CHANGES IN SERUM INSULIN AND PROINSULIN LEVELS IN GESTATIONAL DIABETES - A BRIEF REVIEW
Received
11 December 2021
Revised
26 January 2022
Accepted
18 February 2022
Available Online
15 March 2022
Abstract
GESTATIONAL DIABETES MELLITUS (GDM) IS A COMPLICA TION OF PREGNANCY CHARACTERIZED BY HYPERGLYCAEMIA WITH ONSET OR FIRST RECOGNITION IN PREGNANCY. PREVALENCE OF GDM IS INCREASING GLOBALLY . GDM IS ASSOCIATED WITH SHORT AND LONG -TERM MATE RNO- FETAL COMPLICATIONS AND IS CONSIDERED A PREDIABETES STATE BECAUSE IT HAS A HIGH RISK OF DEVELOPING TYPE 2 DIABETES FOR BOTH MOTHER AND CHILD. THE PATHOGENESIS OF GDM INCLUDES INSULIN RESISTANCE (IR) AND Β -CELL DYSFUNCTION. PATIENTS WITH GDM ARE MORE INSULIN RESISTANT THAN PREGNANT NONDIABETIC WOMEN 7 AND THEY ARE PREDISPOSED TO HAVE DEFECTIV E INSULIN SECRETION AND DEFECTIVE INSULIN ACTION. IN GDM , HYPERPROINSULINEMIA DEVELOPS IN PARALLEL WITH PROGRESSIVE Β -CELL DYSFUNCTION. THUS, MEAN LEVELS OF PRO -INSULIN ARE SIGNIFICANTLY HIGHER DURING A GDM PREGNANCY AS COMPARED TO A NORMAL PREGNANCY. THE PURPOSE OF THIS REVIEW IS TO ANALYSE CHANGES OF SERUM LE VELS AND THE ROLE OF INSULIN AND PROINSULINE IN THE PATHOPHYSIOLOGY OF PREGNANCIES COMPLICATED WITH GESTATIONAL DIABETES. UNDERSTANDING THE PATHOPHYSIOLOGY OF GDM IS ESSENTIAL FOR A BETTER MANAGEMENT OF THIS DISEASE.
Keywords
GESTATIONAL DIABETES
PATHOGENESIS
ADIPOKINES
INSULIN RESISTANCE
Full Text
The body of this article is intentionally hidden on the public page. Please use the PDF reader or the PDF download for the complete text.
References
[1]
Cristiane de Freitas Paganoti , Rafaela Alkmin da Costaa , Ana Maria da Silva Sousa Oliveira, Mara Sandra Hoshidac , R ossana Pulcineli Vieira Francisco ;Adiponectin does not improve the prediction of insulin need in pregnant women with gestational diabetes mellitu s . Endocrine and Metabolic Science, 2021
[2]
Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2022 , American Diabetes Association Professional Practice Committee, Diabetes Care 2022;45(Supplement_1):S232– S243
[3]
Cho NH et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271-81
[4]
Plows JF et al. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;
[5]
Barbour L.A., McCurdy C.E., Hernandez T.L., Kirwan J.P., Catalano P.M., Friedman J.E. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30(Suppl. S2):S112–S119.
[6]
MacNeill S, Dodds L, Hamilton DC, Armson B A, VandenHof M . Rates and risk factors for recurrence of gestational diabetes. Diabetes Care 2001;24:659-62.
[7]
Sonagra A.D., Biradar S.M., Dattatreya K., DS J.M. Normal PregnancState of Insulin Resistance. J. Clin. Diagn. Res. 2014
[8]
Wilcox G. Insulin and Insulin Resistance. Clin. Biochem. Rev. 2005;
[9]
Barbour L.A., McCurdy C.E., Hernandez T.L., Kirwan J.P., Catalano P. M., Friedman J.E. Cellular Mechanisms for Insulin Resistance in Normal Pregnancy and Gestational Diabete s. Diabetes Care. 2007;30(Suppl. 2):S112–S119.
[10]
McIntyre H.D., Chang A.M., Callaway L.K., Cowley D.M., Dyer A.R., Radaelli T., Farrell K.A., Huston-Presley L., Amini S.B., Kirwan J.P., et al . Hormonal and Metabolic Factors Associated With Variations in Insulin Sensitivity in Human Pregnancy. Diabetes Care. 2010;
[11]
E. A. Ryan,A. Savu,R. O. Yeung,L. E. Moore,S. L. Bowker,P. Kau, Elevated fasting vs post -load glucose levels and pregnancy outcomes in gestational diabetes: a population -based study, Diabetic Medicine, 2019
[12]
Bellamy L, Casas JP, Hingorani AD, Williams D . Type 2 diabetes mellitus after gestational diabete s: a systematic review and meta-analysis. Lancet 2009;373:1773-9.
[13]
Catalano PM et al. Trying to understand gestational diabetes. Diabet Med. 2014
[14]
Thorens B. Glucose sensing and the pathogenesis of obesity and type 2 diabetes. Int. J. Obes. 2005. 2008;32(Suppl. 6):S62–S71.
[15]
Xiang AH, et al. Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes. Diabetes. 1999;48(4):848–54.
[16]
Homko C, et al. Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. J Clin Endocrinol Metab. 2001;86(2):568–73.
[17]
Amara FE, Meleis ME, Seif MA, et al. Study of pro -insulin level and its role in a cohort of women with gestational diabetes in Alexandria, Egypt. J Diabetol 2011;2:4.
[18]
Retnakaran R, Hanley AJ, Raif N, H irning CR, Connel ly PW, Sermer M, Kahn SE, Zinman B: Adiponectin and beta cell dysfunction in gestational diabetes: pathophysiological implication s. Diabetologia 48:993–1001, 2005
[19]
Dornhorst A, Davies M, Anyaoku V, et al. Abnormalities in fasting circulati ng proinsulin concentration in mild gestational diabetes. Clin Endocrinol 1991;34:211–3.
[20]
Swinn RA, et al. Excessive secretion of insulin precurso rs characterizes and predicts gestational diabetes. Diabetes. 1995;44(8):911–5.
[21]
Kautzky-Willer A, Thomaseth K, Ludvik B, et al. Elevated islet amyloid pancreatic polypeptide and proinsulin in lean gestational diabetes. Diabetes 1997;46:607–14
[22]
Phelps RL, Be rgenstal R, Freinkel N, et al. Carbohydrate metabolism in pregnancy: XIII. Relationships between plasma insuli n and proinsulin during late pregnancy in normal and diabetic subjects. J Clin Endocrinol Metab 1975;41:1085–91.
[23]
Polonsky KS, Rubenstein AH : C -peptide as a measure of the secre tion and hepatic extraction of insulin. Diabetes 33:486–494, 1984
[24]
Cuilin Zhang, Sjurdur F Olsen , Stefanie N Hinkle , Robert E Gore-Langton, Allan Vaag, Louise Groth Grunnet , Edwina H Yeung, Diabetes & Women’s Health (DWH) Study: an observational study of long -term health consequences of ges tational diabetes, their determinants and underlying mechanisms in the USA and Denmark, BMJ, 2019
[25]
Jimenez J, Zuniga -Guajardo S, Zinman B, Angel A : Effects of weight loss in massive obesity on insulin and C -peptide dynamics: sequential changes in insulin pr oduction, clearance, and sensitivity. J Clin Endocrinol Metab 64:661–668, 1987
[26]
Pradhan AD, Manson JE, Meigs JB, Rifai N, B uring JE, Liu S, Ridker PM: Insulin, proinsulin, proinsulin:insulin ratio, and the risk of developing type 2 diabetes mellitus in wome n. Am J Med 114:438–444, 2003
[27]
Kautzky-Willer A, et al. Pronounced insulin resistance and inadequate beta -cell secretion characterize lean gestational diabetes during and after pregnancy. Diabetes Care. 1997;20(11):1717 –23.
[28]
Dornhorst A, Davies M, Anyaoku V , Hampton SM, Elkeles RS, Beard RW, Johnston DG: Abnormalities in fasting circulating proinsulin concentration in mild ges tational diabetes. Clin Endocrinol 34:211–213, 1991
[29]
Festa A, Shnawa N, Schernthaner G, Haffner SM : Proinsulin in pregnant women with normal glucose tolerance or mild gestational diabetes mellitus. Exp Clin Endocrinol Diabetes 107:447 –452,
[30]
Flavius-Cristian M ărcău, Sorin Purec, George Niculescu , „ Study on the refusal of vaccination against Covid-19 in Romania” în Vaccines 2022, 10, 261.https://doi.org/10.3390/vaccines10020261
[31]
Stumvoll M, Van Haeften TV, Fritsche A, Gerich J: Oral glucose tolerance test indexes for insulin sensitivity and secretion based on various ava ilabilities of sampling times. Diabetes Care 24:796 –797,
[32]
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF , Turner RC: Homeostasis model assessment: insulin resistance and -cell function from fasting plasma glucose and insulin concentrations in man. Diabetes
[33]
Kirwan JP, Huston -Presley L, Kalhan SC, Catalano PM : Clinically useful estimates of insulin sensitivity during pregnancy : vali dation studies in women with normal glucose tolerance and gestational diabetes mellitus. Diabetes Care 24:1602–1607, 2001