Inflammatory Markers in Older Women with a History of Gestational Diabetes and the Effects of Weight Loss

Abstract

The purpose of this study was to compare systemic inflammation in older women with a history of gestational diabetes (GDM) who developed impaired glucose tolerance (IGT) or type 2 diabetes (T2DM) to that in those with normal glucose tolerance (NGT) and to determine, in these women, the effect of weight loss (WL) induced by diet and exercise training on systemic inflammation and adipokine levels. This was a longitudinal clinical investigation of overweight/obese (BMI: 32 ± 1 kg/m2) women (59 ± 1 years) with a GDM history (n=19) who had normal glucose tolerance (NGT, n=7) or IGT/T2DM (n=12). Women completed 6 months of weight loss induced by diet and exercise and underwent VO2max, body composition, blood draw, glucose tolerance testing, and 2-hour hyperinsulinemic-euglycemic clamps (40 mU·m−2·min−1). Glucose utilization (M) was 42% higher in the NGT group (P<0.05). CRP was two-fold higher in the IGT/T2DM group than that in the NGT group (P<0.01). Adiponectin levels were 59% higher in the NGT group than those in the IGT/T2DM group (P<0.01). IL-6sR was higher in the NGT group (P<0.01). The women lost body weight, body fat, visceral fat, and subcutaneous abdominal fat (P<0.001). Fasting glucose (P<0.05), fasting insulin, glucose, and insulin AUC decreased (all P<0.005) after the intervention. M increased by 21% (P<0.05). CRP (−16%) and TNFR1 (−6%) tended to decrease, whereas TNFα, IL-6, SAA, and adiponectin did not change in the group. In conclusion, older women with a history of GDM who have developed IGT or T2DM have higher CRP and reduced adiponectin levels despite similar BMI and total and abdominal obesity to those with NGT. Six months WL induced by diet and exercise improves body composition and increases insulin sensitivity without a significant modification of inflammatory markers and adiponectin levels.