Visfatin response to glucose is reduced in women with gestational diabetes mellitus.

T he insulin-mimetic adipocytokine visfatin has been associated with insulin resistance in some studies and is regulated by glucose. We hypothesized that glucose-induced changes in plasma visfatin are different in women with gestational diabetes mellitus (GDM). Plasma visfatin concentrations were studied in 10 women with GDM and 10 age-matched healthy women, in pregnancy weeks 24– 28, during a standard oral glucose tolerance test (OGTT). Women with GDM had lower systemic visfatin concentrations than control subjects (1.9 0.8 vs. 5.2 4.4 ng/ml, respectively, P 0.05), which were associated with fasting glucose (P 0.05). The glucose-induced increase in visfatin over baseline was smaller in women with GDM, with an area under the curve of 409 106 vs. 780 345 ng ml 1 min 1 in control subjects (P 0.05). Reduced glucose-induced increases in circulating visfatin may be associated with impaired glucose tolerance in women with GDM. Women with GDM are at increased risk for developing type 2 diabetes; however, the pathophysiology is still poorly understood. Nonetheless, a variety of abnormalities that are also found in patients with type 2 diabetes are seen early in women in GDM (1). Among the factors that might contribute to altered glucose handling are changes in adipocytokines. For example, plasma adiponectin concentrations are lowered (2), and leptin and resistin persistently increased after delivery in women with GDM and are associated with hyperglycemia and insulin resistance (3,4). The adipocytokine visfatin has been reported to mimic actions of insulin by activating the insulin signal transduction pathway through binding to the same receptor (5). Systemic visfatin concentrations are acutely regulated by glucose and insulin (6) and elevated in patients with insulin resistance, obesity, and diabetes, as well as by rosiglitazone treatment (7– 11). In an effort to address the question whether plasma visfatin regulation is altered in women with GDM, we have studied its concentration during pregnancy weeks 24–28 and compared it with that of matched healthy pregnant women during a standard OGTT.