What question did this study set out to answer?

This study aims to compare the influence of early pregnancy insulin resistance on early and late gestational diabetes.

June 7, 2026

2156-P: Early Insulin Resistance Is a Stronger Predictor of Early than Late Gestational Diabetes

Key Points

This study aims to compare the influence of early pregnancy insulin resistance on early and late gestational diabetes.
Conducted a multicenter randomized controlled trial with pregnant women at risk for gestational diabetes.
Used a 75g oral glucose tolerance test (OGTT) and measured fasting serum insulin.
Applied logistic binomial regression to estimate odds ratios adjusted for confounders.
Mean HOMA-IR was significantly higher in early gestational diabetes (eGDM) than late (lGDM) with p<0.001.
Odds ratios per 1-SD increase in HOMA-IR were 2.09 for eGDM and 1.39 for lGDM.
AUROC was significantly higher for eGDM (0.71) compared to lGDM (0.60).

Abstract

Introduction and Objective: Early pregnancy insulin resistance (eIR) increases risk of gestational diabetes (GDM). We compared early (eGDM) and late GDM (lGDM) in their relationship with eIR. Methods: Pregnant women with GDM risk factors enrolled in a multicenter RCT had a 75g OGTT before 20w using IADPSG criteria, with fasting serum insulin measured. Repeat OGTT occurred at 24-28w if OGTT was normal and in 50% of those with eGDM. Homeostatic Model Assessment (HOMA)-IR (Glucose x Insulin)/22.5) values were log-transformed and standardized to a z score to estimate odds ratios (OR(95% CI)) per 1-SD increase in log-HOMA. Logistic binomial regression was used to adjust the OR of GDM for confounders. A non-linear association between HOMA-IR and GDM was assessed by adding a squared term for HOMA-IR. Area under the receiver operator curve (AUROC) with 95% CI was used for eGDM and lGDM prediction. Results: Among 1225 women (mean age 32±5y, BMI 29.6±7.8 kg/m2, OGTT gestation 15±2w, 43.3% European), mean HOMA-IR (1.44±1.86 for no-GDM) was 2.44±2.08 for eGDM and 1.58±1.85 for lGDM (p0.001). The OR for eGDM and lGDM were 2.09 (1.82-2.40) and 1.39 (1.17-1.65) per 1-SD increase in HOMA-IR respectively with adjusted OR 2.03(1.69-2.42) and 1.45 (1.15-1.82). The association was nonlinear for eGDM (p=0.002) but linear for lGDM (fig 1). The AUROC was significantly higher for eGDM than lGDM (0.71 (95% CI 0.68-0.74) vs 0.60(0.56-0.64)). Conclusion: Early pregnancy insulin resistance is a stronger predictor of eGDM than lGDM. Disclosure D. Simmons: Speaker's Bureau; Ended; Novo Nordisk. Other - Educational grant; Ended; Abbott Diabetes. Research Support; Current; Novo Nordisk. Consultant; Ended; Dexcom, Inc. A. Sweeting: None. J. Immanuel: None. M. Hivert: None. V.W. Wong: None. J. Harreiter: None. W.M. Hague: None. N. Pham: None. C. Nolan: None. N. Cheung: Other - honorarium for speakership; Ended; AstraZeneca. V. Mohan: None. A. Kautzky-Willer: None. M.J. Peek: None. E. Gianatti: None. A.A. Hardikar: None. M.V. Joglekar: None. H.E. Backman: None. Funding NHMRC (grants 1104231 and 2009326); Region Örebro Research Committee DnrOLL-970566, OLL-942177; Medical Scientific Fund of the Mayor of Vienna, project 15205; SouthWestern Sydney Local Health District Academic Unit grant 2016; Western Sydney University AinsworthTrust grant 2019

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2156-P: Early Insulin Resistance Is a Stronger Predictor of Early than Late Gestational Diabetes

Key Points

Abstract

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