Glucose characteristics of patients with lesser degrees of hyperglycemia during pregnancy

OBJECTIVE: It has been shown thai gravidas having lesser degrees of hyperglycemia (non-GDM but (.ITT values greater than Coustan, Sacks or 1-abnormal criteria) are associated with outcome comparable to standard (ACOG) GDM patients. However, the pathophvsiology of these patienis has not been examined. Therefore, we sought to determine the insulin resistance/secretion profiles ol gravidas with lesser degrees of hyperglvceTiiia. METHODS: 36 patients uiih lessor degrees oi' hvperglycemia participated in the studv. Insulin sensitiviu and secretion uere examined using the insulin-modified. Minimal Model (20 samples per subject). The\ were compared to a control group nl' 20 gravi<las normal bv all criteria (GTT values below Cou.stan, Sacks and 1-abnonnal) and to f>0 patients with 2 or more GTT values abnormal (GDM). RESULTS: 62% of the lesser degree women had both S, and insulin response below the normal airve (figure), i.e. values in the lower left corner of the graph. Additionallv, there were no significant differences between study vs GDM gravidas in: ( 1 ) area under glucose curve - 6642 vs 7393 mg/dL min, p - .09; (2) 1st phase insulin response - 2.2 vs 2.4 mU/ mL min, p = .3S; (3) insulin sensitiviu - 0.39 vs 0.4ti 10 ' min ' /pmol/ I., p = .26. CONCLUSION: The decreased sensiti\u\ and insulin secretion found in gnuidas with lesser degrees of lupergKcemia i- sinnlar to standard GDM gravidas These common abnoimalities form die core oi their padioph\siologv, aiid confirm the need to treat them as GDM.