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Luiro K, Auvinen AM, Auvinen J, Jokelainen J, Järvelä I, Knip M, Tapanainen JS. Autoantibodies predict type 1 diabetes after gestational diabetes - a 23-year cohort study. Front Endocrinol (Lausanne) 2023; 14:1286375. [PMID: 38192417 PMCID: PMC10773701 DOI: 10.3389/fendo.2023.1286375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Objective To study the predictive value of autoantibodies for type 1 (T1DM) and type 2 (T2DM) diabetes morbidity after gestational diabetes (GDM) in a 23-year follow-up study. Design Prospective population-based cohort study. Methods We studied 391 women with GDM, and 391 age- and parity-matched controls, who delivered in 1984-1994. Four autoantibodies were analysed in first-trimester blood samples: islet cell autoantibodies (ICAs), glutamic acid decarboxylase autoantibodies (GADAs), insulin autoantibodies (IAAs) and insulinoma-associated antigen-2 autoantibodies (IA-2As). Two follow-up questionnaires (1995-1996, 2012-2013) were sent to assess development of T1DM and T2DM. Predictive value of autoantibodies and clinical factors were analysed by conditional linear regression and ROC analyses. Results Single autoantibody positivity was detected in 12% (41/342) of the GDM cohort and in 2.3% (8/353) of the control cohort. In the GDM cohort, 2.6% (9/342) tested positive for two autoantibodies and 2.3% (8/342) for three autoantibodies, whereas only one subject in the control cohort had two autoantibodies. ICA positivity was found in 12.5% of the cases, followed by GADA (6.0%), IA-2A (4.9%) and IAA (1.2%). In the control cohort, GADA positivity was found in 1.4%, IA-2A in 0.8%, IAA in 0.6%, and ICA in 0.3% of the subjects. Detection of ICA, GADA and/or IA-2A autoantibodies decreased T1DM-free survival time and time to diagnosis. All subjects with three positive autoantibodies developed T1DM within seven years from the GDM pregnancy. Development of T2DM after GDM occurred independent of autoantibody positivity. Conclusion Development of T1DM can be reliably predicted with GADA and ICA autoantibodies during early pregnancy.
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Affiliation(s)
- Kaisu Luiro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Maaria Auvinen
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Northern Finland Birth Cohorts, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ilkka Järvelä
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Mikael Knip
- Pediatric Research Center, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | - Juha S. Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, HFR – Cantonal Hospital of Fribourg and University of Fribourg, Fribourg, Switzerland
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Auvinen AM, Luiro K, Jokelainen J, Järvelä I, Knip M, Auvinen J, Tapanainen JS. Type 1 and type 2 diabetes after gestational diabetes: a 23 year cohort study. Diabetologia 2020; 63:2123-2128. [PMID: 32725280 PMCID: PMC7476985 DOI: 10.1007/s00125-020-05215-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study. METHODS We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984-1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, ≥4.8 mmol/l; 1 h, ≥10.0 mmol/l; and 2 h, ≥8.7 mmol/l. Two follow-up questionnaires were sent (in 1995-1996 and 2012-2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7-28.8) years. RESULTS Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]). CONCLUSIONS/INTERPRETATION All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.
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Affiliation(s)
- Anna-Maaria Auvinen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland
| | - Kaisu Luiro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO 140 (Haartmaninkatu 2E), 00029, Helsinki, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Ilkka Järvelä
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Mikael Knip
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.
- PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland.
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO 140 (Haartmaninkatu 2E), 00029, Helsinki, Finland.
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Incani M, Baroni MG, Cossu E. Testing for type 1 diabetes autoantibodies in gestational diabetes mellitus (GDM): is it clinically useful? BMC Endocr Disord 2019; 19:44. [PMID: 31053128 PMCID: PMC6500053 DOI: 10.1186/s12902-019-0373-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/22/2019] [Indexed: 12/13/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder in pregnancy, and it is associated with increased risk of morbidity in maternal-fetal outcomes. GDM is also associated with a higher risk to develop diabetes in the future. Diabetes-related autoantibodies (AABs) have been detected in a small percentage (usually less than 10%) of women with gestational diabetes. The prevalence in gestational diabetes of these autoimmune markers of type 1 diabetes (T1D) has been assessed in many studies, together with the risk of progression of AABs-positive GDM towards impaired glucose regulation (IFG or IGT) and overt diabetes after pregancy. The question whether it is necessary to test for T1D autoantibodies in all pregnancies with GDM is still debated. Here we examine the epidemiology of T1D autoantibodies in GDM, their clinical relevance in term of future risk of diabetes or impaired glucose regulation and in term of maternal-fetal outcomes, and discuss when it may be the most appropriate time to search for T1D autoantibodies in women with gestational diabetes.
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Affiliation(s)
- Michela Incani
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marco Giorgio Baroni
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy.
| | - Efisio Cossu
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Ikeoka T, Sako A, Kuriya G, Yamashita H, Yasuhi I, Horie I, Ando T, Abiru N, Kawakami A. Type 1 Diabetes Mellitus Diagnosed during Follow-up of Gestational Diabetes Mellitus in the Early Postpartum Period. Intern Med 2018; 57:3413-3418. [PMID: 30101928 PMCID: PMC6306539 DOI: 10.2169/internalmedicine.1188-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/06/2018] [Indexed: 11/10/2022] Open
Abstract
A 27-year-old woman with a history of gestational diabetes mellitus (GDM) developed type 1 diabetes mellitus (T1D) in the early postpartum period. Women with a history of GDM are at an increased risk of developing T1D, which is rarer than type 2 diabetes mellitus. A postpartum follow-up 75-g oral glucose tolerance test and the measurement of glutamic acid decarboxylase autoantibodies aided in the early detection of T1D in this patient. Careful attention should be paid to women with a history of GDM who exhibit clinical features suggestive of future development of T1D.
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Affiliation(s)
- Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ayaka Sako
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ichiro Horie
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takao Ando
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Norio Abiru
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
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5
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Guo CC, Jin YM, Lee KKH, Yang G, Jing CX, Yang X. The relationships between HLA class II alleles and antigens with gestational diabetes mellitus: A meta-analysis. Sci Rep 2016; 6:35005. [PMID: 27721507 PMCID: PMC5056346 DOI: 10.1038/srep35005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/22/2016] [Indexed: 01/10/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. It is associated with an increased risk of pregnancy complications. Susceptibility to GDM is partly determined by genetics and linked with type 1 diabetes-associated high risk HLA class II genes. However, the evidence for this relationship is still highly controversial. In this study, we assessed the relationship between HLA class II variants and GDM. We performed meta-analysis on all of literatures available in PubMed, Embase, Web of Science and China National Knowledge Infrastructure databases. The odds ratio and 95% confidence interval of each variant were estimated. All statistical analyses were conducted using the Comprehensive Meta Analysis 2.2.064 software. At the allelic analysis, DQB1*02, DQB1*0203, DQB1*0402, DQB1*0602, DRB1*03, DRB1*0301 and DRB1*1302 reached a nominal level of significance, and only DQB1*02, DQB1*0602 and DRB1*1302 were statistically significant after Bonferroni correction. At the serological analysis, none of DQ2, DQ6, DR13 and DR17 was statistically significant following Bonferroni correction although they reached a nominal level of significance. In sum, our meta-analysis demonstrated that there were the associations between HLA class II variants and GDM but more studies are required to elucidate how these variants contribute to GDM susceptibility.
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Affiliation(s)
- Cong-Cong Guo
- Medical College, Jinan University, Guangzhou 510632, China
| | - Yi-Mei Jin
- Medical College, Jinan University, Guangzhou 510632, China
| | - Kenneth Ka Ho Lee
- Key Laboratory for Regenerative Medicine of the Ministry of Education, School of Biomedical Sciences, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Guang Yang
- Medical College, Jinan University, Guangzhou 510632, China.,Key Laboratory of environmental exposure and health in Guangzhou, Jinan University, Guangzhou, 510632, China
| | - Chun-Xia Jing
- Medical College, Jinan University, Guangzhou 510632, China.,Key Laboratory of environmental exposure and health in Guangzhou, Jinan University, Guangzhou, 510632, China
| | - Xuesong Yang
- Medical College, Jinan University, Guangzhou 510632, China
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Chiba H, Fukui A, Fuchinoue K, Funamizu A, Tanaka K, Mizunuma H. Expression of Natural Cytotoxicity Receptors on and Intracellular Cytokine Production by NK Cells in Women with Gestational Diabetes Mellitus. Am J Reprod Immunol 2016; 75:529-38. [PMID: 26813019 DOI: 10.1111/aji.12491] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/28/2015] [Indexed: 12/14/2022] Open
Abstract
PROBLEM To determine the role of peripheral blood NK (pNK) cells in putative etiology of gestational diabetes, the expression of surface markers on pNK cells and the percentage of cytokine-producing pNK cells in women at 12 weeks of pregnancy with gestational diabetes mellitus (GDM) were studied. METHOD OF STUDY Multicolor flow cytometry was used to analyze the expression of NK cell surface receptors (CD16, NKp46, and NKp30) and intracellular cytokines (IFN-γ, TNF-α, TGF-β, and VEGF) in pNK cells (CD56(dim) and CD56(bright) ) at 12 weeks of pregnancy with GDM (n = 7) and non-GDM (n = 28). RESULTS CD56(bright) /CD16(-) NK and CD56(bright) /NKp46(+) NK cell percentage were significantly lower in GDM women than that in non-GDM women. IFN-γ- and TNF-α-producing CD56(+) cells, respectively, were significantly high, while TGF-β- and VEGF-producing CD56(+) cells and CD56(bright) cells, respectively, were significantly low in GDM women. CONCLUSIONS Women with GDM possibly have abnormal NK cell function for the expression of surface receptors and cytokine production.
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Affiliation(s)
- Hitomi Chiba
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Kohei Fuchinoue
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Ayano Funamizu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Kanji Tanaka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Hideki Mizunuma
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
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7
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Katsarou A, Claesson R, Ignell C, Shaat N, Berntorp K. Seasonal Pattern in the Diagnosis of Gestational Diabetes Mellitus in Southern Sweden. J Diabetes Res 2016; 2016:8905474. [PMID: 28105444 PMCID: PMC5220490 DOI: 10.1155/2016/8905474] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
Aim. The aim of this study was to examine seasonal patterns in glucose tolerance and in the diagnosis of gestational diabetes mellitus (GDM). Methods. Altogether, 11 538 women underwent a 75-g oral glucose tolerance test (OGTT) in the twenty-eighth week of pregnancy during the years 2003-2005 in southern Sweden. GDM was defined by the 2-h capillary glucose concentration in the OGTT (≥8.9 mmol/L). Chi-squared test, analysis of variance, and regression analyses were used for statistical evaluations. Results. The seasonal frequency of GDM ranged from 3.3% in spring to 5.5% in summer (p < 0.0001). Mean 2-h glucose concentrations followed the same seasonal trend, with a difference of 0.15 mmol/L between winter and summer (p < 0.0001). The 2-h glucose level increased by 0.009 mmol/L for every degree increase in temperature (p < 0.0001). In regression analysis, summer (June-August) was associated with increased 2-h glucose level (p < 0.001) and increased frequency of GDM compared to the other seasons (odds ratio 1.51, 95% confidence interval 1.24-1.83, and p < 0.001). Conclusions. Our findings suggest seasonal variation in the 2-h glucose concentration in the OGTT and in the proportion of women diagnosed with GDM, with a peak in the summer.
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Affiliation(s)
- Anastasia Katsarou
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- *Anastasia Katsarou:
| | - Rickard Claesson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Office for Healthcare “Kryh”, Ystad, Sweden
| | - Claes Ignell
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Office for Healthcare “Sund”, Helsingborg, Sweden
| | - Nael Shaat
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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Zdziarski P. A Case of Stiff Person Syndrome: Immunomodulatory Effect of Benzodiazepines: Successful Rituximab and Tizanidine Therapy. Medicine (Baltimore) 2015; 94:e954. [PMID: 26061327 PMCID: PMC4616492 DOI: 10.1097/md.0000000000000954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Stiff person syndrome (SPS) is a rare autoimmune disease. Most patients have high-titer antibodies against glutamate decarboxylase (GADAb), which is without practical value in disease monitoring. Benzodiazepines are the first line drugs, but long-term use is not well characterized. This report demonstrates ineffective benzodiazepine therapy of SPS that prompts tachyphylaxis, loss of responsiveness, and finally benzodiazepine withdrawal syndrome. Convulsion and anxiety correlate with high level of creatine phosphokinase (CK). Although tonus and spasm attacks were successfully controlled by tizanidine, glutamate release inhibitor, the immune response, and autoimmune diabetes development require the plasmapheresis, mycophenolat mofetil, and rituximab therapy that results in a significant decrease of GADAb, impaired glucose tolerance (IGT), lactate dehydrogenase (LDH), and CK normalization. Unfortunately, reintroduction of benzodiazepine was a source of rapid and high increase of CK, LDH, GADAb titer (up to 1:15,000), IGT, and SPS relapse. Contrary to previous publications, we observed IGT that correlated with high anti-GAD level, but without high immunogenetic susceptibility to haplotype human leukocyte antigens-DR3, DQw2. This preliminary observation and the last finding of immunomodulatory properties of peripheral benzodiazepine receptor suggest that increased antigenic stimulation during benzodiazepine therapy and glutamatergic hyperactivity could account for convulsions observed in SPS. Benzodiazepine withdrawal prompted alternative muscle relaxant therapy (tizanidine). Muscular and brain abnormalities observed in SPS indicate that noncardiac CK level may be a useful tool in SPS therapy monitoring.
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Affiliation(s)
- Przemyslaw Zdziarski
- From the Department of Clinical Immunology, Lower Silesian Center for Cellular Transplantation, Wroclaw, Poland
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9
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Lundberg TP, Højlund K, Snogdal LS, Jensen DM. Glutamic acid decarboxylase autoantibody-positivity post-partum is associated with impaired β-cell function in women with gestational diabetes mellitus. Diabet Med 2015; 32:198-205. [PMID: 25345799 DOI: 10.1111/dme.12615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/18/2014] [Accepted: 10/15/2014] [Indexed: 01/25/2023]
Abstract
AIMS To investigate whether the presence of glutamic acid decarboxylase (GAD) autoantibodies post-partum in women with prior gestational diabetes mellitus was associated with changes in metabolic characteristics, including β-cell function and insulin sensitivity. METHODS During 1997-2010, 407 women with gestational diabetes mellitus were offered a 3-month post-partum follow-up including anthropometrics, serum lipid profile, HbA1c and GAD autoantibodies, as well as a 2-h oral glucose tolerance test (OGTT) with blood glucose, serum insulin and C-peptide at 0, 30 and 120 min. Indices of insulin sensitivity and insulin secretion were estimated to assess insulin secretion adjusted for insulin sensitivity, disposition index (DI). RESULTS Twenty-two (5.4%) women were positive for GAD autoantibodies (GAD+ve) and the remainder (94.6%) were negative for GAD autoantibodies (GAD-ve). The two groups had similar age and prevalence of diabetes mellitus. Women who were GAD+ve had significantly higher 2-h OGTT glucose concentrations during their index-pregnancy (10.5 vs. 9.8 mmol/l, P = 0.001), higher fasting glucose (5.2 vs. 5.0 mmol/l, P = 0.02) and higher 2-h glucose (7.8 vs. 7.1 mmol/l, P = 0.05) post-partum. Fasting levels of C-peptide and insulin were lower in GAD+ve women compared with GAD-ve women (520 vs. 761 pmol/l, P = 0.02 and 33 vs. 53 pmol/l, P = 0.05) Indices of insulin sensitivity were similar in GAD+ve and GAD-ve women, whereas all estimates of DI were significantly reduced in GAD+ve women. CONCLUSION GAD+ve women had higher glucose levels and impaired insulin secretion adjusted for insulin sensitivity (DI) compared with GAD-ve women. The combination of OGTT and GAD autoantibodies post-partum identify women with impaired β-cell function. These women should be followed with special focus on development of Type 1 diabetes.
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MESH Headings
- Adult
- Autoantibodies/analysis
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/epidemiology
- Autoimmune Diseases/etiology
- Autoimmune Diseases/immunology
- Biomarkers/blood
- Cohort Studies
- Denmark/epidemiology
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/etiology
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/immunology
- Diabetes, Gestational/blood
- Diabetes, Gestational/immunology
- Diabetes, Gestational/physiopathology
- Diagnosis, Differential
- Early Diagnosis
- Female
- Follow-Up Studies
- Glutamate Decarboxylase/antagonists & inhibitors
- Glutamate Decarboxylase/immunology
- Humans
- Insulin/blood
- Insulin/metabolism
- Insulin Resistance
- Insulin Secretion
- Insulin-Secreting Cells/immunology
- Insulin-Secreting Cells/metabolism
- Postpartum Period
- Pregnancy
- Prevalence
- Prospective Studies
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Affiliation(s)
- T P Lundberg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; The Clinical Research Institute, University of Southern Denmark, Odense, Denmark
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Kim C. Maternal outcomes and follow-up after gestational diabetes mellitus. Diabet Med 2014; 31:292-301. [PMID: 24341443 PMCID: PMC3944879 DOI: 10.1111/dme.12382] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/12/2013] [Accepted: 11/29/2013] [Indexed: 12/25/2022]
Abstract
Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease.
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Affiliation(s)
- C Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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