Impairments of insulin and glucagon sensitivity in Chinese women with gestational diabetes mellitus

Abstract Aim To evaluate insulin and glucagon sensitivity in Han Chinese women with and without gestational diabetes mellitus (GDM). Methods In total, 81 women with GDM and 81 age‐matched healthy controls were evaluated with a 75 g oral glucose tolerance test (OGTT) at gestational weeks 24‐28. Plasma glucose concentrations were measured at fasting and 1 h and 2 h post‐OGTT. Fasting plasma insulin, glucagon and amino acids were also measured. Insulin and glucagon sensitivity were assessed by the homeostatic model assessment of insulin resistance (HOMA‐IR) and glucagon‐alanine index, respectively. Results As expected, plasma glucose concentrations were higher at fasting and 1 h and 2 h post‐OGTT in GDM participants ( p < .001 each). Both the HOMA‐IR and the glucagon‐alanine index were higher in GDM participants. There was a weak positive correlation between HOMA‐IR and glucagon‐alanine index (r = 0.24, p = .0024). Combining the HOMA‐IR and the glucagon‐alanine index yielded better capacity (area under the curve = 0.878) than either alone (area under the curve = 0.828 for HOMA‐IR and 0.751 for glucagon‐alanine index, respectively) in differentiating GDM from healthy participants. While the majority of GDM participants (64%) exhibited both reduced insulin and glucagon sensitivity, a third of them presented either reduced insulin (20%) or glucagon (14%) sensitivity alone. HOMA‐IR and glucagon‐alanine index correlated differentially with fasting glucose, triglycerides, low‐density lipoprotein cholesterol, sum of amino acids and hepatic steatosis index. Conclusions Impairments of both insulin and glucagon sensitivity occur frequently in Chinese women with GDM, which may, individually or together, drive metabolic derangements in GDM. These observations provide new insights into the pathophysiology of GDM and support the need to target insulin or glucagon resistance, or both, in the management of GDM.