Diabetes Care Journal current issue

• Associations of Visceral and Subcutaneous Fat Areas With the Prevalence of Metabolic Risk Factor Clustering in 6,292 Japanese Individuals: The Hitachi Health Study
  OBJECTIVE

  We examined the relationships of visceral fat area (VFA), subcutaneous fat area, and waist circumference, determined using computed tomography (CT), and BMI with metabolic risk factors in a large Japanese population.

  RESEARCH DESIGN AND METHODS

  Study subjects comprised 6,292 men and women who participated in the Hitachi Health Study and received CT examinations in 2007 and 2008.

  RESULTS

  Regarding the clustering of metabolic risk factors, the odds ratios (ORs) for the VFA quintiles were 1.0 (ref.), 2.4, 3.4, 5.0, and 9.7 for men and 1.0 (ref.), 1.5, 2.6, 4.6, and 10.0 for women (P < 0.001 for trends in both sexes). For the highest quintiles, the OR for VFA was 1.5 to 2 times higher than those of the other anthropometric indexes in both sexes.

  CONCLUSIONS

  We demonstrated a superior performance of VFA to predict the clustering of metabolic risk factors compared with other anthropometric indexes.

  
  
  
• Fatigue in Hemodialysis Patients With and Without Diabetes: Results From a Randomized Controlled Trial of Two Glucose-Containing Dialysates
• Errata
• Improving Type 1 Diabetes After Treatment of Immune Thrombocytopenia With Rituximab: Killing Two Birds With One Stone
• Errata
• Utility of Childhood Glucose Homeostasis Variables in Predicting Adult Diabetes and Related Cardiometabolic Risk Factors: The Bogalusa Heart Study: Comment on Nguyen et al.
• Genetic Determinants Predicting Efficacy of Glucose-Lowering Drugs?: A long way to go ...
• Utility of Childhood Glucose Homeostasis Variables in Predicting Adult Diabetes and Related Cardiometabolic Risk Factors: The Bogalusa Heart Study: Response to d'Annunzio, Russo, and Lorini
• World Congress on the Insulin Resistance Syndrome, 2009: The kidney, the liver, and insulin resistance
• Eating Fish and Risk of Type 2 Diabetes: A Population-Based, Prospective Follow-Up Study: Comment on van Woudenbergh et al.
• Errata
• Eating Fish and Risk of Type 2 Diabetes: A Population-Based, Prospective Follow-Up Study: Response to Boucher and Mannan
• The Public Health Implications of the Cost-Effectiveness of Bariatric Surgery for Diabetes
• Pericardial Adipose Tissue, Atherosclerosis, and Cardiovascular Disease Risk Factors: The Jackson Heart Study: Comment on Liu et al.
• Diabetes and Heart Failure in Patients With Coronary Disease: Separating Markers From Mediators
• Pericardial Adipose Tissue, Atherosclerosis, and Cardiovascular Disease Risk Factors: The Jackson Heart Study: Response to Iacobellis and Malavazos
• The Effects of Fenofibric Acid Alone and With Statins on the Prevalence of Metabolic Syndrome and Its Diagnostic Components in Patients With Mixed Dyslipidemia
  OBJECTIVE

  To compare fenofibric acid (FA) + statin to respective monotherapies on the prevalence of metabolic syndrome and its diagnostic components in patients with mixed dyslipidemia.

  RESEARCH DESIGN AND METHODS

  Post hoc analysis of over 2,000 metabolic syndrome patients administered either FA + low- or moderate-dose statin; FA alone; or low-, moderate-, or high-dose statin alone.

  RESULTS

  FA + low- or moderate-dose statin combination therapy reduced the presence of metabolic syndrome (35.7 or 35.9%, respectively) more than low-, moderate-, or high-dose statin monotherapy (15.5, 16.6, or 13.8%, respectively), mostly due to improvements in triglycerides and HDL cholesterol levels. Mean glucose levels slightly decreased with FA monotherapy, slightly increased with statin monotherapy, and were essentially unchanged with FA + statin. FA with or without statin also reduced non-HDL cholesterol, apolipoprotein B, total cholesterol, VLDL cholesterol, and high-sensitivity C-reactive protein.

  CONCLUSIONS

  FA + statin in patients with mixed dyslipidemia reduces the prevalence of metabolic syndrome.

  
  
  
• A1C Between 5.7 and 6.4% as a Marker for Identifying Pre-Diabetes, Insulin Sensitivity and Secretion, and Cardiovascular Risk Factors: The Insulin Resistance Atherosclerosis Study (IRAS)
  OBJECTIVE

  A1C is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose for detecting at-risk individuals is not well known.

  RESEARCH DESIGN AND METHODS

  A 2-h glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained at the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study (IRAS). For this report, 385 individuals were at increased risk of diabetes as defined by A1C between 5.7 and 6.4%, impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG).

  RESULTS

  IFG and IGT identified 69.1 and 59.5% of all individuals at increased risk of diabetes, respectively. A1C 5.7–6.4% detected 23.6% of all at-risk individuals, although more African Americans (31.4%) and Hispanics (35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26; P < 0.01), acute insulin response (r = – 0.20 vs. – 0.09; P < 0.01), and waist circumference (r = 0.43 vs. 0.25; P < 0.001) by the Spearman correlation test. Similarly, 2-h plasma glucose was more strongly related to Si (r = – 0.40 vs. – 0.27; P < 0.01) and triglycerides (r = 0.30 vs. 0.08; P < 0.001).

  CONCLUSIONS

  A1C 5.7–6.4% is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h plasma glucose seem to be more precise correlates of insulin resistance and secretion than A1C and, in general, better for other metabolic disorders.

  
  
  
• One-Hour Plasma Glucose Identifies Insulin Resistance and {beta}-Cell Dysfunction in Individuals With Normal Glucose Tolerance: Cross-sectional data from the Relationship between Insulin Sensitivity and Cardiovascular Risk (RISC) study
  OBJECTIVE

  Some individuals with normal glucose tolerance (NGT) exhibit a 1-h excursion of plasma glucose during oral glucose tolerance testing as high as that of individuals with impaired glucose tolerance (IGT). The aim of this study was to characterize their metabolic phenotype.

  RESEARCH DESIGN AND METHODS

  A total of 1,205 healthy volunteers (aged 29–61 years) underwent assessment of 1) oral glucose tolerance and 2) insulin sensitivity (standardized euglycemic-hyperinsulinemic clamp), as part of the Relationship between Insulin Sensitivity and Cardiovascular Risk (RISC) study.

  RESULTS

  One-hour plasma glucose correlated better than 2-h plasma glucose with total insulin secretion (r = 0.43), β-cell glucose sensitivity (r = –0.46), and β-cell rate sensitivity (r = –0.18). Receiver operating characteristic analysis identified 8.95 mmol/l as the best cutoff value for prediction of IGT from 1-h plasma glucose (sensitivity 77% and specificity 80%). Participants with NGT with 1-h plasma glucose >8.95 mmol/l had larger waist circumference, higher BMI, lower insulin sensitivity, higher fasting glucose, and higher insulin secretion than their counterparts with 1-h plasma glucose ≤8.95 mmol/l (P < 0.001 for all comparisons). Moreover, they exhibited lower β-cell glucose sensitivity (P < 0.001), β-cell rate sensitivity (P < 0.001), and potentiation factor (P = 0.026). When compared with conventionally defined IGT, they were not different in waist circumference and BMI, hepatic insulin extraction, β-cell glucose sensitivity, β-cell rate sensitivity, and potentiation factor but did have greater insulin sensitivity along with reduced basal (P = 0.001) and total insulin secretion (P = 0.002).

  CONCLUSIONS

  Higher values of 1-h plasma glucose may identify an intermediate condition between NGT and IGT characterized by greater insulin resistance, reduced β-cell glucose sensitivity, and reduced β-cell rate sensitivity.

  
  
  
• Diabetes, Glycemic Control, and New-Onset Heart Failure in Patients With Stable Coronary Artery Disease: Data from the Heart and Soul Study
  OBJECTIVE

  Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure.

  RESEARCH DESIGN AND METHODS

  We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years).

  RESULTS

  Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37–3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65–6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17–1.58]).

  CONCLUSIONS

  In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction.

  
  
  
• Postchallenge Glucose, A1C, and Fasting Glucose as Predictors of Type 2 Diabetes and Cardiovascular Disease: A 10-year prospective cohort study
  OBJECTIVE

  A1C has been proposed as a new indicator for high risk of type 2 diabetes. The long-term predictive power and comparability of elevated A1C with the currently used high-risk indicators remain unclear. We assessed A1C, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) as predictors of type 2 diabetes and cardiovascular disease (CVD) at 10 years.

  RESEARCH DESIGN AND METHODS

  This prospective population-based study of 593 inhabitants from northern Finland, born in 1935, was conducted between 1996 and 2008. An oral glucose tolerance test (OGTT) was conducted at baseline and follow-up, and A1C was determined at baseline. Those with a history of diabetes were excluded from the study. Elevated A1C was defined as 5.7–6.4%. Incident type 2 diabetes was confirmed by two OGTTs. Cardiovascular outcome was measured as incident CVD or CVD mortality. Multivariate log-binomial regression models were used to predict diabetes, CVD, and CVD mortality at 10 years. Receiver operating characteristic curves compared predictive values of A1C, IGT, and IFG.

  RESULTS

  Incidence of diabetes during the follow-up was 17.1%. Two of three of the cases of newly diagnosed diabetes were predicted by a raise in ≥1 of the markers. Elevated A1C, IGT, or IFG preceded diabetes in 32.8, 40.6, and 21.9%, respectively. CVD was predicted by an intermediate and diabetic range of 2-h glucose but only by diabetic A1C levels in women.

  CONCLUSIONS

  A1C predicted 10-year risk of type 2 diabetes at a range of A1C 5.7–6.4% but CVD only in women at A1C ≥6.5%.

  
  
  
• Common Genetic Variation in GLP1R and Insulin Secretion in Response to Exogenous GLP-1 in Nondiabetic Subjects: A pilot study
  OBJECTIVE

  Glucagon-like peptide (GLP)-1 receptor is encoded by GLP1R. The effect of genetic variation at this locus on the response to GLP-1 is unknown. This study assessed the effect of GLP1R polymorphisms on insulin secretion in response to hyperglycemia and to infused GLP-1 in nondiabetic subjects.

  RESEARCH DESIGN AND METHODS

  Eighty-eight healthy individuals (aged 26.3 ± 0.6 years, fasting glucose 4.83 ± 0.04 mmol/l) were studied using a hyperglycemic clamp. GLP-1 was infused for the last 2 h of the study (0.75 pmol/kg/min over 121–180 min, 1.5 pmol/kg/min over 181–240 min). β-Cell responsivity (_Total) was measured using a C-peptide minimal model. The effect of 21 tag single nucleotide polymorphisms (SNPs) in GLP1R on _Total was examined.

  RESULTS

  Two SNPs (rs6923761 and rs3765467) were nominally associated with altered β-cell responsivity in response to GLP-1 infusion.

  CONCLUSIONS

  Variation in GLP1R may alter insulin secretion in response to exogenous GLP-1. Future studies will determine whether such variation accounts for interindividual differences in response to GLP-1–based therapy.

  
  
  
• Incidence and Trend of a Metabolic Syndrome Phenotype Among Tehranian Adolescents: Findings from the Tehran Lipid and Glucose Study, 1998-2001 to 2003-2006
  OBJECTIVE

  To assess the incidence and trend of the metabolic syndrome phenotype in adolescents from the Tehran Lipid and Glucose Study during 3.6 years of follow-up.

  RESEARCH DESIGN AND METHODS

  A total of 932 adolescents, aged 10–19 years, who had complete data and returned for reassessment 3.6 years later were investigated.

  RESULTS

  Prevalence of metabolic syndrome at baseline and after 3.6 years was 7.4 and 6.7%, respectively, based on the Adult Treatment Panel (ATP) III definitions; 3.5 and 8.0%, respectively, based on the International Diabetes Federation (IDF) definitions; 4.1 and 9.4%, respectively, based on the American Heart Association (AHA) definitions; and 13.6 and 13.4%, respectively, based on the National Health and Nutrition Examination Survey (NHANES) definitions. Incidence rates were 5.2% (95% CI 3–6) based on ATP III, 6.8% (5–8) based on IDF, 8.3% (6–10) based on AHA, and 8.8% (6–10) based on NHANES definitions.

  CONCLUSIONS

  Incidence of metabolic syndrome is high in Tehranian adolescents.

  
  
  
• Disposition Index, Glucose Effectiveness, and Conversion to Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study (IRAS)
  OBJECTIVE

  Disposition index (DI) and glucose effectiveness (S_G) are risk factors for diabetes. However, the effect of DI and S_G on future diabetes has not been examined in large epidemiological studies using direct measures.

  RESEARCH DESIGN AND METHODS

  Insulin sensitivity index (S_I), acute insulin response (AIR), and S_G were measured in 826 participants (aged 40–69 years) in the Insulin Resistance Atherosclerosis Study (IRAS) by the frequently sampled intravenous glucose tolerance test. DI was expressed as S_I x AIR. At the 5-year follow-up examination, 128 individuals (15.5%) had developed diabetes.

  RESULTS

  The area under the receiver operating characteristic curve of a model with S_I and AIR was similar to that of DI (0.767 vs. 0.774, P = 0.543). In a multivariate logistic regression model that included both DI and S_G, conversion to diabetes was predicted by both S_G (odds ratio x 1 SD, 0.61 [0.47–0.80]) and DI (0.68 [0.54–0.85]) after adjusting for demographic variables, fasting and 2-h glucose concentrations, family history of diabetes, and measures of obesity. Age, sex, race/ethnicity, glucose tolerance status, obesity, and family history of diabetes did not have a significant modifying impact on the relation of S_G and DI to incident diabetes.

  CONCLUSIONS

  The predictive power of DI is comparable to that of its components, S_I and AIR. S_G and DI independently predict conversion to diabetes similarly across race/ethnic groups, varying states of glucose tolerance, family history of diabetes, and obesity.

  
  
  
• Changes in Serum Lipid Levels During Pregnancy in Type 1 and Type 2 Diabetic Subjects
  OBJECTIVE

  Alterations in maternal lipid metabolism could affect fetal programming and the susceptibility for atherosclerosis in the offspring; therefore, we studied differences in lipid profiles of pregnant women with type 1 and type 2 diabetes.

  RESEARCH DESIGN AND METHODS

  A total of 173 diabetic pregnancies were studied prior to conception (V0), at each trimester (V1–V3), and after delivery and were compared with 137 healthy women at V3.

  RESULTS

  During gestation, the increase in serum lipid concentrations was less pronounced in type 2 diabetic subjects. At V3, the lipid levels of type 1 diabetic women with normal glucose tolerance were similar but significantly higher then those of type 2 diabetic women. Elevated triglycerides and low HDL cholesterol at V3 were significant predictors for large-for-gestational-age (LGA) newborns.

  CONCLUSIONS

  Our data suggest smaller changes in serum lipid concentrations during pregnancy in type 2 diabetic mothers. Additionally, we found a positive association between maternal triglycerides and LGA infants independently of chronic glycemic control.

  
  
  
• Renal Hyperfiltration and Arterial Stiffness in Humans With Uncomplicated Type 1 Diabetes
  OBJECTIVE

  We have reported that renal hyperfiltration is associated with endothelial dysfunction in early type 1 diabetes. However, the relationship between renal hyperfiltration and arterial stiffness is unknown. Accordingly, we measured arterial stiffness in type 1 diabetic subjects with hyperfiltering (n = 20) or normofiltering (n = 18).

  RESEARCH DESIGN AND METHODS

  Augmentation index (AIx), aortic pulse wave velocity (PWV), renal hemodynamic function (inulin and paraaminohippurate clearances), and urinary and circulating plasma cGMP were measured in normoalbuminuric subjects with type 1 diabetes during clamped euglycemia (glucose 4–6 mmol/l) and hyperglycemia (glucose 9–11 mmol/l).

  RESULTS

  During clamped euglycemia, hyperfiltering subjects (glomerular filtration rate ≥135 ml/min/1.73 m²) exhibited lower AIx values (–6.1 ± 2.9 vs. 13.9 ± 2.7%, P = 0.001) and higher cGMP levels in urine and plasma compared with normofiltering subjects. These differences were maintained during clamped hyperglycemia. As expected, renal hemodynamic responses to clamped hyperglycemia were exaggerated in normofilterers, but values for AIx remained unchanged.

  CONCLUSIONS

  Renal hyperfiltration is associated with reduced arterial stiffness in subjects with uncomplicated type 1 diabetes.

  
  
  
• Increased CD36 Expression Signals Monocyte Activation Among Patients With Type 2 Diabetes
  OBJECTIVE

  To explore the hypothesis that CD36, a scavenger receptor and fatty acid translocase, is upregulated in peripheral blood mononuclear cells (PBMCs) among patients with type 2 diabetes and is a biomarker of PBMC activation and inflammation.

  RESEARCH DESIGN AND METHODS

  We used a cross-sectional observational design to study a multi-racial/ethnic population sample consisting of Caucasians, Hispanics, and Native Americans with type 2 diabetes (n = 33) and nondiabetic control subjects (n = 27). PBMC CD36 mRNA/protein and plasma high sensitivity (hs) C-reactive protein (hsCRP), hs–interleukin-6 (hsIL-6), and adiponectin were measured.

  RESULTS

  Unadjusted PBMC CD36 mRNA and protein were 1.56- and 1.63-fold higher, respectively, among type 2 diabetic subjects versus control subjects. PBMC CD36 protein was directly associated with CD36 mRNA, plasma hsCRP, and hsIL-6 and inversely associated with plasma adiponectin in both groups.

  CONCLUSIONS

  Increased CD36 expression is a biomarker of PBMC activation and inflammation and may become a useful tool in cardiovascular disease risk stratification.

  
  
  
• Latent Autoimmune Diabetes in Adults Differs Genetically From Classical Type 1 Diabetes Diagnosed After the Age of 35 Years
  OBJECTIVE

  We studied differences between patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes, and classical type 1 diabetes diagnosed after age 35 years.

  RESEARCH DESIGN AND METHODS

  Polymorphisms in HLA-DQB1, INS, PTPN22, and CTLA4 were genotyped in patients with LADA (n = 213), type 1 diabetes diagnosed at >35 years of age (T1D_>35y; n = 257) or <20 years of age (T1D_<20y; n = 158), and type 2 diabetes.

  RESULTS

  Although patients with LADA had an increased frequency of HLA-DQB1 and PTPN22 risk genotypes and alleles compared with type 2 diabetic subjects, the frequency was significantly lower compared with T1D_>35y patients. Genotype frequencies, measures of insulin secretion, and metabolic traits within LADA differed according to GAD antibody (GADA) quartiles, but even the highest quartile differed from type 1 diabetes. Having two or more risk genotypes was associated with lower C-peptide concentrations in LADA.

  CONCLUSIONS

  LADA patients differed genetically and phenotypically from both T1D_>35y and type 2 diabetic patients in a manner dependent on GADA levels.

  
  
  
• Maternal Glucose Tolerance in Pregnancy Affects Fetal Insulin Sensitivity
  OBJECTIVE

  Offspring of mothers with impaired glucose tolerance are far more likely to develop type 2 diabetes. We tested the hypothesis that maternal glucose tolerance in pregnancy affects fetal insulin sensitivity or β-cell function.

  RESEARCH DESIGN AND METHODS

  In a prospective singleton pregnancy cohort study, we analyzed glucose, insulin, and proinsulin concentrations in maternal blood at the 50-g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation and in venous cord blood (n = 248). The cord blood glucose-to-insulin ratio and proinsulin concentration were used as indicators of fetal insulin sensitivity and the proinsulin-to-insulin ratio was used as an indicator of fetal β-cell function.

  RESULTS

  Higher OGTT blood glucose levels were associated with significantly lower cord plasma glucose-to-insulin ratios (r = –0.31, P < 0.001) and higher proinsulin concentrations (r = 0.31, P < 0.001) but not with proinsulin-to-insulin ratios. In a comparison of gestational diabetic (n = 26) versus euglycemic pregnancy, cord blood glucose-to-insulin ratios were substantially lower (geometric mean 10.1 vs. 20.0 mg/dl/µU/ml; P < 0.001), whereas proinsulin concentrations were much higher (24.4 vs. 13.8 pmol/l; P < 0.001), despite similar cord blood glucose concentrations indicating adequate management of diabetes. The differences remained significant after controlling for prepregnancy and fetal adiposity, family history of diabetes, gestational age, and other potential confounders. Significant changes in the glucose-to-insulin ratio and proinsulin concentration were also observed in obese (n = 31) mothers, but the differences became not statistically significant after adjustment for maternal glucose tolerance and fetal adiposity.

  CONCLUSIONS

  Maternal glucose intolerance may impair fetal insulin sensitivity (but not β-cell function) and consequently "program" the susceptibility to type 2 diabetes.

  
  
  
• Differences in Maternal Circulating Fatty Acid Composition and Dietary Fat Intake in Women With Gestational Diabetes Mellitus or Mild Gestational Hyperglycemia
  OBJECTIVE

  We investigated the relationship between maternal circulating fatty acids (FAs) and dietary FA intake in pregnant women with gestational diabetes mellitus (GDM; n = 49), women with hyperglycemia less severe than GDM (impaired glucose challenge test [GCT] non-GDM; n = 80), and normal control subjects (n = 98).

  RESEARCH DESIGN AND METHODS

  A case-control design was nested within a prospective cohort of healthy pregnant women. Fasting concentrations of serum total FAs (enzymatic assay) and FA composition (gas chromatography–mass spectrometry) were determined at entry and the third trimester. Dietary fat intake data were obtained from 24-h recalls.

  RESULTS

  There was a graded increase among groups (control subjects, impaired GCT non-GDM, and GDM) during the third trimester for total FAs and individual FAs, including myristic, palmitic, palmitoleic, oleic, linoleic, linolenic, arachidonic, eicosapentaenoic, and docosahexaenoic acids (P for trend <0.03 to P < 0.001). Similar relationships were observed at entry in total FAs and for four FAs (myristic, palmitic, palmitoleic, and eicosapentaenoic acids). Women with impaired GCT non-GDM with BMI ≥25 kg/m² had the highest levels of FAs at entry, whereas women with GDM with BMI ≥25 kg/m² had the highest levels during the third trimester, and all grouped FAs were significantly different from lean women with impaired GCT non-GDM or control subjects (P < 0.05). Dietary intake of polyunsaturated FAs was decreased, but saturated FAs were increased in GDM compared with impaired GCT non-GDM or control subjects (P < 0.05).

  CONCLUSIONS

  Abnormalities in fat metabolism are present in both GDM and impaired GCT non-GDM women. Reducing pregravid weight and altering diet might prevent the associated elevation of circulating FAs.