AUTHOR=Lesniara-Stachon Anna , Cosson Emmanuel , Lacroix Alain , Schenk Sybille , Quansah Dan Yedu , Puder Jardena J. 

TITLE=Postpartum glucose intolerance after gestational diabetes mellitus: tailored prediction according to data-driven clusters and BMI-categories

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1381058

DOI=10.3389/fendo.2024.1381058

ISSN=1664-2392

ABSTRACT=Objectives: To account for the heterogeneity of gestational diabetes (GDM), the aim of the study was to investigate tailored predictors during pregnancy and at 6-8 weeks postpartum of glucose intolerance (GI) at 1-year postpartum. We also aimed to identify predictors according to data-driven clusters, analogously to the newly proposed diabetes classification, and for clinical ease according to BMI-categories. 
Methods: This is a secondary analysis of the MySweetheart trial including 179 women with GDM who underwent a 75g oral glucose tolerance test (oGTT) and HbA1c measurement at 1-year postpartum. Predictors were determined according to: a) cluster analysis based on age, BMI, HOMA-IR and HOMA-B; and b) BMI-categories (normal weight [NW], and overweight/obesity [OW/OB]). 
Results: We identified two clusters during pregnancy and at 6-8 weeks postpartum (“insulin-resistant”, and “insulin-deficient”). The “insulin-resistant” clusters were associated with a 2.9-fold (CI: 1.46-5.87; pregnancy) and 3.5-fold (CI: 1.63-7.52; at 6-8 weeks postpartum) increased risk of GI at 1-year postpartum. During pregnancy, the most relevant predictors of GI were history of previous GDM and fasting glucose for the “insulin-deficient”  and NW women, and HOMA-IR for the “insulin-resistant” and OW/OB category (all p ≤0.035). In the postpartum, predictors were more heterogenous and included the insulin-sensitivity-adjusted-secretion index and 1-h glucose in the “insulin-deficient” and NW. 
Main conclusions: In women with GDM, we identified “insulin-resistant” and “insulin-deficient” clusters with distinct risks of future GI. Predictors varied according to clusters/ BMI-categories emphasizing the need for tailored risk assessments.