Posted on May 25, 2020, 2 p.m.
Metabolites in blood have been identified by scientists that can accurately predict whether a woman will develop type 2 diabetes after experiencing a transient form of illness during pregnancy. The study published in the journal Plos Medicine may lead to testing that could help physicians identify those at greatest risk and potentially avert the disease through interventions including diet and exercise.
"There is a metabolic dysregulation that occurs in the group of women that will go on to develop type 2 diabetes that is present in the early postpartum period, suggesting that there is an underlying problem that exists already and we can detect it," says Professor Michael Wheeler, who is also a senior scientist at Toronto General Hospital Institute at University Health Network.
According to the findings the metabolic signature can predict with over 85% accuracy if a woman will develop type 2 diabetes, During pregnancy 1 in 10 women will develop gestational diabetes which puts them at an increased risk for developing type 2 diabetes with 30-50% of these women going on to develop the disease within 10 years of delivery.
Those who develop gestational diabetes are recommended to have an annual oral glucose tolerance test after delivery to measure the body’s ability to remove sugar from the bloodstream. type 2 diabetes hampers the ability to regulate blood sugar levels and this can lead to serious complications. However, the procedure is time/labor consuming and less than half of the affected women follow through with the recommendation.
"If you've got a newborn at home one of the last things you are thinking about or have time for is your own health," says Wheeler. "This is one of the main reasons why we performed this study, to potentially develop a simple blood test reducing the number of hospital visits."
The metabolic signature predictive of type 2 diabetes was first uncovered in a pilot study of 1033 women with gestational diabetes who were recruited for the SWIFT Study. This new study builds on the prior research following the same cohort of women over a longer period of time, during which more women developed type 2 diabetes. Profiling their blood samples on a deeper level being tracked over time allowed for the discovery of the new compounds that are associated with the disease.
Baseline blood samples were collected from the women between 6-9 weeks after birth and twice every two years after. Participant health was followed through electronic medical records for up to 8 years, during this time 173 women developed type 2 diabetes and these blood samples were compared to 495 women enrolled in the study who were matched for age, weight and ethnicity who had not developed the disease.
"This study is unique as we are not simply comparing healthy people to people with advanced disease," says Hannes Röst, who holds Canada Research Chair in Mass Spectrometry-based Personalized Medicine and led the statistical data analysis. "Instead, we are comparing women who are clinically the same—they all had GD but are back to being non-diabetic post-partum. This is the holy grail of personalized medicine to find molecular differences in seemingly healthy people and predict which ones will develop a disease," says Röst.
Sugar molecules prominently feature in the identified compounds, along with amino acids and lipid molecules being present that indicate an underlying issue in protein and fat metabolism, according to Röst. If the amino acids are removed the predictive power of the tests decreases suggesting that the processes beyond sugar metabolism may occur very early in the development of the disease. Findings may explain why complications occur in patients even when blood sugar is strictly controlled with medications.
Participants in the SWIFT Study were invited back for a 10 years follow up visit to be tested for the disease. The researchers hope to turn this discovery into a simple blood test that women will be able to take shortly after delivery.
"The information we glean from this study will bring us even closer to our goal of developing this blood test," says Erica Gunderson, a research scientist at the Kaiser Permanente Division of Research. "It will also help us to identify metabolic differences among race and ethnic groups that this test will need to take into account. The test is intended to help obstetricians and primary care providers identify the women with recent gestational diabetes who are most at risk for developing type 2 diabetes and to support them with breastfeeding and other healthful lifestyle habits during the first year postpartum that may reduce their risk."
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