Considerations in the Management of Gestational Diabetes Mellitus: "You Are What Your Mother Ate!"

Bibliometric analysis on microbial corrosion in dentistry

Abstract: Aim: The present bibliometric analysis was conducted to find the evidence regarding microbial corrosion in dentistry since corrosion by whatever means affect the intraoral performance of the metallic appliances. Materials and methods: Material and methods: Dimensions software was used to search for published literature pertaining to the keywords “microbial corrosion” AND “dentistry”. Two reviewers assessed the articles in terms of year of publication, authors, country of origin, journal of publication, and the affiliated institutions of the authors as well as their collaborations and the most cited publications. Results: The search revealed a total of 3,118 articles between the years 2000 to 2022. The number of publications was on the rising pattern with a spike between 2004-2007, again with a small spike between 2014 and 2016 and then a steep increase from 2017 onwards.  The publications were almost equally split between Engineering science and Medical Sciences. United States topped the list of countries with 378 documents with total link strength of 106224. Sao Paulo University topped the list in terms of organizations with total link strength of 12722. The journal of Anatomia Histologia Embryologia topped with 136 publications followed by Materials with 94 publications. Valentim from Brazil topped the authors with 22 publications. Conclusion: Microbial corrosion is needs equal concentration as any other forms of intraoral corrosion given that oral cavity is loaded with huge varieties of microorganisms with some of them known to cause microbial corrosion like sulfate reducing bacteria. The recent decline in research and publications in this field especially in 2022 is concerning. More studies are needed to learn more on microbial corrosion and its effects in dentistry.  Keywords: microbial corrosion, dentistry, sulfate reducing bacteria  

Regeneration of β-cells of the islet apparatus of the pancreas. Literature review

Diabetes of both type 1 and type 2 is characterized by a progressive loss of β-cell mass, which contributes to the disruption of glucose homeostasis. The optimal antidiabetic therapy would be simple replacement of lost cells, but at present, many researchers have shown that the pancreas (PZ) of adults has a limited regenerative potential. In this regard, significant efforts of researchers are directed to methods of inducing the proliferation of β-cells, stimulating the formation of β-cells from alternative endogenous sources and/or the generation of β-cells from pluripotent stem cells. Factors that regulate β-cell regeneration under physiological or pathological conditions, such as mediators, transcription factors, signaling pathways and potential pharmaceuticals, are also being intensively studied. In this review, we consider recent scientific studies carried out in the field of studying the development and regeneration of insulin-producing cells obtained from exogenous and endogenous sources and their use in the treatment of diabetes. The literature search while writing this review was carried out using the databases of the RSIC, CyberLeninka, Scopus, Web of Science, MedLine, PubMed for the period from 2005 to 2021. using the following keywords: diabetes mellitus, pancreas, regeneration, β-cells, stem cells, diabetes therapy.

Universal versus selective screening for gestational diabetes mellitus among antenatal clinic attendees in Abakaliki: using the one-step 75 gram oral glucose tolerance test

AIM

To compare universal screening with selective risk factor based screening for GDM, using the one-step 75 g oral glucose tolerance test (OGTT).

MATERIALS AND METHOD

A cross-sectional, comparison between universal and selective risk factor based screening for GDM, among 400 antenatal care clients at Alex-Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). All the participants had 75 g OGTT at 24-28 weeks of gestation and risk factor screening for GDM. All 400 participants formed the universal group while participants with one or more of the considered risk factors formed the selective risk factor group. Data were analyzed using IBM SPSS version 20. Statistical comparison was done using t- test for continuous variables. Logistics regression was used to determine the level of associations of the independent predictors for hyperglycemia. Level of significance was set at P < 0.05.

RESULTS

The point prevalence of GDM using universal and selective screening were 11.51 and 7.93% respectively, giving a selective screening miss rate of 31.11%. The sensitivity, specificity, positive predictive value and negative predictive value were 73.58, 48.82, 19.12 and 92.51% respectively for the selective risk factor based screening compared to universal screening. On multivariate analysis; age ≥ 35 years, weight ≥ 90 kg, history of previous GDM and hypertension were significantly related to the development of hyperglycemia.

CONCLUSION

Selective risk factor based screening missed 31.11% of patients with GDM when compare to Universal screening with one step 75 g OGTT. Universal screening for GDM using the one step 75 g OGTT is recommended for pregnant women and more studies are needed to compare pregnancy outcomes for pregnant women diagnosed with GDM with and without risk factors.

Global research trends on bioflocculant potentials in wastewater remediation from 1990 to 2019 using a bibliometric approach

The preference of biofloculants over chemical flocculants in water and wastewater remediation systems has gained wider attention due to their biodegradability, innocuousness, safety to human and environmental friendliness. The present study aimed to evaluate research outputs on bioflocculant potentials in wastewater remediation from 1990 to 2019 using bibliometric analyses. To the best of our knowledge, this is the first bibliometric report in bioflocculant research. The subject bibliometric dataset was extracted from the Web of Science Core Collection (WoSCC) and Scopus using the Boolean, 'bioflocculant* and waste*' and analysed for indicators such as a yearly trend, productivity (authors, articles, country, institution and journal source), conceptual framework and collaboration network. We found 119 documents with 347 authors from 78 journal sources on the subject, an annual growth rate of 12·1%, and average citations/document of 15·08. Guo J. and Wang Y. were the top researchers with 15 and 12 outputs respectively. China (42%) and South Africa (9·24%) ranked the top two dominant countries in the field. The top journals were Bioresource Technology (9 papers, 506 citations), Applied Microbiology and Biotechnology (5 papers, 268 citations), whereas, the top institution was Chengdu University of Information and Technology (n = 9 documents) followed by Sichuan Univ. Sci. & Engn, China (n = 8 documents). This study found that lack of intercountry collaboration and research funding adversely affects research participants in the field.

Benefits of Adhering to a Mediterranean Diet Supplemented with Extra Virgin Olive Oil and Pistachios in Pregnancy on the Health of Offspring at 2 Years of Age. Results of the San Carlos Gestational Diabetes Mellitus Prevention Study

The intrauterine environment may be related to the future development of chronic diseases in the offspring. The St. Carlos gestational diabetes mellitus (GDM) prevention study, is a randomized controlled trial that evaluated the influence of the early (before 12th gestational week) Mediterranean diet (MedDiet) on the onset of GDM and adverse gestational outcomes. Out of 874 women assessed after delivery (440 control group (CG)/434 intervention group (IG)), 703 children were followed (365/338; CG/IG), with the aim to assess whether the adherence to a MedDiet during pregnancy induces health benefits for the offspring during the first two years of life. Logistic regression analysis showed that the IG in children of mothers with pre-gestational body mass index (BMI) < 25 kg/m² and normal glucose tolerance (NGT), was associated with a lower risk (RR(95% CI)) of suffering from severe events requiring hospitalization due to bronchiolitis/asthma (0.75(0.58–0.98) and 0.77(0.59–0.99), respectively) or other diseases that required either antibiotic (0.80(0.65–0.98) and 0.80(0.65–0.99), respectively), corticosteroid treatment (0.73(0.59–0.90) and 0.79(0.62–1.00) respectively) or both (all p < 0.05). A nutritional intervention based on the MedDiet during pregnancy is associated with a reduction in offspring’s hospital admissions, especially in women with pre-gestational BMI < 25 kg/m² and NGT.

A Bibliometric Analysis of the Top 30 Most-cited Articles in Gestational Diabetes Mellitus Literature (1946-2019)

Objective The aim of this bibliometric analysis is to evaluate the importance and impact of the articles that have been published with the title gestational diabetes mellitus (GDM) in the specialty of obstetrics & gynecology and endocrinology during the period 1946-2019. It also reveals that the area of GDM has received increased attention and interest by researchers, research funding institutions, and practitioners. Material and methods A thorough database search of Scopus and Web of Science was performed and the articles pertaining to gestational diabetes mellitus that were published between 1946 and 2019 were reviewed by two reviewers, Iftikhar PM and Ali F, with respect to their year of publication, authors, country of origin, journal of publication, and the affiliated institutions of the authors as well as journals. Institutional review board approval was not required for this study, as the data being analyzed were already available electronically, and otherwise, in libraries and databases. Results The 30 most-cited articles on gestational diabetes mellitus were thoroughly analyzed. The top article was cited 5028 times while the least number of citations for any article was 328. Among these 30 articles, five were published in the year 2005, which is the highest number of publications in any given year of the timeline being considered in this study. Most of the articles (n = 18) were from the United States of America, followed by Australia (n = 3); other countries contributed to two or fewer articles. Diabetes Care made most (n = 8) of the list. We found one author who had three publications and the rest contributed two or less articles. The top article in our study was cited almost 5028 times; meanwhile, there are 13 journals from different specialties that have referenced the most cited articles pertaining to gestational diabetes. Conclusion Our bibliometric analysis provides a picture of scientific research, which will help in evidence-based descriptions, comparisons, and visualizations of research output in GDM, and it can be used to explicate and describe the patterns of performance and impact of GDM research.

Influence of gestational diabetes on the activity of δ-aminolevulinate dehydratase and oxidative stress biomarkers

OBJECTIVES

This study aimed to evaluate the activity of delta-aminolevulinate dehydratase (δ-ALA-D) and oxidative stress biomarkers in pregnant women with gestational diabetes mellitus (GDM), in order to demonstrate the involvement of oxidative stress in this condition, which presents pathophysiology still undetermined.

METHODS

δ-ALA-D activity, lipid peroxidation estimated as the levels of thiobarbituric acid reactive substances (TBARS), protein (P-SH) and non-protein thiol (NP-SH) content, catalase (CAT) activity and concentration of vitamin C (VIT C) in samples of pregnant women with GDM (n = 48) and in healthy pregnant women (n = 30), who constituted the control group.

RESULTS

The δ-ALA-D activity was significantly lower in pregnant women with GDM compared to controls, as well as levels of thiols, VIT C and CAT activity. Lipid peroxidation was higher in GDM group.

DISCUSSION

The results suggest that the main factor for the increase in oxidative stress and reduced δ-ALA-D activity in diabetic pregnant women is gestational hyperglycemic environment, which changed the redox balance and interfered on mechanism of the δ-ALA-D activity in relation to normoglycemic pregnant women.

Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

OBJECTIVES

To assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.

RESEARCH DESIGN AND METHODS

This is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA1c) levels at 36-38 GWs in GDMw and women with normal glucose tolerance (NGTw).

RESULTS

GDMw as compared with NGTw had higher HbA1c levels at 24-28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36-38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24-28 GWs (p=0.001) but became similar at 36-38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw.

CONCLUSIONS

Using a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.

Increased fetal epicardial fat thickness: A novel ultrasound marker for altered fetal metabolism in diabetic pregnancies

OBJECTIVE

To evaluate whether fetal epicardial fat thickness (EFT) differs in diabetic and nondiabetic pregnant women.

METHODS

Retrospective case-control study of pregnancies between 24 and 36 weeks complicated by preexisting (PDM) or gestational (GDM) diabetes mellitus, matched one to one with controls for body mass index and gestational age (GA). Epicardial fat was identified as the hypoechogenic area between myocardium and visceral pericardium over the right ventricle and its thickness was measured by a single observer blinded to clinical condition and outcomes. A linear regression analysis was performed to assess the relationship between GA and EFT, and regression lines were compared between diabetics and controls.

RESULTS

53 PDM and 53 GDM pregnant women were matched with controls. With the exception of maternal age, the demographics were similar among groups. EFT increased significantly with advancing gestation in both diabetics and controls (P < 0.0001) and was significantly greater in diabetics than in controls (P < 0.0001). The best fit lines were different between diabetics (EFT = 0.05 × GA + 0.07 mm; R²  = 0.70) and controls (EFT = 0.07 × GA + 0.04 mm; R²  = 0.93) (P < 0.0001).

CONCLUSION

Fetal EFT was greater in diabetics than in nondiabetics, and even greater in pregestational diabetics. EFT maybe an additional and/or earlier marker to identify early changes in fetal metabolism before accelerated fetal growth and polyhydramnios is apparent.

Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting

The feasibility of “point-of-care” screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9–18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal “point-of care” non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.

Predicting type 2 diabetes mellitus: a comparison between the FINDRISC score and the metabolic syndrome

BACKGROUND

The aim of this study to compare the diagnostic accuracy of the metabolic syndrome (MetS) with the FINDRISC score to screen for type 2 diabetes mellitus T2DM in an overweight/obese population.

METHODS

Subjects 18 years or older visiting the obesity clinic of the Antwerp University Hospital were consecutively recruited between 2012 and 2014. Every patient underwent a standard metabolic work-up including a clinical examination with anthropometry. Glucose status was tested using OGTT and Hba1c. FINDRISC questionnaire and MetS were examined.

RESULTS

Of 651 subjects, 50.4% were diagnosed with prediabetes, whereas 11.1% was diagnosed with T2DM. FINDRISC score increased with worsening of glucose status 11 ± 3, 13 ± 4 and 15 ± 5 in respectively, subjects without T2DM, prediabetes and T2DM. 312 subjects had the MetS. The aROC of the FINDRISC to identify subjects with T2DM was 0.76 (95% CI 0.72-0.82), sensitivity was 64% and specificity was 63% with 13 as cutoff point. Adding FPG or HbA1c to FINDRISC, the aROC increased significantly to 0.91(95% CI 0.88-0.95) and 0.93(95% CI 0.90-0.97), respectively (p < 0.001). The aROC of the MetS to identify subjects with diabetes was 0.72 (95% CI 0.65-0.78), sensitivity was 75% and specificity was 55%. The aROC of the FINDRISC + HbA1c was significantly higher than the MetS for predicting T2DM (p < 0.001).

CONCLUSION

Prediction of type 2 diabetes is important for timely intervention and to avoid chronic complications associated with the disease. Our findings suggest, that it may be of good clinical practice to use the FINDRISC score + HbA1c in a two-step screening model for diabetes rather than using the metabolic syndrome.

Effect of iron supplementation on HbA1c levels in pregnant women with and without anaemia

BACKGROUND

Iron deficiency anaemia has been associated with higher HbA1c levels. However, during and after iron supplementation there is a decrease in HbA1c results, causing a misinterpretation. Our aim was to analyse the effect of iron supplementation on HbA1c levels in nondiabetic pregnant women with and without anaemia.

METHODS

Pregnant women in prenatal care, without gestational diabetes (GDM) or previous diabetes mellitus (DM) that performed an oral glucose tolerance test (OGTT) in the third trimester of pregnancy were invited to participate. Clinical and laboratorial analyses were performed, including standardized questionnaire, OGTT, full blood count and HbA1c.

RESULTS

A total of 231 pregnant women without DM or GDM were included in the study. According to anaemia and/or iron supplementation, we divided women in: no iron and no anaemia - Group 1 (N=86); no iron and with anaemia - Group 2 (N=29); iron and no anaemia - Group 3 (N=87); iron and anaemia - Group 4 (N=29). There was statistically a significant, although no clinically relevant, difference between HbA1c values in pregnant women in Groups 1 and 4 [5.1±0.4% (32±4.4mmol/mol) and 4.8±0.3% (29±3.3mmol/mol), P<0.01; respectively]. HbA1c values in pregnant women in Groups 1, 2 and 3 were similar, independently of anaemia [5.1±0.4% (32±4.4mmol/mol); 5.0±0.4% (31±4.4mmol/mol) and 5.0±0.4% (31±4.4mmol/mol); p>0.05; respectively].

CONCLUSIONS

Iron supplementation during pregnancy does not affect HbA1c levels and has no clinical impact in the final interpretation of results in the absence of anaemia or presence of mild anaemia. Interpreting HbA1c results in pregnant women during iron therapy and with moderate or severe anaemia still requires caution.

Comparison of glyburide and insulin in the management of gestational diabetes: A meta-analysis

Objective

The aim of this meta-analysis was to determine the efficacy and safety of glyburide as a treatment for gestational diabetes mellitus (GDM) compared to insulin.

Methods

A meta-analysis was conducted to compare the management of gestational diabetes with glyburide and insulin. Studies fulfilling all of the following inclusion criteria were included in this meta-analysis: subjects were women with gestational diabetes requiring drug treatment; the comparison treatment included glyburide vs insulin; one or more outcomes (maternal or neonatal) should be provided in the individual study; the study design should be a randomized control trial. Exclusion criteria: non-RCT studies; non-human data. PubMed, Embase and CENTRAL databases were searched from inception until 10 October 2016.

Results

Ten randomized control trials involving 1194 participants met the inclusion criteria and were included. 13 primary outcomes (6 maternal, 7 neonatal) and 26 secondary outcomes (9 maternal, 17 neonatal) were detected and analyzed in this study. Glyburide significantly increased the risk of any neonatal hypoglycemia [risk ratio (RR), 1.89; 95% confidence interval (95%CI), 1.26 to 2.82; p = 0.002]. Sensitivity analysis confirmed robustness of this result [RR, 2.29; 95%CI, 1.49 to 3.54; p = 0.0002]. No differences were observed between the two groups with respect to birth weights [mean difference (MD), 79; 95%CI, -64 to 221.99; p = 0.28] and the risk of macrosomia [RR, 1.69; 95%CI, 0.57 to 5.08; p = 0.35].

Conclusion

For women with gestational diabetes, no differences in maternal short term outcomes were observed in those treated with glyburide or insulin. However, the incidence of neonatal hypoglycemia was higher in the glyburide group compared to the insulin group.

Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population

OBJECTIVE

Type 2 diabetes (T2DM) is known to be underdiagnosed. Tests for diagnosis include fasting plasma glucose (FPG), oral glucose tolerance test (OGTT) and HbA1c. HbA1c can be tested in non-fasting conditions. Therefore, general practitioners almost no longer execute OGTT's. We evaluated the performance of OGTT versus HbA1c in a population consisting of overweight and obese subjects, which can be considered a 'high risk' population.

RESEARCH DESIGN AND METHODS

A total of, 1241 overweight and obese subjects without a history of diabetes (male/female: 375/866, age 44±13 years, body mass index 38.0±6.1 kg m^-2) were tested for glucose tolerance status using FPG, OGTT and HbA1c.

RESULTS

Exactly, 46.8% were found to have prediabetes and 11.9% were newly diagnosed with T2DM (male/female=18.9/8.9%) using ADA criteria. Testing only HbA1c would have resulted in 78 subjects being diagnosed with T2DM, but 47.3% of newly diagnosed patients would have been missed if OGTT would not have been done. Exactly 581 subjects were diagnosed with prediabetes, 1.4% subjects had impaired fasting glucose (IFG) 30.5% had impaired glucose tolerance (IGT), 5.1% subjects had a combined IFG+IGT, and 9.8% had an isolated elevated HbA1c (5.7-6.4%). Of the 581 subjects with prediabetes, 257 had an HbA1c <5.7%. Therefore, 44.2% subjects would have been missed when OGTT would not have been done.

CONCLUSION

In a population with only overweight and obese adult subjects, 46.8% were diagnosed with prediabetes and 11.9% were newly diagnosed with diabetes. Exactly, 5.6 and 20.7% of total population met the diagnostic criteria of the OGTT for diabetes and prediabetes, respectively, but did not meet the diagnostic criteria of the HbA1c. These data suggest that not performing an OGTT results in significant underdiagnose of T2DM in an overweight and obese adult population.

Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas

Purpose:

To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs).

Design:

Experimental randomized controlled community pilot study.

Setting:

Three community clinics in MUAs located within San Bernardino County, California.

Participants:

Thirty-two randomly assigned Latinos with A1C greater than 6.4: 15 control and 17 experimental.

Intervention:

Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics—1, 3, and 6 months posteducation.

Measures:

Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure.

Analysis:

Baseline characteristics for both groups were analyzed using independent t tests and χ2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups.

Results:

Mean A1C levels decreased from baseline to 6 months for both groups: control, μ1 = 9.57, μ2 = 9.49; experimental, μ1 = 8.53, μ2 = 7.31.

Conclusion:

The experimental group demonstrated a statistically significant reduction in mean A1C levels ( P = .002) when compared to the control group.