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Serum Ferritin and Glucose Homeostasis in Women With Recent Gestational Diabetes

  • Samantha Hershenfeld
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Chang Ye
    Affiliations
    Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Anthony J. Hanley
    Affiliations
    Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada

    Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Philip W. Connelly
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada

    Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada

    Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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  • Bernard Zinman
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada

    Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada

    Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Ravi Retnakaran
    Correspondence
    Address for correspondence: Ravi Retnakaran MD, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, Ontario M5T 3L9, Canada.
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada

    Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada

    Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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      Abstract

      Objectives

      Serum markers of iron storage have been linked to type 2 diabetes; however, the mechanism underlying this association is unclear. In pregnancy, increased serum ferritin has been reported in women with gestational diabetes (GDM), a patient population at high risk of future type 2 diabetes. However, in the years after pregnancy, it is not known if ferritin relates to their diabetes risk or the pathophysiologic determinants thereof (insulin sensitivity and beta-cell function). Therefore, we sought to characterize the relationship between ferritin and glucose homeostasis in the early postpartum years in women with and without recent GDM.

      Methods

      At both 1 and 3 years postpartum, 340 women (105 with recent GDM) underwent serum ferritin measurement and an oral glucose tolerance test that enabled assessment of insulin sensitivity and/or resistance (Matsuda index and Homeostasis Model Assessment [HOMA-IR]), beta-cell function (Insulin Secretion-Sensitivity Index-2 and insulinogenic index/HOMA-IR) and glucose tolerance.

      Results

      Serum ferritin did not differ between women who had GDM and their peers at either 1 or 3 years postpartum. Baseline-adjusted change in ferritin between 1 and 3 years correlated with the concomitant change in C-reactive protein (r=0.21, p=0.0002) but was not associated with measures of insulin sensitivity and/or resistance, beta-cell function or glycemia. On adjusted analyses, neither baseline ferritin nor its change from 1 to 3 years was independently associated with any of the following metabolic outcomes at 3-years postpartum: Matsuda index, HOMA-IR, Insulin Secretion-Sensitivity Index-2, insulinogenic index/HOMA-IR, fasting glucose, 2-h glucose or glucose intolerance.

      Conclusions

      Serum ferritin is not associated with glucose homeostasis in the early years after a GDM pregnancy.

      RÉSUMÉ

      Objectifs

      Les marqueurs sériques du stockage du fer ont été associés au diabète de type 2. Toutefois, on ignore le mécanisme sous-jacent à cette association. Durant la grossesse, on a signalé des concentrations sériques accrues de la ferritine chez les femmes atteintes du diabète sucré gestationnel (DSG), une population de patientes exposées à un risque élevé d'un futur diabète de type 2. Toutefois, dans les années qui suivent la grossesse de ces femmes, on ignore si la ferritine a un lien avec leur risque de diabète ou les déterminants physiopathologiques de ce dernier (insulinosensibilité et fonctionnement des cellules bêta). Par conséquent, nous avons cherché à décrire la relation entre la ferritine et l'homéostasie glucidique dans les premières années qui suivent l'accouchement des femmes atteintes ou non d'un DSG récent.

      Méthodes

      Un an et 3 ans après l'accouchement, 340 femmes (dont 105 étaient atteintes d'un DSG récent) ont subi des analyses pour mesurer les concentrations sériques de la ferritine et une épreuve d'hyperglycémie provoquée par voie orale qui a permis l’évaluation de l'insulinosensibilité et/ou de l'insulinorésistance (indice de Matsuda et l’évaluation du modèle d'homéostasie de l'insulinorésistance [de l'anglais, HOMA-IR]), le fonctionnement des cellules bêta (indice d'insulinosécrétion et d'insulinosensibilité 2 [de l'anglais, ISSI-2] et l'indice insulinogénique/HOMA-IR) et la tolérance au glucose.

      Résultats

      Les concentrations sériques de la ferritine n’étaient pas différentes entre les femmes qui avaient un DSG et leurs pairs 1 an ou 3 ans après l'accouchement. Les changements ajustés aux concentrations initiales de la ferritine entre 1 et 3 ans étaient en corrélation avec les changements concomitants de la protéine C réactive (r = 0,21, p = 0,0002), mais n’étaient pas associés aux mesures de l'insulinosensibilité et/ou de l'insulinorésistance, au fonctionnement des cellules bêta ou à la glycémie. Dans les analyses ajustées, ni les concentrations initiales de la ferritine ni leurs changements après 1 et 3 ans n’étaient indépendamment associés aux résultats métaboliques suivants 3 ans après l'accouchement: indice de Matsuda, HOMA-IR, indice ISSI-2, indice insulinogénique/HOMA-IR, glycémie à jeun, 2 heures après avoir bu un liquide contenant 75 g de glucose ou intolérance au glucose.

      Conclusions

      Les concentrations sériques de la ferritine ne sont pas associées à l'homéostasie glucidique dans les premières années après la grossesse des femmes atteintes d'un DSG.

      Keywords

      Mots clés

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