Gestational diabetes and future risk of diabetes

Metabolomics and biochemical insights on the regulation of aging-related diabetes by a low-molecular-weight polysaccharide from green microalga Chlorella pyrenoidosa

•

C. pyrenoidosa polysaccharide (CPP) have hypoglycemic activity and oxidation resistance.

•

CPP prevents oxidative stress and stimulates insulin via affecting phenylpyruvic acid.

•

CPP can regulate the GLP-1R/IL-6R and ZO-1/MMP-2 pathways.

•

CPP activated BCL-6 to promote cell survival in brain.

Globally, aging and diabetes are considered prevalent threats to human health. Chlorella pyrenoidosa polysaccharide (CPP) is a natural active ingredient with multiple health benefits including antioxidant and hypolipidemic activities. In this study, the aging-related diabetic (AD) mice model was established to investigate the underlying hypoglycemic and antioxidant mechanisms of CPP. It improved superoxide dismutase, catalase (CAT), glutathione peroxidase (GSH-px), and malondialdehyde activities in liver and insulin secretion. CAT and GSH-px activity in the brain increased after CPP administration. In addition, through histopathological examinations, it was evident that injuries in the liver, brain, jejunum, and pancreas were restored by CPP. This restoration was likely mediated via the activation of glucagon-like peptide-1 receptor/FOXO-1 (forkhead box O1) pathway concurrent with the inhibition of interleukin-6 receptor/FOXO-1 pathway. Furthermore, metabolomics and correlation analysis revealed that CPP possibly relived AD through changes in insulin levels and declined oxidative stress as regulated by phenylpyruvic acid. These findings suggested that CPP exerted antioxidant and hypoglycemic roles in an AD mice model, thereby providing a sound scientific foundation for further development and utilization of CPP.

Lifestyle Medicine for Women: The Time Is Now!

As the founders of the American College of Lifestyle Medicine's Women's Health Member Interest Group, we welcome this issue focused on the important issues facing women, their providers, and researchers in this field. Women's health extends beyond sex-specific reproductive health issues, by also encompassing the medical conditions that are more prevalent in women as well as conditions that are expressed differently in women. Inadequate representation of women in clinical research has contributed to poorer outcomes. As lifestyle medicine forms the foundation of true health, the time is now to recognize and address these issues with research, education, and advocacy.

Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria

OBJECTIVES

To identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance.

DESIGN

Prospective cohort study.

SETTING

Gondar town public health facilities in Northwest Ethiopia.

PARTICIPANTS

Women who had gestational diabetes mellitus were advised to undergo postpartum oral glucose tolerance test at 6-12 weeks of delivery.

MAIN OUTCOME

Postpartum glucose intolerance.

DATA ANALYSIS

Predictors of postpartum glucose intolerance were identified using multivariable logistic regression analysis. The discriminative power of the predictor variables for postpartum glucose intolerance and the model accuracy were computed by area under the receiver operating characteristic curve and estimated by area under the curve (AUC) with 95% CI.

RESULTS

A total of 112 (85.5%) women with gestational diabetes mellitus returned and completed the postpartum oral glucose tolerance test. The incidence of postpartum glucose intolerance was 21.4% (95% CI14.3 to 28.4), inclusive of 18.7% pre-diabetes and 2.7% diabetes. Multivariable logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose level at diagnosis, overweight and/or obesity, and antenatal depression were predictors of postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI 0.822 to 0.937). Fasting plasma glucose at diagnosis of gestational diabetes mellitus (AUC=0.736, 95% CI0.616 to 0.845) and overweight and/or obesity (AUC=0.718, 95% CI 0.614 to 0.814) were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of fasting plasma glucose at diagnosis and mid-upper arm circumference was 0.822 (95% CI 0.722 to 0.907), which was the best predictor.

CONCLUSIONS

The incidence of postpartum glucose intolerance was high among women with gestational diabetes mellitus. Antenatal predictors modestly predicted postpartum glucose intolerance. The findings suggest ongoing glucose screening is indicated for all women with gestational diabetes mellitus.

Serum Vitamin D levels and gestational diabetes mellitus: analysis of early pregnancy cohort from a teaching hospital of Kashmir Valley

Background and Aims:

The association of gestational diabetes mellitus and serum Vitamin D levels in different trimesters of pregnancy has been studied recently. We conducted this study in an prospective observational cohort of well-characterized healthy pregnant women to examine the relationship between 1^st trimester Vitamin D levels and Gestational Diabetes Mellitus (GDM) status during pregnancy.

Methods:

All pregnant women attending the out-patient department of Gynecology & Obstetrics, aged less than 35 years, and who were in their first trimester were included in the study. Socio-demographic, anthropometric details, clinical details, food frequency questionnaire and physical activity data was collected using validated pretested questionnaire.

Results:

The comparison between those with GDM and those with normal glucose levels has been illustrated. Women in the GDM are older than those in the non-GDM group. The women in GDM group were taller, heavier and their BMI was greater than those in the non-GDM group. There were no significant differences in dietary intake at baseline between mothers with GDM and those with normal glucose levels. Further, it was found that Vitamin D concentration of <30 nmol/L was found among higher among those with GDM and the relationship was statistically significant.

Conclusion:

There is an association between maternal Vitamin D deficiency and increased risk for GDM in early pregnancy among Kashmiri women.

Relationship of Early Vitamin D Concentrations and Gestational Diabetes Mellitus in Indian Pregnant Women

Background: A high prevalence of vitamin D deficiency exists in pregnant Indian women (~90%). Increasing evidence suggests that vitamin D could play a pivotal role in maintaining normal glucose homeostasis. We aimed to determine the association between maternal vitamin D concentrations in early pregnancy and the risk of gestational diabetes mellitus (GDM). Methods: A prospective observational study was conducted on healthy pregnant women (n = 392) attending routine antenatal care at St. John's Medical College Hospital, Bangalore recruited at ~12 weeks of gestation. At baseline, details on socio-economic status, obstetric history, dietary intakes, and anthropometry were collected. Venous plasma total vitamin D concentration was assessed using tandem liquid chromatography mass spectrophotometry (LC-MS/MS). Oral glucose tolerance test (OGTT) at recruitment, followed by glucose tolerance test (GTT) at mid-pregnancy was conducted. GDM was diagnosed and confirmed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) classification. Univariate and adjusted logistic regression models were used to evaluate the associations between total vitamin D concentrations at enrollment with GDM. Results: Of the cohort, 10.2% were diagnosed as GDM. Women with GDM were older (26 vs. 24 years) and heavier (51.6 vs. 51.2 kg) compared to the rest. A higher prevalence of GDM was observed among women with 1st trimester plasma total vitamin D in the lowest quartile (≤23.6 nmol/L) compared to the subjects in the other three quartiles (16.1 vs. 8.6%, p = 0.033). Adjusted multivariable regression analysis showed that women in the lowest quartile of plasma total vitamin D had twice the odds of GDM compared to women belonging to the remaining quartiles [OR = 2.32 (95%CI: 1.10, 4.91), p = 0.028]. Conclusions: Low plasma total vitamin D concentrations in early pregnancy may be associated with a higher risk of GDM.

One-hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance

Aims/Introduction

Gestational diabetes mellitus (GDM) is a risk for adverse perinatal outcomes, and patients with a history of GDM have an increased risk of impaired glucose tolerance (IGT). Here, we carried out two non‐interventional and retrospective studies of GDM patients in Japan.

Materials and Methods

In the first study, we enrolled 529 GDM patients and assessed predictors of the need for insulin therapy. In the second study, we enrolled 185 patients from the first study, and assessed predictors of postpartum IGT.

Results

In the first study, gestational weeks at GDM diagnosis and history of pregnancy were significantly lower, and pregestational body mass index, family history of diabetes mellitus, 1‐ and 2‐h glucose levels in a 75‐g oral glucose tolerance test (OGTT), the number of abnormal values in a 75‐g OGTT, and glycated hemoglobin were significantly higher in participants receiving insulin therapy. In the second study, 1‐ and 2‐h glucose levels in a 75‐g OGTT, the number of abnormal values in a 75‐g OGTT, glycated hemoglobin, and ketone bodies in a urine test were significantly higher in participants with OGT. Logistic regression analysis showed that gestational weeks at GDM diagnosis, 1‐h glucose levels in a 75‐g OGTT and glycated hemoglobin were significant predictors of the need for insulin therapy, and 1‐h glucose levels in a 75‐g OGTT at diagnosis and ketone bodies in a urine test were significant predictors for postpartum IGT.

Conclusions

Antepartum 1‐h glucose levels in a 75‐g OGTT was a predictor of the need for insulin therapy in pregnancy and postpartum IGT.