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Faal Siahkal S, Javadifar N, Najafian M, Iravani M, Zakerkish M, Heshmati R. Psychosocial needs of inpatient women with gestational diabetes mellitus: a qualitative study. J Reprod Infant Psychol 2024; 42:464-480. [PMID: 35946413 DOI: 10.1080/02646838.2022.2110221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is one of the most common medical complications associated with pregnancy. Its treatment requires multidisciplinary cooperation, and identifying the psychosocial needs of patients is important in the management of their condition. OBJECTIVE This study investigates the psychosocial needs of inpatient mothers with GDM from the joint perspectives of future mothers and healthcare providers. METHODS This qualitative study used a content analysis approach. Semi-structured individual interviews focusing on the psychosocial needs of women with GDM were conducted with twelve women suffering from GDM and eight medical staff. Sampling continued until data saturation. RESULTS According to the findings of this study, the psychosocial needs of these mothers were classified into the following categories: Support for worries related to the consequences of the disease, Interpersonal support, Infrastructural support, educational support. CONCLUSION The psychosocial needs of inpatient mothers with GDM were identified in this study. Attention to these needs can help enhance the mother's satisfaction and treatment adherence, and reduce worries and anxiety during hospitalisation. ABBREVIATIONS GDM: Gestational Diabetes Mellitus; hPGH: human placental growth hormone; COREQ: Consolidated criteria for reporting qualitative research; WHO: World Health Organization; HCP: healthcare provider.
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Affiliation(s)
- Shahla Faal Siahkal
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Javadifar
- Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery and Reproductive Health Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnoosh Zakerkish
- Department of Endocrinology and Metabolism, Faculty of Medicine, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rasoul Heshmati
- Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
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Venkatesh KK, Chiang CW, Castillo WC, Battarbee AN, Donneyong M, Harper LM, Costantine M, Saade G, Werner EF, Boggess KA, Landon MB. Changing patterns in medication prescription for gestational diabetes during a time of guideline change in the USA: a cross-sectional study. BJOG 2022; 129:473-483. [PMID: 34605130 PMCID: PMC8752504 DOI: 10.1111/1471-0528.16960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To define patterns of prescription and factors associated with choice of pharmacotherapy for gestational diabetes mellitus (GDM), namely metformin, glyburide and insulin, during a period of evolving professional guidelines. DESING Cross-sectional study. SETTING US commercial insurance beneficiaries from Market-Scan (late 2015 to 2018). STUDY DESIGN We included women with GDM, singleton gestations, 15-51 years of age on pharmacotherapy. The exposure was pharmacy claims for metformin, glyburide and insulin. MAIN OUTCOMES Pharmacotherapy for GDM with either oral agent, metformin or glyburide, compared with insulin as the reference, and secondarily, consequent treatment modification (addition and/or change) to metformin, glyburide or insulin. RESULTS Among 37 762 women with GDM, we analysed data from 10 407 (28%) with pharmacotherapy, 21% with metformin (n = 2147), 48% with glyburide (n = 4984) and 31% with insulin (n = 3276). From late 2015 to 2018, metformin use increased from 17 to 29%, as did insulin use from 26 to 44%, whereas glyburide use decreased from 58 to 27%. By 2018, insulin was the most common pharmacotherapy for GDM; metformin was more likely to be prescribed by 9% compared with late 2015/16, but glyburide was less likely by 45%. Treatment modification occurred in 20% of women prescribed metformin compared with 2% with insulin and 8% with glyburide. CONCLUSIONS Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for GDM among a privately insured US population during a time of evolving professional guidelines. Further evaluation of the relative effectiveness and safety of metformin compared with insulin is needed. TWEETABLE ABSTRACT Insulin followed by metformin has replaced glyburide as the most common pharmacotherapy for gestational diabetes mellitus in the USA.
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Affiliation(s)
- K K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - C W Chiang
- Department of Bioinformatics, The Ohio State University, Columbus, OH, USA
| | - W C Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - A N Battarbee
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AB, USA
| | - M Donneyong
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - L M Harper
- Department of Women's Health, University of Texas, Dell Medical School, Austin, TX, USA
| | - M Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - G Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - E F Werner
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - K A Boggess
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - M B Landon
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
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Mercado-Méndez S, González-Sepúlveda L, Romaguera J, González-Rodríguez LA. The Use of Oral Hypoglycemic Agents during Pregnancy: An Alternative to Insulin? PUERTO RICO HEALTH SCIENCES JOURNAL 2021; 40:162-167. [PMID: 35077074 PMCID: PMC9048127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Gestational Diabetes Mellitus (GDM) and Type 2 Diabetes Mellitus (DM2) are metabolic disorders characterized by increased insulin resistance. Although insulin is the treatment of choice in pregnant patients with DM, the prescription of oral hypoglycemic agents (OHA) has been increasing among practitioners. This study aimed to evaluate the maternal and neonatal outcomes when oral hypoglycemic agents were used in diabetic pregnant women. METHODS Medical records from the Maternal-Infant Care Unit Clinics SoM-UPR (n=149) were reviewed. Patients that were treated with metformin, sulfonylurea or insulin were included. Maternal and neonatal outcomes were compared between groups. RESULTS Patient's mean age was 28 ± 6 years. The majority had GDM (91%). The most common comorbidity was hypertension (9.9%). Lifestyle modification was used as treatment in 77% of patients during the second trimester, but its use decreased to 33% during the third trimester. Insulin was the treatment of choice. Among the OHA, sulfonylurea was preferred. Postprandial glucose levels were lower in patients who used insulin as compared to those without medications. CONCLUSION No significant differences were found in maternal outcomes such as C-section, induction of labor, episiotomy or preterm labor, or neonatal outcomes such as macrosomia, neonatal hypoglycemia or congenital abnormalities among treatment groups. OHA can be considered as an alternative to insulin for the treatment of DM during pregnancy in selected cases.
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Affiliation(s)
- Sheila Mercado-Méndez
- University of Puerto Rico School of Medicine – Department of Medicine - Endocrinology, Diabetes and Metabolism Division
| | - Lorena González-Sepúlveda
- Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico Medical Sciences Campus
| | - Josefina Romaguera
- University of Puerto Rico School of Medicine – Department of Obstetrics and Gynecology
| | - Loida A. González-Rodríguez
- University of Puerto Rico School of Medicine – Department of Medicine - Endocrinology, Diabetes and Metabolism Division
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Cui J, Song L, Wang R, Hu S, Yang Z, Zhang Z, Sun B, Cui W. Maternal Metformin Treatment during Gestation and Lactation Improves Skeletal Muscle Development in Offspring of Rat Dams Fed High-Fat Diet. Nutrients 2021; 13:nu13103417. [PMID: 34684418 PMCID: PMC8538935 DOI: 10.3390/nu13103417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 12/04/2022] Open
Abstract
Maternal high-fat (HF) diet is associated with offspring metabolic disorder. This study intended to determine whether maternal metformin (MT) administration during gestation and lactation prevents the effect of maternal HF diet on offspring’s skeletal muscle (SM) development and metabolism. Pregnant Sprague-Dawley rats were divided into four groups according to maternal diet {CHOW (11.8% fat) or HF (60% fat)} and MT administration {control (CT) or MT (300 mg/kg/day)} during gestation and lactation: CH-CT, CH-MT, HF-CT, HF-MT. All offspring were weaned on CHOW diet. SM was collected at weaning and 18 weeks in offspring. Maternal metformin reduced plasma insulin, leptin, triglyceride and cholesterol levels in male and female offspring. Maternal metformin increased MyoD expression but decreased Ppargc1a, Drp1 and Mfn2 expression in SM of adult male and female offspring. Decreased MRF4 expression in SM, muscle dysfunction and mitochondrial vacuolization were observed in weaned HF-CT males, while maternal metformin normalized them. Maternal metformin increased AMPK phosphorylation and decreased 4E-BP1 phosphorylation in SM of male and female offspring. Our data demonstrate that maternal metformin during gestation and lactation can potentially overcome the negative effects of perinatal exposure to HF diet in offspring, by altering their myogenesis, mitochondrial biogenesis and dynamics through AMPK/mTOR pathways in SM.
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Affiliation(s)
- Jiaqi Cui
- Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China;
| | - Lin Song
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (L.S.); (R.W.); (S.H.)
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of China, Xi’an Jiaotong University, Xi’an 710061, China
| | - Rui Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (L.S.); (R.W.); (S.H.)
| | - Shuyuan Hu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (L.S.); (R.W.); (S.H.)
| | - Zhao Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China;
| | - Zengtie Zhang
- Department of Pathology, Xi’an Jiao Tong University Health Science Center, Xi’an 710061, China;
| | - Bo Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (L.S.); (R.W.); (S.H.)
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of China, Xi’an Jiaotong University, Xi’an 710061, China
- Correspondence: (B.S.); (W.C.)
| | - Wei Cui
- Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China;
- Correspondence: (B.S.); (W.C.)
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Wang X, Kang J, Liu Q, Tong T, Quan H. Fighting Diabetes Mellitus: Pharmacological and Non-pharmacological Approaches. Curr Pharm Des 2021; 26:4992-5001. [PMID: 32723251 DOI: 10.2174/1381612826666200728144200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The increasing worldwide prevalence of diabetes mellitus confers heavy public health issues and points to a large medical need for effective and novel anti-diabetic approaches with negligible adverse effects. Developing effective and novel anti-diabetic approaches to curb diabetes is one of the most foremost scientific challenges. OBJECTIVES This article aims to provide an overview of current pharmacological and non-pharmacological approaches available for the management of diabetes mellitus. METHODS Research articles that focused on pharmacological and non-pharmacological interventions for diabetes were collected from various search engines such as Science Direct and Scopus, using keywords like diabetes, glucagon-like peptide-1, glucose homeostasis, etc. Results: We review in detail several key pathways and pharmacological targets (e.g., the G protein-coupled receptors- cyclic adenosine monophosphate, 5'-adenosine monophosphate-activated protein kinase, sodium-glucose cotransporters 2, and peroxisome proliferator activated-receptor gamma signaling pathways) that are vital in the regulation of glucose homeostasis. The currently approved diabetes medications, the pharmacological potentials of naturally occurring compounds as promising interventions for diabetes, and the non-pharmacological methods designed to mitigate diabetes are summarized and discussed. CONCLUSION Pharmacological-based approaches such as insulin, metformin, sodium-glucose cotransporters 2 inhibitor, sulfonylureas, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase IV inhibitors represent the most important strategies in diabetes management. These approved diabetes medications work via targeting the central signaling pathways related to the etiology of diabetes. Non-pharmacological approaches, including dietary modification, increased physical activity, and microbiota-based therapy are the other cornerstones for diabetes treatment. Pharmacological-based approaches may be incorporated when lifestyle modification alone is insufficient to achieve positive outcomes.
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Affiliation(s)
- Xin Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Jinhong Kang
- College of Pharmacy, Korea University, Sejong 30019, Korea
| | - Qing Liu
- Jilin Green Food Engineering Research Institute, Changchun, 130022, China
| | - Tao Tong
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Helong Quan
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, Zhejiang Province, 321004, China
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Mate A, Blanca AJ, Salsoso R, Toledo F, Stiefel P, Sobrevia L, Vázquez CM. Insulin Therapy in Pregnancy Hypertensive Diseases and its Effect on the Offspring and Mother Later in Life. Curr Vasc Pharmacol 2020; 17:455-464. [PMID: 30426902 DOI: 10.2174/1570161117666181114125109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 01/24/2023]
Abstract
Pregnancy hypertensive disorders such as Preeclampsia (PE) are strongly correlated with insulin resistance, a condition in which the metabolic handling of D-glucose is deficient. In addition, the impact of preeclampsia is enhanced by other insulin-resistant disorders, including polycystic ovary syndrome and obesity. For this reason, there is a clear association between maternal insulin resistance, polycystic ovary syndrome, obesity and the development of PE. However, whether PE is a consequence or the cause of these disorders is still unclear. Insulin therapy is usually recommended to pregnant women with diabetes mellitus when dietary and lifestyle measures have failed. The advantage of insulin therapy for Gestational Diabetes Mellitus (GDM) patients with hypertension is still controversial; surprisingly, there are no studies in which insulin therapy has been used in patients with hypertension in pregnancy without or with an established GDM. This review is focused on the use of insulin therapy in hypertensive disorders in the pregnancy and its effect on offspring and mother later in life. PubMed and relevant medical databases have been screened for literature covering research in the field especially in the last 5-10 years.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiologia, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/ Universidad de Sevilla, E- 41013 Sevilla, Spain
| | - Antonio J Blanca
- Departamento de Fisiologia, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain
| | - Rocío Salsoso
- Departamento de Fisiologia, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain.,Unidad de Enfermedades Coronarias Agudas, Instituto del Corazón, Escuela de Medicina, Universidad de Sao Paulo, Sao Paulo 05403-000 Brazil
| | - Fernando Toledo
- Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, Chillan 3780000, Chile.,Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile
| | - Pablo Stiefel
- Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/ Universidad de Sevilla, E- 41013 Sevilla, Spain
| | - Luis Sobrevia
- Departamento de Fisiologia, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain.,Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago 8330024, Chile.,University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Queensland, Australia
| | - Carmen M Vázquez
- Departamento de Fisiologia, Facultad de Farmacia, Universidad de Sevilla, E-41012 Sevilla, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/ Universidad de Sevilla, E- 41013 Sevilla, Spain
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Lorenzo-Almorós A, Hang T, Peiró C, Soriano-Guillén L, Egido J, Tuñón J, Lorenzo Ó. Predictive and diagnostic biomarkers for gestational diabetes and its associated metabolic and cardiovascular diseases. Cardiovasc Diabetol 2019; 18:140. [PMID: 31666083 PMCID: PMC6820966 DOI: 10.1186/s12933-019-0935-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as the presence of high blood glucose levels with the onset, or detected for the first time during pregnancy, as a result of increased insulin resistance. GDM may be induced by dysregulation of pancreatic β-cell function and/or by alteration of secreted gestational hormones and peptides related with glucose homeostasis. It may affect one out of five pregnancies, leading to perinatal morbidity and adverse neonatal outcomes, and high risk of chronic metabolic and cardiovascular injuries in both mother and offspring. Currently, GDM diagnosis is based on evaluation of glucose homeostasis at late stages of pregnancy, but increased age and body-weight, and familiar or previous occurrence of GDM, may conditionate this criteria. In addition, an earlier and more specific detection of GDM with associated metabolic and cardiovascular risk could improve GDM development and outcomes. In this sense, 1st-2nd trimester-released biomarkers found in maternal plasma including adipose tissue-derived factors such as adiponectin, visfatin, omentin-1, fatty acid-binding protein-4 and retinol binding-protein-4 have shown correlations with GDM development. Moreover, placenta-related factors such as sex hormone-binding globulin, afamin, fetuin-A, fibroblast growth factors-21/23, ficolin-3 and follistatin, or specific micro-RNAs may participate in GDM progression and be useful for its recognition. Finally, urine-excreted metabolites such as those related with serotonin system, non-polar amino-acids and ketone bodies, may complete a predictive or early-diagnostic panel of biomarkers for GDM.
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Affiliation(s)
- A Lorenzo-Almorós
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - T Hang
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - C Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - L Soriano-Guillén
- Department of Paediatrics, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - J Egido
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain
| | - J Tuñón
- Department of Cardiology, Fundación Jiménez Díaz, Madrid, Spain
| | - Ó Lorenzo
- Renal, Vascular and Diabetes Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. Reyes Católicos 2, 28040, Madrid, Spain.
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain.
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Maple-Brown LJ, Lindenmayer G, Barzi F, Whitbread C, Connors C, Moore E, Boyle J, Kirkwood M, Lee IL, Longmore D, van Dokkum P, Wicks M, Dowden M, Inglis C, Cotter M, Kirkham R, Corpus S, Chitturi S, Thomas S, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown A, Shaw JE. Real-world experience of metformin use in pregnancy: Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register. J Diabetes 2019; 11:761-770. [PMID: 30680949 DOI: 10.1111/1753-0407.12905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. METHODS The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. RESULTS Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non-Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84%-90% T2D, 42%-48% GDM/DIP) and increased over time in non-Indigenous women (43%-100% T2D, 14%-35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39%; adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87-1.81), large for gestational age (24% vs 13%; aOR 1.5, 95% CI 0.9-2.5), or serious neonatal adverse events (9.4% vs 5.9%; aOR 1.32, 95% CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. CONCLUSIONS We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.
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Affiliation(s)
- Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Greta Lindenmayer
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Christine Connors
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Jacqueline Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Paula van Dokkum
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Population Health Research, Baker Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia
| | - Mary Wicks
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | | | | | - Margaret Cotter
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Sridhar Chitturi
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sujatha Thomas
- Obstetrics and Gynaecology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kerin O'Dea
- Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Paul Zimmet
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harold D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Alex Brown
- Obstetrics and Gynaecology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jonathan E Shaw
- Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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de Wit L, Rademaker D, Voormolen DN, Akerboom BMC, Kiewiet-Kemper RM, Soeters MR, Verwij-Didden MAL, Assouiki F, Schippers DH, Vermeulen MAR, Kuppens SMI, Oosterwerff MM, Zwart JJ, Diekman MJM, Vogelvang TE, Gallas PRJ, Galjaard S, Visser W, Horree N, Klooker TK, Laan R, Heijligenberg R, Huisjes AJM, van Bemmel T, van Meir CA, van den Beld AW, Hermes W, Vidarsdottir S, Veldhuis-Vlug AG, Dullemond RC, Jansen HJ, Sueters M, de Koning EJP, van Laar JOEH, Wouters-van Poppel P, Sanson-van Praag ME, van den Akker ES, Brouwer CB, Hermsen BB, Potter van Loon BJ, van der Heijden OWH, de Galan BE, van Leeuwen M, Wijbenga JAM, de Boer K, van Bon AC, van der Made FW, Eskes SA, Zandstra M, van Houtum WH, Braams-Lisman BAM, Daemen-Gubbels CRGM, Wouters MGAJ, IJzerman RG, Mensing van Charante NA, Zwertbroek R, Bosmans JE, Evers IM, Mol BW, de Valk HW, Groenendaal F, Naaktgeboren CA, Painter RC, deVries JH, Franx A, van Rijn BB. SUGAR-DIP trial: oral medication strategy versus insulin for diabetes in pregnancy, study protocol for a multicentre, open-label, non-inferiority, randomised controlled trial. BMJ Open 2019; 9:e029808. [PMID: 31427334 PMCID: PMC6701578 DOI: 10.1136/bmjopen-2019-029808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/11/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION In women with gestational diabetes mellitus (GDM) requiring pharmacotherapy, insulin was the established first-line treatment. More recently, oral glucose lowering drugs (OGLDs) have gained popularity as a patient-friendly, less expensive and safe alternative. Monotherapy with metformin or glibenclamide (glyburide) is incorporated in several international guidelines. In women who do not reach sufficient glucose control with OGLD monotherapy, usually insulin is added, either with or without continuation of OGLDs. No reliable data from clinical trials, however, are available on the effectiveness of a treatment strategy using all three agents, metformin, glibenclamide and insulin, in a stepwise approach, compared with insulin-only therapy for improving pregnancy outcomes. In this trial, we aim to assess the clinical effectiveness, cost-effectiveness and patient experience of a stepwise combined OGLD treatment protocol, compared with conventional insulin-based therapy for GDM. METHODS The SUGAR-DIP trial is an open-label, multicentre randomised controlled non-inferiority trial. Participants are women with GDM who do not reach target glycaemic control with modification of diet, between 16 and 34 weeks of gestation. Participants will be randomised to either treatment with OGLDs, starting with metformin and supplemented as needed with glibenclamide, or randomised to treatment with insulin. In women who do not reach target glycaemic control with combined metformin and glibenclamide, glibenclamide will be substituted with insulin, while continuing metformin. The primary outcome will be the incidence of large-for-gestational-age infants (birth weight >90th percentile). Secondary outcome measures are maternal diabetes-related endpoints, obstetric complications, neonatal complications and cost-effectiveness analysis. Outcomes will be analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the Utrecht University Medical Centre. Approval by the boards of management for all participating hospitals will be obtained. Trial results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NTR6134; Pre-results.
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Affiliation(s)
- Leon de Wit
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Doortje Rademaker
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Daphne N Voormolen
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bettina M C Akerboom
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Maarten R Soeters
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Fahima Assouiki
- Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Daniela H Schippers
- Department of Obstetrics and Gynaecology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Mechteld A R Vermeulen
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Simone M I Kuppens
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Joost J Zwart
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | | | - Tatjana E Vogelvang
- Department of Obstetrics and Gynaecology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - P Rob J Gallas
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Sander Galjaard
- Department of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willy Visser
- Department of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole Horree
- Department of Obstetrics and Gynaecology, Flevoziekenhuis, Almere, The Netherlands
| | - Tamira K Klooker
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Rosemarie Laan
- Department of Obstetrics and Gynaecology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Rik Heijligenberg
- Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Anjoke J M Huisjes
- Department of Obstetrics and Gynaecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Thomas van Bemmel
- Department of Internal Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Claudia A van Meir
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, The Netherlands
| | | | - Wietske Hermes
- Department of Obstetrics and Gynaecology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Solrun Vidarsdottir
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Anneke G Veldhuis-Vlug
- Department of Internal Medicine, Medical Center Jan van Goyen, Amsterdam, The Netherlands
| | - Remke C Dullemond
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Henrique J Jansen
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marieke Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith O E H van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
| | | | | | | | | | - Brenda B Hermsen
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
| | | | - Olivier W H van der Heijden
- Department of Obstetrics and Gynaecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Marsha van Leeuwen
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Johanna A M Wijbenga
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Karin de Boer
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Arianne C van Bon
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Flip W van der Made
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Silvia A Eskes
- Department of Internal Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Mirjam Zandstra
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | | | | | - Maurice G A J Wouters
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard G IJzerman
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Rolf Zwertbroek
- Department of Internal Medicine, Dijklander Hospital, Hoorn, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Inge M Evers
- Department of Obstetrics and Gynaecology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Australia, Melbourne, The Netherlands
| | - Harold W de Valk
- Department of Internal Medicine and Endocrinology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Hans deVries
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation(s)
- Marina Scavini
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy.
| | - Antonio Secchi
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical Transplant Unit, Division of Immunology, Transplantation and Infectious Diseases San Raffaele Scientific Institute, Milan, Italy
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Song H, Xu Y, Yang X, Rong X, Wang Y, Wei N. Tertiary butylhydroquinone alleviates gestational diabetes mellitus in C57BL/KsJ-Lep db/+ mice by suppression of oxidative stress. J Cell Biochem 2019; 120:15310-15319. [PMID: 31050362 DOI: 10.1002/jcb.28798] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
Abstract
Gestational diabetes mellitus (GDM) is a common disorder characterized by abnormal glucose metabolism during pregnancy, affecting 2% to 5% of pregnant women. Currently, clinical treatment for GDM is very limited. The present study was designed to investigate the effect and underlying molecular mechanism of tertiary butylhydroquinone (TBHQ) in a pregnant C57BL/KsJ-Lep db/+ (referred to as db+) GDM mouse model. The results showed that nonpregnant db/+ mice did not show a diabetic phenotype, and TBHQ had no effect on glucose and insulin tolerance in these mice. Moreover, in db/+ pregnant mice exhibiting typical diabetes symptoms, such as hyperglycemia and hypoinsulinemia, TBHQ could remarkably decrease the blood glucose level, increase insulin level, and improve glucose and insulin intolerance. The results also revealed that TBHQ could inhibit oxidative stress in pregnant db/+ mice. Furthermore, TBHQ greatly improved offspring survival rate, glucose metabolism, and insulin tolerance. In addition, TBHQ inhibited oxidative stress by reducing malondialdehyde (MDA) and reactive oxygen species (ROS) levels and increased superoxide dismutase (SOD), and glutathione peroxidase (GPx) activities. Moreover, we found that TBHQ activated the nuclear factor erythroid 2-related factor 2 (Nrf2), thereby increasing the levels of Nrf2, and ultimately upregulating the expression of heme oxygenase 1 (NO-1) and superoxide dismutase 2 (SOD2). In conclusion, our findings demonstrated that TBHQ alleviated GDM via Nrf2 activation.
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Affiliation(s)
- Hongbi Song
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Yin Xu
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Xiaowu Yang
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Xiaoting Rong
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Ying Wang
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
| | - Na Wei
- Department of Obstetrics, Guizhou Provincial People's Hospital, Guiyang, People's Republic of China
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Corcoy R, Balsells M, García-Patterson A. In relation to "Pharmacological treatment of gestational diabetes mellitus: point/counterpoint" by Oded Langer. Am J Obstet Gynecol 2018; 219:629-630. [PMID: 30121226 DOI: 10.1016/j.ajog.2018.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Langer O. Reply. Am J Obstet Gynecol 2018; 219:630. [PMID: 30121227 DOI: 10.1016/j.ajog.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Saccone G, Khalifeh A, Al-Kouatly HB, Sendek K, Berghella V. Screening for gestational diabetes mellitus: one step versus two step approach. A meta-analysis of randomized trials. J Matern Fetal Neonatal Med 2018; 33:1616-1624. [DOI: 10.1080/14767058.2018.1519543] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Adeeb Khalifeh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Einstein Medical Center, Phila, PA, USA
| | - Huda B. Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Phila, PA, USA
| | - Kerri Sendek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Phila, PA, USA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Phila, PA, USA
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Lu MX, Yang Y, Zou QP, Luo J, Zhang BB, Liu XQ, Hwang EH. Anti-Diabetic Effects of Acankoreagenin from the Leaves of Acanthopanax Gracilistylus Herb in RIN-m5F Cells via Suppression of NF-κB Activation. Molecules 2018; 23:molecules23040958. [PMID: 29671829 PMCID: PMC6017878 DOI: 10.3390/molecules23040958] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 12/21/2022] Open
Abstract
Diabetes mellitus is a chronic degenerative disease that causes long-term complications and represents a serious public health problem. In this manuscript, acankoreagenin isolated from the leaves of Acanthopanax gracilistylus (LAG) is thought to possess excellent anti-diabetic properties. In vitro, anti-diabetic activities were assessed based on the inhibitory activities with α-glucosidase (IC50 13.01 μM), α-amylase (IC50 30.81 μM), and PTP1B (IC50 16.39 μM). Acankoreagenin showed better anti-diabetic effects. Then, an investigation was performed to analyze the insulin secretion effects of the insulin-secreting cell line in RIN-m5F cells. It was found that acankoreagenin could increase the insulin release in RIN-m5F cells. It was also found that acankoreagenin reduced NO production, activity of caspase-3, and the reactive oxygen species levels in the cells injured by processing of cytokines. In western blotting, inactivation of NF-κB signaling was confirmed. Acankoreagenin (20 μM) showed a higher I-κBα expression and lower NF-κB expression than the control group and showed a better expression than the positive control L-NAME (1 mM) (p < 0.05). This study demonstrates the anti-diabetic effects of acankoreagenin in vitro and suggests acankoreagenin might offer therapeutic potential for treating diabetes mellitus.
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Affiliation(s)
- Man-Xia Lu
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
| | - Yang Yang
- School of Life Sciences, Datong University, Datong 037009, China.
| | - Qin-Peng Zou
- Changsha Broad-Ocean Bio-Science and Technique Co., Ltd., Changsha 410205, China.
| | - Jiao Luo
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
| | - Bin-Bei Zhang
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
| | - Xiang-Qian Liu
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China.
| | - Eun-Hee Hwang
- Department of Food and Nutrition, Wonkwang University, Iksan 54538, Korea.
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