemia, suggesting isolated postprandial defect in insulin sensitivity
Pregnancy outcomes
- Most GDM subgroups had pregnancy outcomes comparable to normoglycaemic women; HOMA2-B and HOMA2-S were weak predictors
- Maternal BMI predicted a similar number of outcomes to HOMA2-S; no additional predictive value of HOMA2-S
- Similar findings with different indices and standard specimen handling
Original publication
A critique of measurement of defective insulin secretion and insulin sensitivity as a precision approach to gestational diabetes. Diabetologia. Published 2 December 2024. doi:10.
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