25-Aug-2014
Ever
growing number of women with gestational diabetes suggests future will be
filled with children with early diabetes
New research published in Diabetologia
(the journal of the European Association for the Study of Diabetes) shows that
children exposed to gestational diabetes in the wombs of their mothers are
themselves around six times more likely to develop diabetes or prediabetes than
children not exposed.
The research is by Dr Sonia Caprio, Yale University
School of Medicine, New Haven, CT, USA, and colleagues.
With the increase in gestational diabetes (GDM),
there is a growing need to understand the effects of glucose exposure on the
newborn in the womb, at birth and later in life. The risk of developing
impaired glucose tolerance (IGT) (prediabetes) in individuals exposed to
diabetes in the womb has not, say the authors, been adequately investigated.
Thus in this new study, the authors examined the risk in obese youths of
developing IGT after exposure to GDM in the womb. The authors say: "We
hypothesised that prenatal exposure to GDM in obese children with normal glucose
tolerance (NGT) would be associated with development of altered glucose
metabolism over time, driven by an impairment of beta cell secretion relative
to the insulin sensitivity."
255 obese adolescents with a normal glucose
tolerance were selected for the study. All of them were investigated for in
utero exposure to GDM and underwent an OGTT, which was repeated after
approximately 3 years. The authors found that 210 (82%) participants were not
exposed to GDM (called the NGDM group), and 45 (18%) were exposed to GDM (the
EGDM group). In the NGDM group, only 9% (n=18) developed either IGT or type 2
diabetes compared with 31% (n=14) of the EGDM group who developed either IGT or
type 2 diabetes, with both results statistically significant.. "Exposure
to GDM was the most significant predictor of developing IGT or type 2 diabetes,
with an increased risk of almost six times for those children exposed to GDM in
the womb," say the authors.
At baseline, the EGDM group showed a reduction in
beta cell function (the cells that produce insulin), and, at follow-up, they
also displayed a reduction in insulin sensitivity compared with the NGDM group.
"Our study demonstrates that obese normal
glucose-tolerant children of GDM mothers have pre-existing defects in beta cell
function," say the authors. "This is in turn a strong risk factor for
these children to develop prediabetes or diabetes."
They add: "The ever growing number of women
with gestational diabetes (18%) suggests that the future will be filled with
children with early diabetes at a rate that far exceeds the current
prevalence."
They conclude: " Offspring of GDM mothers
ought to be screened for IGT and/or impaired fasting glucose (another form of
prediabetes), and preventive and therapeutic strategies should be considered
before the development of full clinical manifestation of diabetes. While we
cannot use this analysis for development of definitive screening guidelines, we
strongly suggest that, among obese children and adolescents exposed to GDM,
specifically if additional risk factors are present—such as severe obesity or
being of ethnicity minorities at higher risk—oral glucose tolerance tests
should be performed at baseline (specifically in mid-pubertal adolescents) and
potentially repeated based on clinical judgement. Furthermore, the need for
studies aimed at unravelling the role of genetic or epigenetic factors and
environmental postnatal factors that might be causing functional defects in the
beta cell has never been more urgent."
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