Pathophysiology of postprandial hyperglycaemia in women with type 1 diabetes during pregnancy

Murphy, H R, Elleri, D, Allen, J M, Harris, J, Simmons, D, Rayman, G, Temple, R C, Umpleby, A M, Dunger, D B, Haidar, A, Nodale, M, Wilinska, M E and Hovorka, R (2012) Pathophysiology of postprandial hyperglycaemia in women with type 1 diabetes during pregnancy. Diabetologia, 55 (2). pp. 282-293. ISSN 0012-186X

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Aims/hypothesis  Although maternal hyperglycaemia is associated with increased risk of adverse pregnancy outcome, the mechanisms of postprandial hyperglycaemia during pregnancy are poorly understood. We aimed to describe glucose turnover in pregnant women with type 1 diabetes, according to stage of gestation (early vs late gestation).  Methods  The rates of systemic glucose appearance (R a) and glucose disposal (R d) were measured in ten pregnant women with type 1 diabetes during early (12–16 weeks) and late (28–32 weeks) gestation. Women ate standardised meals—a starch-rich 80 g carbohydrate dinner and a sugar-rich 60 g carbohydrate breakfast—and fasted between meals and overnight. Stable-label isotope tracers ([6,6-2H2]glucose and [U-13 C]glucose) were used to determine R a, R d and glucose bioavailability. Closed-loop insulin delivery maintained stable glycaemic conditions.  Results  There were no changes in fasting R a (10 ± 2 vs 11 ± 2 μmol kg–1 min–1; p = 0.32) or fasting R d (11 ± 2 vs 11 ± 1 μmol kg–1 min–1; p = 0.77) in early vs late gestation. There was increased hepatic insulin resistance (381 ± 237 vs 540 ± 242 μmol kg–1 min–1 × pmol/l; p = 0.04) and decreased peripheral insulin sensitivity (0.09 ± 0.04 vs 0.05 ± 0.02 μmol kg–1 min–1 per pmol/l dinner, 0.11 ± 0.05 vs 0.07 ± 0.03 μmol kg–1 min–1 per pmol/l breakfast; p = 0.002) in late gestation. It also took longer for insulin levels to reach maximal concentrations (49 [37–55] vs 71 [52–108] min; p = 0.004) with significantly delayed glucose disposal (108 [87–125] vs 135 [110–158] min; p = 0.005) in late gestation.  Conclusions/interpretation  Postprandial glucose control is impaired by significantly slower glucose disposal in late gestation. Early prandial insulin dosing may help to accelerate glucose disposal and potentially ameliorate postprandial hyperglycaemia in late pregnancy.

Item Type: Article
Uncontrolled Keywords: oral administration,adult,blood glucose,body mass index,carbohydrates,type 1 diabetes mellitus,gestational diabetes,fasting,female,humans,hyperglycemia,insulin resistance,postprandial period,pregnancy,pregnancy complications,pregnancy outcome,risk,time factors,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Depositing User: Pure Connector
Date Deposited: 25 May 2016 16:01
Last Modified: 19 Oct 2023 01:42
DOI: 10.1007/s00125-011-2363-6

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