Different Treatment Outcomes in Women with New-Onset Type 2 Diabetes, with Previous Gestational Diabetes
E.Inashvili, N.Asatiani, R.Kurashvili, M.Dundua, E.Shelestova, A.Kopaleishvili
National Center for Diabetes Research, Tbilisi, Georgia
Background.
Some literary data demonstrate that the twin defect of beta-cell failure and insulin resistance that underline type 2 diabetes (T2DM) can be reversed by acute negative energy balance alone.
The aim of the present work was to assess treatment outcomes in women with new onset T2DM, who were previously diagnosed with gestational diabetes mellitus (GDM) treated with acute dietary restriction or conventionally at 32 weeks postpartum (PP).
Methods: In total 102 women with GDM were enrolled in the study; patients’ age range 27 - 36 yrs, BMI – 29.8 ± 2.01kg/m. Patients were tested at 32, 40 and 48 weeks PP. During first 2 weeks PP diagnosis of T2DM was put in all the cases. During 32 weeks (a breast feeding period) conventional diet (1 600 – 2 000 kcal/day) and Metformin (1000 – 2000 mg) were initiated.
Patients were divided into two groups (Gr.): Gr.1 - Acute Dietary Energy Restriction - 34 women who were recommended to eat 600kcal/day for 8 weeks (32- 40 weeks PP), during next 8 weeks (40 – 48 weeks PP) their daily calorie intake was increased to 1 200 – 1 400kcal/day. Metformin was withdrawn. Gr.2 - Conventional Therapy - 78 women who were treated with diet (1 400 – 1800 kcal/day) and Metformin (1000 – 2000 mg) for 16 weeks (32- 48 weeks PP).
Results:
At week 32 PP levels of HbA1c, fasting plasma insulin, triglyceride and BMI statistically did not differ in Gr.1 and Gr.2.
At week 40 PP HbA1c levels decreased in both groups (Gr.1 – by 2.48 ±0.12% and Gr.2 – 1.88± 0.13%; P=0.000), and at week 48 PP HbA1c levels were statistically lower in Gr.1 (P=0.000).
At week 40 PP fasting plasma insulin (mIu/ml) fell from16.1 ±3.6 to 5.2± 1.7 (Gr.1), and 15.9 ±3.1 to 12.1 ±2.3 (Gr.2), (P=0.000); and at week 48 PP these indices were statistically lower in Gr.1 when compared to Gr.2 .
After 8 weeks of treatment (32-40 weeks PP), BMI also reduced in both groups (Gr.1 – by 4.01± 0.08kg/m2 and Gr.2 – by 2.91 ±0.1%, P=0.000) while at week 48 PP statistically lower BMI was observed in Gr.1 (P=0.000).
In Gr.1 average weight loss during the 8 weeks of dietary intervention (32-40 weeks PP) was 14.7 ± 1.5 kg; both waist and hip circumference have also decreased.
Triglyceride levels have dropped in Gr.1 and 2 (by 0.60 ±0.05 and 0.68 ±0.06 mg/dl, respectively) though this decrease was not statistically evident (P =0.907).
Conclusion:
In women with new onset T2DM, who were previously diagnosed with GDM acute dietary restriction at 32 weeks PP significantly reduced plasma insulin levels, HbA1c and BMI when compared to traditional dietary management and Metformin. Our data are in complete accordance with the hypothesis published in the literature, that abnormalities underlying T2DM are reversible by reduced dietary energy intake, that is of an utmost importance for young women after pregnancy and breastfeeding.

Different treatment outcomes in women with new-onset type 2 diabetes, with previous gestational diabetes