The association between adipocytokines and glycemic control in women with gestational diabetes mellitus

<b>Objective:</b> To evaluate the relationship between adipocytokines and glycemic control. <b>Study design:</b> Prospective observational trial of gestations with gestational diabetes mellitus (GDM). Fasting glucose (FG), insulin, adiponectin, leptin, chemerin, retinol-binding protein 4 (RBP-4), osteocalcin, and resistin were measured. HomeOstasis model assessment of insulin resistance (HOMA-IR) and QUantitative insulin sensitivity ChecK Index (QUICKI) were calculated. Women who required medications for glycemic control were compared to women using nutritional therapy only. <b>Results:</b> Overall, 75 women were included −26 (34.7%) required medications to achieve good glycemic control. Factors associated with poor control are as follows: low resistin (aOR 0.84), HOMA-IR (aOR 1.96), QUICKI (aOR 0.62), first trimester FG (aOR 1.43), and maternal age (aOR 1.26). HOMA-IR and QUICKI performed highest for prediction. Resistin, first trimester FG, maternal age, and QUICKI had an AUC of 0.878, sensitivity and specificity of 87.5% for the prediction of the need for medications. <b>Conclusions:</b> Low resistin is associated with poor control. A model utilizing maternal age, first trimester fasting glucose, and first visit QUICKI yields good predictability.

<b>研究目的：</b> 评估脂肪细胞因子与血糖控制之间的关联。<b>研究设计：</b> 针对妊娠糖尿病（gestational diabetes mellitus, GDM）孕妇开展的前瞻性观察性试验。检测空腹血糖（fasting glucose, FG）、胰岛素、脂联素、瘦素、趋化素、视黄醇结合蛋白4（retinol-binding protein 4, RBP-4）、骨钙素及抵抗素水平；计算稳态模型评估胰岛素抵抗指数（HomeOstasis model assessment of insulin resistance, HOMA-IR）与定量胰岛素敏感性检测指数（QUantitative insulin sensitivity ChecK Index, QUICKI）。将需接受药物控制血糖的孕妇与仅采用营养治疗的孕妇进行分组对比。<b>结果：</b> 本研究共纳入75名孕妇，其中26名（34.7%）需借助药物以实现良好的血糖控制。与血糖控制不佳相关的因素如下：低抵抗素（调整后优势比[adjusted odds ratio, aOR] 0.84）、HOMA-IR（aOR 1.96）、QUICKI（aOR 0.62）、孕早期空腹血糖（aOR 1.43）及产妇年龄（aOR 1.26）。其中HOMA-IR与QUICKI的预测效能最优。抵抗素、孕早期空腹血糖、产妇年龄及QUICKI的受试者工作特征曲线下面积（Area Under the Receiver Operating Characteristic Curve, AUC）为0.878，其预测需药物治疗的灵敏度与特异度均为87.5%。<b>结论：</b> 低抵抗素与血糖控制不佳存在显著关联。综合产妇年龄、孕早期空腹血糖及首次就诊QUICKI构建的预测模型具备良好的预测效能。