Glucose Homeostasis, Beta Cell Function, and Insulin Resistance in Relation to Vitamin D Status After Gestational Diabetes Mellitus

Acta Obstet Gynecol Scand. 2017 Jul;96(7):821-827. doi: 10.1111/aogs.13124. Epub 2017 Apr 10.

Abstract

Introduction: We wanted to determine vitamin D status after gestational diabetes mellitus (GDM) and to evaluate whether levels of 25-hydroxyvitamin D3 (25OHD3 ) are associated with beta cell function, insulin resistance or a diagnosis of diabetes after GDM.

Material and methods: Glucose homeostasis was assessed during a 75-g oral glucose tolerance test one to two years after delivery in 376 women with previous GDM (287 European and 78 non-European, including 33 Arab and 35 Asian women). Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR). The insulinogenic index (I/G30) and the disposition index [(I/G30)/HOMA-IR] were used to calculate insulin secretion. Concentrations of serum 25OHD3 were determined.

Results: Mean (±SD) 25OHD3 concentration was 50.0 ± 22.3 nmol/L and differed significantly among subgroups of body mass index, ethnicity, and glucose tolerance status; 53% had 25OHD3 levels <50 nmol/L and 87% had 25OHD3 levels <75 nmol/L. There was a negative correlation between 25OHD3 concentration and HOMA-IR (p < 0.001) and a positive correlation between 25OHD3 and disposition index (p = 0.002) in univariable regression analysis. Correlations attenuated after adjustment for body mass index. In univariable regression analysis, 25OHD3 concentrations were significantly associated with diabetes after GDM (p = 0.004). However, in a multivariable model, non-European origin, HOMA-IR and insulinogenic index were significantly associated with postpartum diabetes, whereas 25OHD3 concentrations were not.

Conclusion: Vitamin D deficiency/insufficiency in previous GDM cases appears to be associated with beta cell dysfunction and insulin resistance, but not with postpartum diabetes when factors well known to influence type-2 diabetes were adjusted for.

Keywords: Disposition index; HOMA-IR; OGTT; ethnicity; gestational diabetes; insulinogenic index; postpartum diabetes; vitamin D.

MeSH terms

  • Adult
  • Arabs
  • Asian Continental Ancestry Group
  • Blood Glucose / physiology
  • Calcifediol / blood*
  • Diabetes, Gestational / blood*
  • Diabetes, Gestational / ethnology
  • Ethnic Groups
  • Female
  • Homeostasis
  • Humans
  • Insulin Resistance / physiology
  • Insulin-Secreting Cells / physiology
  • Postpartum Period / blood
  • Pregnancy
  • Sweden
  • Young Adult

Substances

  • Blood Glucose
  • Calcifediol