INS and diabetes mellitus: GDM patients requiring insulin are at higher risk of developing future diabetes after the index pregnancy, as demonstrated in a systematic review.21 Postpartum is characterized by a decrease in insulin secretion and sensitivity, especially in the first six months which may lead to hyperglycemia.22 This is consistent with the current study showing that any type of A2GDM was associated with an approximately seven-fold risk of prediabetes postpartum.