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Pregnancy glucagon-like peptide 1 predicts insulin but not glucose concentrations.

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Peer-reviewed

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Authors

Barker, Peter 
Turner, Elizabeth H 

Abstract

AIMS: Incretin hormones glucagon-like peptide 1 (GLP-1) and gastric inhibitory peptide (GIP) cause increased insulin secretion in non-pregnant adults, but their role in pregnancy, where there are additional metabolically-active hormones from the placenta, is less clear. The aim of the present study was to assess if fasting and post-load incretin concentrations were predictive of pregnancy insulin and glucose concentrations. METHODS: Pregnant women (n = 394) with one or more risk factors for gestational diabetes were recruited at 28 weeks for a 75 g oral glucose tolerance test (OGTT). Glucose, insulin, GLP-1 and GIP were measured in the fasting state and 120 min after glucose ingestion. RESULTS: Fasting plasma GLP-1 concentrations were associated with plasma insulin (standardised β' 0.393 (0.289-0.498), p = 1.3 × 10-12; n = 306), but not with glucose concentrations (p = 0.3). The association with insulin was still evident when adjusting for BMI (β' 0.271 (0.180-0.362), p = 1.1 × 10-8; n = 297). Likewise, at 120 min the OGTT GLP-1 concentrations were associated with plasma insulin concentrations (β' 0.216 (0.100-0.331), p  = 2.7 × 10-4; n = 306) even after adjusting for BMI (β' 0.178 (0.061-0.294), p = 2.9 × 10-3; n = 296), but not with glucose (p  = 0.9). GIP concentrations were not associated with insulin or glucose concentrations at either time point (all p  > 0.2). In pregnancy plasma GLP-1, but not GIP, concentrations appear to be predictive of circulating insulin concentrations, independently of associations with BMIs. CONCLUSIONS: These results suggest that the relationship between insulin and incretins is preserved in pregnancy, but that other factors, such as placental hormones or counter-regulatory hormones, may be more important determinants of glycaemia and gestational diabetes aetiology.

Description

Acknowledgements: The authors would like to thank all the nurses, doctors, administrative and laboratory staff in the different centres who helped recruit participants, administer the oral glucose tolerances tests, take and process the blood samples for this study. We are also grateful to the participants for taking part in this study. The incretin assays were performed by the National Institute for Health Research Core Biochemistry Assay Laboratory, Cambridge Biomedical Research Centre. The OPHELIA study was supported by a European Foundation for the Study of Diabetes—Sanofi grant for innovative measurement of diabetes outcomes and subsequently by support from the National Institute of Health Research Cambridge Biomedical Research Centre (BRC) and a National Institute of Health Research Clinical Research Network chief investigator award. The OPHELIA study was supported with staff time from the NIHR Clinical Research Network. C.L.M. is supported by the Diabetes UK Harry Keen Intermediate Clinical Fellowship (DUK-HKF 17/0005712) and a European Foundation for the Study of Diabetes—Novo Nordisk Foundation Future Leader’s Award (NNF19SA058974).


Funder: NIHR Cambridge Biomedical Research Centre; doi: http://dx.doi.org/10.13039/501100018956

Keywords

Gestational diabetes, Incretin, Insulin secretion, Insulin sensitivity, Obesity, Adult, Female, Humans, Pregnancy, Insulin, Glucagon-Like Peptide 1, Incretins, Diabetes, Gestational, Blood Glucose, Diabetes Mellitus, Type 2, Placenta, Glucose, Gastric Inhibitory Polypeptide

Journal Title

Acta Diabetol

Conference Name

Journal ISSN

0940-5429
1432-5233

Volume Title

60

Publisher

Springer Science and Business Media LLC
Sponsorship
Novo Nordisk Foundation (NNF19SA058974)
European Foundation for the Study of Diabetes (EFSD) (NNF19SA058974)
European Foundation for the Study of Diabetes (EFSD) (96353)
Diabetes UK (17/0005712)
National Institute for Health Research Core Biochemistry Assay Laboratory, Cambridge Biomedical Research Centre. The OPHELIA study was supported by a European Foundation for the Study of Diabetes - Sanofi grant for innovative measurement of diabetes outcomes and subsequently by support from the National Institute of Health Research Cambridge Biomedical Research Centre (BRC) and a National Institute of Health Research Clinical Research Network chief investigator award. The OPHELIA study was supported with staff time from the NIHR Clinical Research Network. C.L.M. is supported by the Diabetes UK Harry Keen Intermediate Clinical Fellowship (DUK-HKF 17/0005712) and a European Foundation for the Study of Diabetes - Novo Nordisk Foundation Future Leader’s Award (NNF19SA058974).