Date of Award

January 2016

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sonia Caprio

Second Advisor

Jeffrey Gruen

Abstract

With the new increase in pregnancies affected by gestational diabetes mellitus (GDM) there is a growing need to understand the effects of intrauterine glucose exposure on the newborn at birth and later in life. The risk of developing impaired glucose tolerance (IGT) in individuals exposed to diabetes in utero has not been adequately investigated. Our study examined the increased risk in obese youth, exposed to GDM, of developing IGT and the β cell function relative to insulin sensitivity. We analyzed a cohort of 255 obese adolescents with a documented history of exposure to gestational diabetes and normal glucose tolerance (NGT) at first oral glucose tolerance test (OGTT), which was repeated after approximately 2.8 years.Within this study population 82.3% (n=210) were not exposed to gestational diabetes mellitus (NGDM) and 17.7% (n=45) were exposed to gestational diabetes mellitus (EGDM). In the NGDM group only 8.6% (n=18) developed either IGT or Type 2 diabetes in comparison to the 31.1% (n=14) of the EGDM group that developed either IGT or Type 2 diabetes (p<0.001). After analyzing multiple covariates, exposure to gestational diabetes was the most significant predictor for developing IGT or Type 2 diabetes (OR 5.75, 95% CI 2.19, 15.07, p<0.001). At baseline and at follow-up, the EGDM group showed a reduction in β cell function determined by the oral disposition index (p=0.03 and p=0.01, respectively), and, at follow-up they also displayed a reduction in insulin sensitivity compared with the NGDM group (p=0.05). Obese youth exposed in utero to GDM show early inability of the beta cell to compensate.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

Download

Share

COinS