Gestational Diabetes Linked to Type 2 Diabetes, but Causes Vary by Individual: Study Finds - Video

Women who have gestational diabetes have increased risk of type 2 diabetes in the years after delivery. Those who go on to develop the chronic disease fall into three “clusters,” each with a distinct molecular driver, according to a new study from University of Pittsburgh researchers published in Diabetes/Metabolism Research and Reviews.

These clusters point to targets for potential precision-medicine approaches for type 2 diabetes.

The team focused on 225 women who had a history of gestational diabetes and then developed type 2 diabetes within 12 years of delivery. The researchers used blood samples that had been gathered periodically as the women progressed to the chronic disease, applying computational modeling and machine learning to metabolomic, proteomic and genomic data, as well as clinical measures such as triglycerides, insulin and glucose levels.

The researchers determined that in one cluster of study participants, their diabetes was driven by pancreatic beta-cell dysfunction; in a second cluster, it was driven by insulin resistance; and in a third cluster, the disease was driven by a mixture of the two. About 50% of study participants fell in this “mixed” cluster.

“In type 2 diabetes research, many pathways will pop up again and again, and cause-and-effect interactions are difficult to understand,” said lead author Saifer Khan, Ph.D., research faculty member at the Vascular Medicine Institute at Pitt and the VA Medical Center, Pittsburgh. “By examining this very high-risk population, we were able to target the very early stages of disease and simplify the pathways.”

Reference: Khan, S.R., Van, J.A.D., Xiangyu, Z., Alexeeff, S.E., Razani, B., Wheeler, M.B. and Gunderson, E.P. (2025), Early Postpartum Metabolic Heterogeneity Among Women Who Progressed to Type 2 Diabetes After Gestational Diabetes: A Prospective Cohort. Diabetes Metab Res Rev, 41: e70027. https://doi.org/10.1002/dmrr.70027