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Chatterjee B, Thakur SS. Proteins and metabolites fingerprints of gestational diabetes mellitus forming protein-metabolite interactomes are its potential biomarkers. Proteomics 2023; 23:e2200257. [PMID: 36919629 DOI: 10.1002/pmic.202200257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Gestational diabetes mellitus (GDM) is a consequence of glucose intolerance with an inadequate production of insulin that happens during pregnancy and leads to adverse health consequences for both mother and fetus. GDM patients are at higher risk for preeclampsia, and developing diabetes mellitus type 2 in later life, while the child born to GDM mothers are more prone to macrosomia, and hypoglycemia. The universally accepted diagnostic criteria for GDM are lacking, therefore there is a need for a diagnosis of GDM that can identify GDM at its early stage (first trimester). We have reviewed the literature on proteins and metabolites fingerprints of GDM. Further, we have performed protein-protein, metabolite-metabolite, and protein-metabolite interaction network studies on GDM proteins and metabolites fingerprints. Notably, some proteins and metabolites fingerprints are forming strong interaction networks at high confidence scores. Therefore, we have suggested that those proteins and metabolites that are forming protein-metabolite interactomes are the potential biomarkers of GDM. The protein-metabolite biomarkers interactome may help in a deep understanding of the prognosis, pathogenesis of GDM, and also detection of GDM. The protein-metabolites interactome may be further applied in planning future therapeutic strategies to promote long-term health benefits in GDM mothers and their children.
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Affiliation(s)
- Bhaswati Chatterjee
- National Institute of Pharmaceutical Education and Research, Hyderabad, India
- National Institute of Animal Biotechnology (NIAB), Hyderabad, India
| | - Suman S Thakur
- Centre for Cellular and Molecular Biology, Hyderabad, India
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Valadan M, Bahramnezhad Z, Golshahi F, Feizabad E. The role of first-trimester HbA1c in the early detection of gestational diabetes. BMC Pregnancy Childbirth 2022; 22:71. [PMID: 35086491 PMCID: PMC8793236 DOI: 10.1186/s12884-021-04330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background We aimed to assess the utility of HbA1c in the early detection of gestational diabetes (GDM) in the first trimester. Methods This prospective study was performed on 700 pregnant women in the perinatology clinic at a tertiary university hospital from March 2018 to March 2020. For all pregnant women, HbA1c and fasting blood glucose (FBG) levels were examined during the first trimester. Then, a GDM screening test was done within 24–28 weeks of pregnancy using a 100 g oral glucose tolerance test (OGTT) as the gold standard test. The GDM diagnosis was made according to the American Diabetes Association (ADA) criteria. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of HbA1c and FBG were calculated using the receiver operating characteristic (ROC) curve. Results Of 700 participants, one hundred and fifteen (16.4%) women had GDM. The GDM patients were significantly older and had a higher pre-gestational body mass index and pregnancy weight gain compared to the non-GDM participants. The sensitivity and specificity for ruling out GDM at an HbA1c cut-off value of 4.85% was 92.2 and 32.8%, respectively, with a 95.5% NPV and a 21.2% PPV. Furthermore, sensitivity and specificity for diagnosing GDM at an HbA1c cut-off value of 5.45% was 54.8 and 96.8%, respectively, with a 91.5% NPV and a 76.8% PPV. Using HbA1c could decline OGTT in 40.4% of the pregnant women (28.7% with HbA1c < 4.85 and 11.7% with HbA1c ≥ 5.45%). Conclusion It seems that the first-trimester HbA1c cannot replace OGTT for the diagnosis of GDM because of its insufficient sensitivity and specificity. However, women with higher first-trimester HbA1c had a high risk for GDM incidence.
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Affiliation(s)
- Mehrnaz Valadan
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Bahramnezhad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Golshahi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Yas Hospital, Tehran, Iran
| | - Elham Feizabad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Calero Rojas M, Jurado Roger A, Gutiérrez Grúa M, de la Peña Carretero L, Romero Sotomayor V, López Braos J, Izquierdo Carrasco F, Herrero Tabanera L, Moreno Aguilar C. Improved gestational diabetes screening protocol. ADVANCES IN LABORATORY MEDICINE 2021; 2:87-107. [PMID: 37359196 PMCID: PMC10197282 DOI: 10.1515/almed-2020-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/12/2020] [Indexed: 06/28/2023]
Abstract
Objectives This work aimed to assess the diagnostic validity of two approaches for the screening of gestational diabetes mellitus (GDM) with less discomfort for pregnant women. Methods A prospective diagnostic validation study was conducted with 2007 pregnant women. According to risk factors for GDM, women were classified into high-risk and low-risk groups. The current diagnostic procedure, based on oral glucose overload, was followed; simultaneously HbA1c was tested and an algorithm combining both biomarkers was applied. Results In the low-risk group, the Glucose challenge test (GCT) showed a higher area under the curve (AUC 0.953; 95% CI 0.915-0.992) than the HbA1c test (0.688; 95% CI 0.541-0.834). The best GCT cut-off, 153.5 mg/dL (8.52 mmol/L), showed higher diagnostic validity than that for HbA1c, 28 mmol/mol (4.75%), and that the algorithm using both tests. In the high-risk group, the GCT showed better diagnostic performance than the HbA1c and the algorithm; the optimal GCT cut-offs were higher than those recommended in current protocols. 13th week: GCT AUC 0.882 (95% CI 0.843-0.921), HbA1c AUC 0.624 (95% CI 0.562-0.686), GCT cut-off 140.5 mg/dL (7.8 mmol/L), HbA1c cut-off 33 mmol/mol (5.15%). 24th week: GCT AUC 0.944 (95% CI 0.925-0.962), HbA1c AUC 0.642 (95% CI 0.575-0.709), GCT cut-off, 145.5 mg/dL (8.08 mmol/L), HbA1c cut-off 29 mmol/mol (4.85%). Conclusions The GDM diagnostic approach using as the first step the GCT with higher cut-offs showed the best diagnostic validity. Applying these thresholds, 55.6 and 13.7% of 100 g. Oral glucose overloads would have been avoided in low-risk and high-risk pregnant women.
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Affiliation(s)
| | - Aurora Jurado Roger
- Immunlogy and Allergy Unit, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain
| | | | | | | | | | | | | | - Carmen Moreno Aguilar
- Immunlogy and Allergy Unit, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain
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Park HD. Current Status of Clinical Application of Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:168-175. [PMID: 33053162 DOI: 10.5858/arpa.2020-0112-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. OBJECTIVE.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. DATA SOURCES.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. CONCLUSIONS.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCT so that it can be optimally used to improve patient management.
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Affiliation(s)
- Hyung-Doo Park
- From the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Arbiol-Roca A, Pérez-Hernández EA, Aisa-Abdellaoui N, Valls-Guallar T, Gálvez-Carmona F, Mariano-Serrano E, Medina-Casanovas M, Ruiz-Morer MR. The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus. Clin Biochem 2021; 90:58-61. [PMID: 33476577 DOI: 10.1016/j.clinbiochem.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Glycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT. METHODS A prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter-Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT). RESULTS The area under the curve (AUC) was 0.67 (0.58-0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT. CONCLUSIONS Adoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.
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Affiliation(s)
- A Arbiol-Roca
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - E A Pérez-Hernández
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - N Aisa-Abdellaoui
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - T Valls-Guallar
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - F Gálvez-Carmona
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - E Mariano-Serrano
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M Medina-Casanovas
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M R Ruiz-Morer
- Laboratori Clínic Territorial Metropolitana Sud - Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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An update on gestational hyperglycemia diagnosis during the COVID-19 pandemic. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2020. [PMCID: PMC7608021 DOI: 10.1016/j.endien.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rayis DA, Ahmed ABA, Sharif ME, ElSouli A, Adam I. Reliability of glycosylated hemoglobin in the diagnosis of gestational diabetes mellitus. J Clin Lab Anal 2020; 34:e23435. [PMID: 32614103 PMCID: PMC7595906 DOI: 10.1002/jcla.23435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background Oral glucose tolerance test (OGTT) performed at 24‐28 weeks gestation is the current recommended method to the diagnosis of gestational diabetes mellitus (GDM). Many recent studies investigating HbA1c in detecting GDM yield different results. There are no published data on HbA1c in the diagnosis of GDM in Sub‐Saharan countries including Sudan. Methods A cross‐sectional study was carried out at the antenatal care of Saad Abuelela Maternity Hospital, Khartoum, Sudan during the period from February to November 2018 to assess the reliability of HbA1c in the diagnosis of GDM. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups using a 75‐g oral glucose tolerance test. Results Three hundred and forty‐eight women were enrolled. The mean (SD) of the age, gravidity, and gestational age of the enrolled women were 27.8 (5.6) years, 2.36 (2.2) and 26.26 (2.43) weeks, respectively. Sixty‐eight women (19.5%) had GDM. A poor productively for HbA1c in diagnosis GDM was shown (AUC = 0.62, 95% CI = 0.55‐0.69). At HbA1c level of 4.150%, the sensitivity and specificity of the diagnosis for GDM were 76.51% and 37.85%, respectively. At HbA1c level of 5.850%, the sensitivity and specificity of the diagnosis for GDM were 13.24% and 91.43%, respectively. While there was no significant (Spearman) correlation between fasting blood glucose and HbA1c, there were significant correlations between HbA1c and OGTT 1 and 2 hours of OGTT. Conclusion In this study, HbA1c has a poor reliability, insufficient sensitivity or specificity for use to diagnose GDM.
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Affiliation(s)
- Duria A Rayis
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Abdel B A Ahmed
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Manal E Sharif
- Unaizah College of Medicine, Qassim University, Unaizah, Saudi Arabia
| | - Amir ElSouli
- Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia, Qassim, Uniazah, Saudi Arabia, 11111, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Qiu S, Du Z, Li W, Chen J, Wu H, Liu J, Cai M, Wang B, Guo H, Sun Z. Exploration and Validation of the Performance of Hemoglobin A1c in Detecting Diabetes in Community-Dwellers With Hypertension. Ann Lab Med 2020; 40:457-465. [PMID: 32539301 PMCID: PMC7295957 DOI: 10.3343/alm.2020.40.6.457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/27/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes can complicate hypertension management by increasing the risk of cardiovascular disease (CVD) and all-cause mortality. Studies targeting diabetes detection in hypertensive individuals demonstrating an increased risk of diabetes are lacking. We aimed to assess the performance of hemoglobin A1c (HbA1c) and its cut-off point in detecting diabetes in the abovementioned population. METHODS Data from 4,096 community-dwellers with hypertension but without known diabetes were obtained from the Study on Evaluation of iNnovated Screening tools and determInation of optimal diagnostic cut-off points for type 2 diaBetes in Chinese muLti-Ethnic (SENSIBLE) study; these data were randomly split into exploration (70% of the sample) and internal validation (the remaining 30%) datasets. The optimal HbA1c cut-off point was derived from the exploration dataset and externally validated using another dataset from 2,431 hypertensive individuals. The oral glucose tolerance test was considered the gold-standard for confirming diabetes. RESULTS The areas under the ROC curves for HbA1c to detect diabetes were 0.842, 0.832, and 0.829 for the exploration, internal validation, and external validation datasets, respectively. An optimal HbA1c cut-off point of 5.8% (40 mmol/mol) yielded a sensitivity of 76.2% and a specificity of 74.5%. Individuals who were not diagnosed as having diabetes by HbA1c at 5.8% (40 mmol/mol) had a lower 10-year CVD risk score than those diagnosed as having diabetes (P=0.01). HbA1c≤5.1% (32 mmol/mol) and ≥6.4% (46 mmol/mol) could indicate the absence and presence of diabetes, respectively. CONCLUSIONS HbA1c could detect diabetes effectively in community-dwellers with hypertension.
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Affiliation(s)
- Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Wei Li
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Juan Chen
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Hang Wu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Jingbao Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Min Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Bei Wang
- School of Public Health, Southeast University, Nanjing, China
| | - Haijian Guo
- Department of Integrated Services, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
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Codina M, Corcoy R, Goya MM. Update of the hyperglycemia Gestational diagnosis during the COVID-19 pandemic. ACTA ACUST UNITED AC 2020; 67:545-552. [PMID: 32553745 PMCID: PMC7236733 DOI: 10.1016/j.endinu.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Mercè Codina
- Endocrinología, Hospital Son Espases, Palma de Mallorca, España
| | - Rosa Corcoy
- Endocrinología, Hospital Santa Creu i Sant Pau, Barcelona, España
| | - María M Goya
- Obstetricia, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Zheng J, Xu J, Zhang Y, Zhou N. Effects of insulin combined with metformin on serum cystatin C, homocysteine and maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus. Exp Ther Med 2019; 19:467-472. [PMID: 31853319 PMCID: PMC6909788 DOI: 10.3892/etm.2019.8224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/02/2019] [Indexed: 12/30/2022] Open
Abstract
Effects of insulin combined with metformin on serum cystatin C (Cys C), homocysteine (Hcy) and maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) were investigated. In total, 80 cases of pregnant women diagnosed with GDM in the Department of Obstetrics and Gynecology of Liaocheng Third People's Hospital from July 2015 to July 2017 were selected and divided into a study group (42 cases) and a control group (38 cases). The study group was treated with insulin combined with metformin, and the control group was treated with insulin. Fasting blood glucose (FBG) and postprandial blood glucose after 2 h (2hPG) of the two groups were compared before and after treatment. Levels of serum Cys C, Hcy, urinary protein (UmAlb), postpartum maternal outcomes and adverse reactions during pregnancy were compared in the two groups before and after treatment. After treatment, the level of FBG and 2hPG in the control group was higher than that in the treatment group (P<0.05). After treatment, the level of serum Cys C and Hcy in both groups were lower than that before the treatment, and the level in the study group was lower than that in the control group (P<0.05). The total incidence of neonatal adverse outcomes and the number of adverse pregnancies in GDM patients in the study group were significantly lower than those in the control group (P<0.05). There were no significant differences in adverse reactions during pregnancy between the two groups (P>0.05). In conclusion, insulin combined with metformin is more effective than insulin alone in reducing serum Cys C and Hcy levels, with significant effect on the improvement of maternal and neonatal outcomes.
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Affiliation(s)
- Jizeng Zheng
- Department of Obstetrics and Gynecology, Liaocheng Third People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Juan Xu
- Department of Obstetrics, Tengzhou Central People's Hospital, Tengzhou, Shandong 277500, P.R. China
| | - Yin Zhang
- Department of Obstetrics and Gynecology, Liaocheng Third People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Nan Zhou
- Department of Health Care, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
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