Aims/hypothesis Gestational diabetes (GDM) carries a high risk of subsequent diabetes. We asked what impact prior GDM has on beta cell function and insulin action in women who maintain normal glucose tolerance (NGT) for a long time. Methods Ninety-one women with NGT (aged 41 +/- 8 years, mean +/- SD)were studied (by mathematical modelling of the C-peptide response to an OGTT) 7  years (median [interquartile range]) after the index pregnancy, during which 52 had GDM (pGDM) and 39 had NGT (pNGT). In all women an OGTT had also been performed at 29 +/- 3 weeks of the index pregnancy. Results Women with pGDM were matched with women with pNGT for age, familial diabetes, time and weight gain since index pregnancy, parity, BMI (25.4 +/- 3.9 vs 26.8 +/- 6.4 kg/m(2)), and fasting (4.64 +/- 0.56 vs 4.97 +/- 0.46 mmol/l) and 2 h plasma glucose levels (5.91 +/- 1.14 vs 5.91 +/- 1.21 mmol/l). Nonetheless, fasting (49  vs 70  pmol min(-1) m(-2), p < 0.001) and total insulin secretion (32  vs 48  nmol m-2, p < 0.0001) and beta cell glucose sensitivity (slope of the insulin secretion/plasma glucose concentration-response function) (95  vs 115  pmol min(-1) m(-2) (mmol/l)(-1), p=0.025) were reduced in the pGDM group compared with the pNGT group, while insulin sensitivity was preserved (424  vs 398  ml min(-1) m(-2)). At index pregnancy, women with pGDM and those with pNGT had similar age and BMI. However, both insulin sensitivity (359  vs 417  ml min(-1) m(-2), p=0.0012) and the insulin/glucose incremental area ratio (an empirical index of beta cell function; 98  vs 138  pmol/mmol, p=0.028) were reduced in women with pGDM. Conclusions Even in women who maintain normal insulin sensitivity, impaired beta cell function is carried over into the NGT status several years after a GDM pregnancy.
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