Methods for assessing insulin resistance in gestational diabetes mellitus

Abstract

Among all endocrine diseases complicating pregnancy, gestational diabetes mellitus (GSD) is the most common. Th is violation of carbohydrate metabolism poses a serious threat to the health of the mother and fetus, associated with a high risk of perinatal complications. At the same time, the eff ective achievement of normoglycemia in a woman suff ering from GSD can signifi cantly improve the prognosis. Th e choice of GSD therapy depends on a number of factors and is decided individually in each case. One of the factors determining the eff ectiveness of non-drug therapy and the need for pharmacological correction may be related to the pathophysiological aspects of the formation of hyperglycemia during pregnancy. Currently, they talk about the heterogeneity of GSD and distinguish its various subtypes depending on the predominance of pancreatic beta-cell dysfunction, insulin resistance (IR) or a combination of these factors in the pathogenesis. Since the prevailing criterion for the verifi cation of GSD subtypes is the presence and severity of IR, various methods of its verifi cation are considered in this review. It is shown that the currently available methods for detecting IR have a number of disadvantages, consisting both in the complexity and complexity of implementation (hyperinsulinemic euglycemic clamp) and in the absence of clear reference intervals (mathematical models). It is necessary to continue research aimed at studying IR methods for the subsequent identifi cation of GSD subtypes.

Keywords

• gestational diabetes mellitus, subtypes of gestational diabetes mellitus, insulin resistance, insulin resistance indices, hyperinsulinemic euglycemic clamp