Сахарный диабет (Dec 2023)
Features of the functional state of the enteropancreatic hormonal system in pregnant women with gestational diabetes mellitus
Abstract
Features of the functional state of the enteropancreatic hormonal system in pregnant women with gestational diabetes mellitus© Fatima O. Ushanova1*, Tatiana Y. Demidova1, Tatiana N. Korotkova21Pirogov Russian National Research Medical University, Moscow, Russia2Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, RussiaBACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is growing rapidly, along with which the typical portrait of a pregnant woman with this disease is changing. Frequent detection of GDM in the early stages of pregnancy causes a high interest in the study of new mechanisms of its development.AIM: Evaluation of the state of the incretin response based on the analysis of the secretion of GLP-1, glucagon, insulin and c-peptide in pregnant women with different periods of GDM development.MATERIALS AND METHODS: A single-center prospective comparative uncontrolled study that included pregnant women with GSD, divided into 2 groups depending on the duration of the disease: group 1 — pregnant women who were diagnosed at <24 weeks of gestation (n=65), group 2 — at ≥24 weeks of gestation (n=26). All patients underwent a set of diagnostic measures, including a stress test with the determination of GLP-1, glucagon, insulin, c-peptide before and after a mixed breakfast, and an assessment of insulin resistance. Glucose monitoring was performed for pregnant women with GSD using the FreeStyle Libre Flash system (Abbott Diabetes Care Ltd., UK).RESULTS: The total number of subjects was 91. The average age was 32.05±5.6 (95% CI 30.9; 33.2) years. Pregnant women of both groups were comparable in age, body weight and glycemic level at the time of diagnosis. The basal blood insulin level in the general group was 7.2 [4.9; 12.1] µme/ml, C-peptide — 1.5 [1.17; 2.24] ng/m, glucagon — 70.1 [56.2; 100] pg/ml, GLP-1 — 1.16 [0.94; 1.22] ng/ml. In 31% For women, the HOMA-IR index was ≥2.7. The basal level of glucagon was significantly higher in the group of early development of GSD: 70.9 [57.7; 109.2] pg/ml versus 61.7 [46.6; 87] pg/ml, p=0.04. In both groups of pregnant women, the decrease in glucagon secretion was not statistically significant, most had a paradoxical increase in glucagon secretion. When assessing the dynamics of GPP-1, a significant increase in the indicator was detected only in the 1st group: Δ GPP-1 0.15 [-0.07; 0.96], p <0.01. In the second, the dynamics of the indicator was not statistically significant (p=0.211). Negative correlation of the increase in GLP-1 with MAGE (r=-0.34, p<0.05), glycemic lability index LI (r=-0.4, p<0.05) and J-index (r=0.44, p<0.05) was revealed.CONCLUSION: The preservation of the physiological secretion of insulin and c-peptide in the form of a satisfactory increase in indicators after a food load was established. A violation of postprandial suppression of glucagon secretion was revealed. The increase in GPP-1 in response to food loading was disrupted in the case of the development of GSD during pregnancy ≥ 24 weeks.
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