Autoimmune Gestational Diabetes

In the United States and Canada, literature about gestational diabetes mellitus (GDM) refers to insulin resistance and the probability that a woman will at some point in her life develop Type 2 diabetes. The Canadian Diabetes Association states, “Women who have had GDM are at increased risk of developing subsequent type 2 diabetes later in life” and make no mention of the increased risk of Type 1 diabetes. However, in Europe, educational materials almost always mention that GDM places a woman at risk for either Type 1 or Type 2 diabetes. The European medical community has long recognized that some women who have gestational diabetes are subsequently diagnosed with Type 1 diabetes. As reported in the August 1998 issue of Diabetes Forecast, in a German study 43 percent of women who developed gestational diabetes went on to have full-blown Type 1 diabetes. They were antibody positive, and they had not been diagnosed with diabetes prior to pregnancy. For example, the British Diabetes Association, Diabetes UK, states, “About five to ten percent of women with GDM develop Type 1 diabetes sometime in their life. These women have a slowly developing form of Type 1 that is ‘unmasked’ during pregnancy.” In the United States, autoimmune gestational diabetes is ignored by the American Diabetes Association and the Juvenile Diabetes Research Foundation. Yet if you ask women on TuDiabetes with Type 1 diabetes, many developed diabetes during pregnancy. Mary Tyler Moore, International Chair of JDRF, was diagnosed with Type 1 diabetes after a miscarriage at age 33. Why is there this disconnect--why do the U.S. and Canada ignore autoimmune gestational diabetes? It is important to identify a woman with autoimmune gestational diabetes, to prevent the severe maternal and fetal complications of Type 1 diabetes developing in pregnancy.

A recent article in the July 2007 issue of Diabetes Care indicated that autoimmune gestational diabetes (new onset Type 1 diabetes) accounts for about 10 percent of all Caucasian women diagnosed with gestational diabetes. In a recent study of Sardinian women (Reproductive Biology and Endocrinology, 2008), 40 percent of women with GDM were antibody positive (GAD, IAA, and/or IA-2) and had autoimmune gestational diabetes. (Sardinia has the second highest prevalence of Type 1 diabetes in the world, after Finland).

Sadly, in the U.S. and Canada many women with autoimmune gestational diabetes go for months if not years with wrong diagnoses, struggling to get appropriate treatment for the disease they have (Type 1 diabetes).

What are signs that you may have autoimmune gestational diabetes? If you are slim and require insulin during pregnancy to control your GDM, it is likely that you have autoimmune gestational diabetes. What can you do? Get antibody testing, which is relatively low cost and is a definitive test for Type 1 autoimmune diabetes.

Tags: 1, GDM, LADA, Type, gestational

2 members like this

Comment by Kelly on April 13, 2010 at 10:50am: "...a German study 43 percent of women who developed gestational diabetes went on to have full-blown Type 1 diabetes." That was published in 1998 and nothing's been done. The CDA does say a small percentage of GDM women are Type 1, but I don't think family docs are paying great attention to it.

I would add that a sign of autoimmune GDM is being diagnosed under the age of 30, having no or little family history of Type 2, and being diagnosed (or testing positive for sugar in urine tests) before 25 weeks gestation.

Thanks for this Melitta!

Comment by John Smith on April 13, 2010 at 1:02pm: Thanks, Melitta, for this blog. I'm interested in looking at the studies that you mention in this post. Will you post a link to those studies?

Comment by Melitta on April 13, 2010 at 7:45pm: http://jcem.endojournals.org/cgi/content/full/84/7/2342
Hi John: Above is the link (you will have to copy and paste, I think) to the article on which the 1998 Diabetes Forecast article was based.
http://www.rbej.com/content/6/1/24
Then the link for the Sardinia article (you can get a pdf via this link)
http://care.diabetesjournals.org/content/30/Supplement_2/S127.full
Finally, the 2007 Diabetes Care article.

Comment by bsc on April 14, 2010 at 7:03am: Another recent article substantiating the 10% of GD is LADA is (http://www.nmcd-journal.com/article/S0939-4753(09)00094-5/abstract).

This article (http://www3.interscience.wiley.com/journal/88013368/abstract) discusses whether LADA in GD is a distinct entity and surveys a range of observational studies.

So the real point is that there is a fair amount of evidence that like 10% of women diagnosed with GDM actually test positive for antibodies. While this is the same rate of LADA occurence found in type 2 diabetics. Presumably pregnant women are already having type 1 and type 2 diabetes, but GDM is occurring on top of those underlying rates, and with 3-5% of women having GDM, perhaps 3-5 women in a 1000 have GDM mediated LADA. In a Ob/Gyn practice, they already know to handle GDM routinely, but they really need to handle LADA routinely.

What we have to realize is that there is "pushback" by the medical establishment. There are claims that nothing can be done to arrest the progression and that no harm is done by failure to diagnose and treat. Here is an example of this position (http://jcem.endojournals.org/cgi/content/abstract/95/1/25). Personally, I feel like there is evidence that early insulin use preserves beta cells. And frankly, arguing that failing to diagnose leaves patients at risk of high blood sugars and complications, let alone the potential for future DKA.

Comment by Melitta on April 14, 2010 at 7:16pm: Brian, the ignorance and inhumanity of researchers like Prof. Polly Bingley never ceases to amaze me. Have these people ever spoken to a Type 1 diabetic who was denied insulin? The misdiagnosed people that I know, including myself, suffered enormously. First, do no harm. I think there is some weird psychological thing going on with these people. The rigid mindset, the denial, etc.

Comment by Sascha on March 14, 2011 at 3:02pm: I'm bookmarking this when I have some time to read the studies. I've been recently diagnosed Type 2 by my gen. practitioner, but had GDM with both my pregnancies. I was diagnosed before 18 weeks with my first, with poor diet/exercise control, so I had to go on insulin for the remainder of my pregnancy. I remained borderline and was put on insulin immediately upon finding out I was pregnant with my second. My youngest is 15, and I've remained borderline until about two years ago. I've struggled with control, have gone through my denial phase where I ignored things for a year, and ended up with 300+ after cortisone shots to treat herniated disks. My A1C was 9.8 :-( I've been put on Janumet by my GP (he just threw them at me and shushed me out the door). Needless to say, I'm finding another physician. I'm glad to have found TuDiabetes...although the amount of information is overwhelming.

Comment by Melitta on March 15, 2011 at 7:47pm: Hi Sascha: As Kelly says below, one of the signs of autoimmune GDM is diagnosis before 25 weeks. I am sorry you are overwhelmed, but do ask questions and get assistance. With an A1c of 9.8, can you request to be put on insulin? It is so important to take care of yourself. MANY women here on TuD were diagnosed with GDM, misdiagnosed as Type 2, but ultimately found to have Type 1 diabetes. It is so common! Best of luck to you.

Comment by Stardust31 on March 16, 2011 at 10:49am: Who new! Makes one wonder about ignorance. This is a great find Melitta!

Comment by Melitta on March 16, 2011 at 11:41am: Thanks, Stardust! You can add yourself to the many women on TuDiabetes who were diagnosed during pregnancy, and have Type 1 diabetes. I figured I had to write a blog about it, because ADA, CDA, and JDRF have their heads in the sand.

Comment by Super_sally on July 28, 2011 at 10:34pm: Me me! Though I don't know what type I am.

I was pretty athletic. My endo used to monitor me regularly so I know bs was pretty fine (except some higher fasting numbers). Gtt pregnant at 38 and had OGTT straight away (my endo wanted me tested straight away) and failed it. Used diet and exercise for 2 months, then had appendicitis, and then when I started eating again blood sugars required insulin for the rest of the pregnancy.

After the pregnancy I was told I could forget about diabetes and insulin. So I did for a few months. However, when I finally tested again numbers were not ok. So started with low carb diet - managed ok.

C-peptide tested low. No GAD antibodies found.

1 year ago, trying for baby No. 2 was given a dose of steroids. Blood sugar went up and never went down again. On insulin since then.

I am also hypothyroid. I am not slim (but not obese either).

I would suspect that LADA makes sense for me.