Lege Artis Medicinae

[Gestational diabetes mellitus and neuropathy: examining the relationship]

STELLA Péter, KERÉNYI ZSUZSA, NÁDASDI Ágnes, TAMÁS GYULA

AUGUST 20, 2002

Lege Artis Medicinae - 2002;12(08)

[BACKGROUND - Little is known about the relationship between gestational diabetes and late diabetes complications. The relationship between these abnormalities was investigated in this study. PATIENTS, METHODS - Besides reclassification of their glucose tolerance, the prevalence and correlating factors of diabetic neuropathy were evaluated in 123 gestational diabetic (GDM) women controlled prior by our team during their pregnancies. 26 pregestational type 2 diabetic patients served as controls. Mean follow-up time was 7.2 years. Vibration perception threshold was measured to diagnose peripheral neuropathy, while cardiovascular autonomic neuropathy was evaluated using the battery of four cardiovascular reflex-tests. RESULTS - From 123 prior GDM women, 63 were characterized as having diabetes (52.9%), while 14 had impaired glucose tolerance (11.8%). Peripheral neuropathy was diagnosed in 23.6 %, parasympathetic neuropathy in 37.4 %, while sympathetic neuropathy was confirmed in 7.3 % of the patients evaluated during follow-up visit. Association between abnormal glucose tolerance and neuropathy was statistically significant only in the case of parasympathetic neuropathy (p=0.0001), and this relationship was independent from elevated BMI, microalbuminuria and the higher rate of hypertension observed in these women (p=0.006). Since the number of abnormal neuropathy tests were also higher than expected in women with normal glucose tolerance, we hypothetised a cross-sectional link between neuropathy and insulin resistance. An additional analysis comfirmed this association between insulin resistance and parasympathetic neuropathy independent of metabolic status of these patients (p=0.005). CONCLUSIONS - The importance of gestational diabetes, which is sometimes underestimated by many clinicians, was highlighted by our study since it projected a high frequency of parasympathetic cardiovascular neuropathy in these patients. This form of diabetes not only projects the development of late onset type 2 diabetes, but could also act as a predictor of late diabetes complications. According to our results diabetic parasympathetic neuropathy may be linked to type 2 diabetes/ insulin resistance syndrome, and could play a role in the excess cardiovascular mortality observed in these patients.]

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