ELEVATED
HOMOCYSTEINE AS A RISK FACTOR FOR THE DEVELOPMENT OF
DIABETES IN WOMEN WITH A PREVIOUS HISTORY OF GESTATIONAL DIABETES MELLITUS: A
4-YEAR PROSPECTIVE STUDY
Soo
Lim, Hak Chul Jang, Hong
Background and
Aims.
To investigate the potential use of the plasma homocysteine level as a
predictor of diabetes in women with a previous history of gestational diabetes
mellitus (GDM).
Materials and
Methods. At 6 weeks postpartum, baseline examination was performed
in 177 GAD negative subjects. Seven subjects who were diagnosed with diabetes
at baseline were excluded from further evaluation, and 170 subjects with normal
or impaired glucose tolerance at baseline were followed annually over 4 years.
The follow-up examinations included 2-hour 75g oral glucose tolerance tests (OGTTs), lipid profiles, homocysteine levels, anthropometric
measurements, history taking, diet and life style. During the OGTTs, insulin and glucose levels were assayed every 30
minutes. Plasma homocysteine levels were determined by ion-exchange
chromatography.
Results. Of the 170 women, 18 (10.6%) converted to
diabetes during the 4-year follow-up period. Mean age, BMI, fasting insulin and
total cholesterol at baseline(6 weeks postpartum test)
were similar in the three study groups (i.e., normal, impaired glucose
tolerance, and diabetes). Fasting glucose levels, insulin/glucose ratios, and
homocysteine levels were significantly higher in the diabetic group (P <
0.05). Higher glucose at the time of the diagnosis of GDM and higher
homocysteine levels at baseline were independently associated with the onset of
postpartum diabetes. These relationships were independent of age, BMI, and
family history of diabetes.
Conclusion. This prospective study identified the
homocysteine level as a significant risk factor for development of diabetes in
women with previous GDM.