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Powers Carson J, Arora J, Carter E. Glycated Albumin to Predict Adverse Neonatal Outcomes among Women with Diabetes and Overweight or Obese Body Mass Index. J Appl Lab Med 2024:jfae079. [PMID: 39087706 DOI: 10.1093/jalm/jfae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/28/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Glycated albumin (GA) has shown promise in predicting risk of adverse neonatal outcomes (ANO) in pregnant women with type 2 diabetes (T2DM) and gestational diabetes (GDM). However, previous studies showing a negative correlation between GA and body mass index (BMI) suggest that lower predictive cutoffs may be needed in populations with elevated BMI. METHODS We performed a case-control study of prospectively enrolled pregnant women with T2DM or GDM and BMI ≥25 kg/m2 matched to biobanked controls without diabetes. Serum collected during the second and/or third trimesters was used to measure the percentage of GA (% GA). Receiver operating characteristic (ROC) curves were used to examine % GA to predict an ANO composite, including macrosomia, hypoglycemia, respiratory distress syndrome, and/or hyperbilirubinemia for the second and third trimesters. RESULTS The median BMIs for cases and controls were 34.0 and 31.0 kg/m2, respectively. The area under the ROC curve to predict the ANO composite was significant for second trimester values but ambiguous for third trimester due to its wide 95% CI. A cutoff of 12.3% GA during second trimester showed 100% sensitivity and 73% specificity. Transference of previously published reference ranges did not validate, suggesting lower ranges are needed for women with overweight/obesity. CONCLUSIONS In this pilot study, % GA shows promise to stratify pregnant patients with diabetes and obesity into risk categories for ANO with excellent predictive ability in the second trimester. If this holds in larger studies, using second trimester % GA could allow additional intervention to improve blood glucose control and minimize ANO.
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Affiliation(s)
- Jennifer Powers Carson
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Jyoti Arora
- Center for Biostatistics and Data Science, Washington University School of Medicine, St. Louis, MO, United States
| | - Ebony Carter
- Divison of Maternal-Fetal Medicine & Ultrasound, Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO, United States
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Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, Hivert MF, Immanuel J, Meek C, Oppermann ML, Nolan CJ, Ram U, Schmidt MI, Simmons D, Chivese T, Benhalima K. Epidemiology and management of gestational diabetes. Lancet 2024; 404:175-192. [PMID: 38909620 DOI: 10.1016/s0140-6736(24)00825-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024]
Abstract
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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Affiliation(s)
- Arianne Sweeting
- Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Helena Backman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Catalano
- Maternal Infant Research Institute, Obstetrics and Gynecology Research, Friedman School of Nutrition Science and Policy, Tufts University School of Medicine, Tufts University, Boston, MA, USA
| | - Maisa Feghali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Willliam H Herman
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Pilgrim Health Care Institute, Harvard Medical School, Harvard University, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jincy Immanuel
- School of Medicine, Western Sydney University, Sydney, NSW, Australia; Texas Woman's University, Denton, TX, USA
| | - Claire Meek
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Maria Lucia Oppermann
- Department of Obstetrics and Gynecology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Department of Endocrinology, Canberra Health Services, Woden, ACT, Australia
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, India
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine of Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Katrien Benhalima
- Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Marra MC, Mappa I, Pietrolucci ME, Lu JLA, D' Antonio F, Rizzo G. Fetal brain development in pregnancies complicated by gestational diabetes mellitus. J Perinat Med 2024; 52:310-316. [PMID: 38231478 DOI: 10.1515/jpm-2023-0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) carries an increased risk of neurocognitive impairment in offsprings. However, the contribution of maternal hyperglycemia in affecting fetal brain development is not fully elucidated yet. The aim of this study was to evaluate fetal brain and sulci development in pregnancies complicated by GDM. METHODS Prospective observational study including 100 singleton pregnancies complicated by GDM and 100 matched controls. All fetuses underwent neurosonography at 29-34 weeks of gestation, including the assessment of the length of the corpus callosum (CC), cerebellar vermis (CV), Sylvian (SF), parieto-occipital (POF) and calcarine fissures (CF). Sub-group analysis according to the specific treatment regimen adopted (n 67 diet vs. 33 insulin therapy) was also performed. RESULTS Fetuses from mothers with GDM under insulin therapy had a smaller CC (35.54 mm) compared to both controls (40 mm; p<0.001) and women with GDM under diet (39.26 mm; p=0.022) while there was no difference in the HC between the groups. Likewise, when corrected for HC, CV depth was smaller in fetuses with GDM both under insulin therapy (7.03 mm) and diet (7.05 mm,) compared to controls (7.36 mm; p=0.013). Finally, when assessing the sulci development of the brain SF (p≤0.0001), POF (p≤0.0001) and CF (p≤0.0001) were significantly smaller in fetuses with maternal GDM. Post-hoc analysis showed that fetuses of GDM mothers requiring insulin therapy had significantly lower values of SF (p=0.032), POF (p=0.016) and CF (p=0.001). CONCLUSIONS Pregnancies complicated by GDM showed a peculiar pattern of fetal brain growth and cortical development and these changes, which are more evident in those requiring insulin supplementation.
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Affiliation(s)
- Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | | | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Sappler M, Neubauer V, Posod A, Schreiner C, Kiechl-Kohlendorfer U, Griesmaier E. Early Brain Activity in Very Preterm Infants of Mothers with Gestational Diabetes Mellitus: A Pilot Study. Neonatology 2024; 121:342-350. [PMID: 38346405 DOI: 10.1159/000536182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/05/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Neurological consequences of preterm infants born to mothers with gestational diabetes mellitus (GDM) are unclear. In this pilot study, we investigated the effect of GDM on brain activity in very preterm infants. METHODS Preterm infants <32 gestational weeks of mothers with GDM compared to gestational age- and sex-matched controls born between 2011 and 2018 were included. Amplitude-integrated electroencephalography (aEEG) was assessed for total maturation and individual component scores according to Burdjalov and colleagues, the dominating visual background, and the presence of sleep-wake cycles per hour in the first 72 h of life and weekly at days 7, 14, 21, and 28. RESULTS We included 47 infants of mothers with GDM and 94 control infants. Both the aEEG total maturation score and its individual component scores, as well as the percentage of continuous background pattern, increased equally during the first 4 weeks after birth in both groups. GDM-exposed infants showed a slightly but significantly higher number of sleep-wake cycles per hour. CONCLUSION We found normal maturation of brain activity in the first 4 weeks after birth in very preterm infants born to mothers with GDM, not differing from a very preterm control group. The higher number of sleep-wake cycles per hour in GDM-exposed infants could indicate transiently enhanced maturation. Further studies on brain activity and brain development in very preterm infants of mothers with GDM are needed to validate our results.
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Affiliation(s)
- Maria Sappler
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria,
| | - Vera Neubauer
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Posod
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Schreiner
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elke Griesmaier
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
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Soffer MD, James KE, Thaweethai T, Callahan M, Barth WH, Powe CE. Glycated Albumin and Glycemia in Pregnancy and Postpartum: A Pilot Study. Am J Perinatol 2024; 41:115-121. [PMID: 37640051 DOI: 10.1055/s-0043-1772746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Percent glycated albumin (%GAlb) is a marker of glycemia over the past 2 to 3 weeks in nonpregnant individuals. Longitudinal changes in %GAlb extending throughout pregnancy and postpartum (PP) have not been described. We aimed to describe levels of %GAlb throughout pregnancy and PP and relationships with glycemia. STUDY DESIGN Fifty women among those in the Study of Pregnancy Regulation of INsulin and Glucose cohort underwent 75-g oral glucose tolerance tests (OGTTs) at a mean of 13 weeks (V1) and 26 weeks (V2) of gestation and 11 weeks' PP. %GAlb was measured on frozen plasma samples. RESULTS Total albumin decreased from V1 to V2 and increased PP to levels higher than at V1. %GAlb declined between V1 and V2 (β = - 0.63% 95% CI [-0.8, -0.6] p < 0.001) and remained stable between V2 and PP (β = - 0.04% [-0.3, 0.2] p = 0.78). Body mass index (BMI) was inversely related to %GAlb in pregnancy (V1: rho = - 0.5, p = 0.0001; V2 rho = - 0.4, p = 0.006), but not PP (rho = - 0.15, p = 0.31). The longitudinal changes in %GAlb persisted after adjusting for BMI. Neither glycemia measurements nor hemoglobin A1c were associated with %GAlb at any time point, and adjustments for BMI did not reveal additional associations. CONCLUSION %GAlb decreases between early and late gestation and remains decreased PP, despite a PP increase in total albumin above early pregnancy values. Given the lack of correlation with OGTT values or A1c, %GAlb is unlikely to be useful in assessing glycemia in pregnant or PP women. KEY POINTS · Changes in %GAlb extending to the postpartum period have not been described.. · %GAlb decreases in pregnancy and remains decreased postpartum, despite a postpartum increase in total albumin above early pregnancy values.. · Glycemia measurements nor A1c were associated with %GAlb at any time point, therefore, %GAlb is unlikely to be useful in assessing glycemia in pregnant or postpartum women..
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Affiliation(s)
- Marti D Soffer
- Harvard Medical School, Boston, Massachusetts
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kaitlyn E James
- Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
- Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital, Boston, Massachusetts
| | - Tanayott Thaweethai
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Callahan
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - William H Barth
- Harvard Medical School, Boston, Massachusetts
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Camille E Powe
- Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Biostatistics, Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
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AlQarni AM, Alghamdi AA, Aljubran HJ, Bamalan OA, Abuzaid AH, AlYahya MA. The Effect of Iron Replacement Therapy on HbA1c Levels in Diabetic and Nondiabetic Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7287. [PMID: 38068338 PMCID: PMC10707099 DOI: 10.3390/jcm12237287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Several studies have reported that iron-deficiency anemia (IDA) and its treatment might lead to a distorted reading of glycated hemoglobin (HbA1c) value. Hence, this review aims to systematically investigate the effect of iron replacement therapy (IRT) on HbA1c levels, as the literature is deficient in assessing this clinical phenomenon. METHODS An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by four independent authors. RESULTS Among the 8332 articles identified using the search strategy, 10 records (with a total of 2113 participants) met the inclusion criteria and were analyzed. In nine of the studies, IRT was found to decrease HbA1c levels; in the remaining study, IRT was found to increase HbA1c levels. The effect size of the pooled standardized mean difference in HbA1c levels between the treatment and control groups with IDA was 1.8 (95% CI = -0.5, 2.31). Heterogeneity was assessed using the I2 and χ2 tests, and the resultant values were 98.46% and p = 0.09, respectively. Additionally, the mean difference between the HbA1c levels (pre-IRT and post-IRT) showed a drop in the HbA1c levels which ranged from 1.20 to 0.43 mg/dL. CONCLUSIONS The results suggest that IRT decreases HbA1c levels, and it is helpful in treating IDA patients with poor glycemic control. Accordingly, the results provide an added perspective on antidiabetic medication dosing and physicians' interpretation of initially elevated HbA1c values.
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Affiliation(s)
- Amani M. AlQarni
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.A.A.); (H.J.A.); (O.A.B.); (A.H.A.); (M.A.A.)
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Wang BB, Xue M. Early neonatal complications in pregnant women with gestational diabetes mellitus and the effects of glycemic control on neonatal infection. World J Diabetes 2023; 14:1393-1402. [PMID: 37771327 PMCID: PMC10523229 DOI: 10.4239/wjd.v14.i9.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/24/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has become increasingly prevalent globally. Glycemic control in pregnant women with GDM has a critical role in neonatal complications. AIM To analyze the early neonatal complications in GDM, and examine the effect of blood glucose control level on neonatal infection. METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed, and the early complications in newborns in the two groups were compared. The patients were divided into the conforming glycemic control group (CGC group) and the non-conforming glycemic control group (NCGC group) based on whether glycemic control in the pregnant women with GDM conformed to standards. Baseline data, immune function, infection-related markers, and infection rates in neonates were compared between the two groups. RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group (P < 0.05). Pregnant women with GDM in the NCGC group (n = 178) had significantly higher fasting plasma glucose, 2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group (n = 58) (P < 0.05). There were no differences in baseline data between the two groups (P > 0.05). Additionally, the NCGC group had significantly decreased peripheral blood CD3+, CD4+, CD8+ T cell ratios, CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group (P < 0.05), while white blood cells, serum procalcitonin and C-reactive protein levels increased significantly. The neonatal infection rate was also significantly increased in the NCGC group (P < 0.05). CONCLUSION The risk of neonatal complications increased in pregnant women with GDM. Poor glycemic control decreased neonatal immune function, and increased the incidence of neonatal infections.
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Affiliation(s)
- Bei-Bei Wang
- Department of Neonatal Intensive Care Unit, Taizhou People’s Hospital of Jiangsu Province, Taizhou 225300, Jiangsu Province, China
| | - Mei Xue
- Department of Neonatal Intensive Care Unit, Taizhou People’s Hospital of Jiangsu Province, Taizhou 225300, Jiangsu Province, China
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Junhasavasdikul S, Panburana P, Bumrungphuet S, Dulyaphat W. The Correlation Between Three-Dimensional Ultrasound Measurement of Fetal Adrenal Gland and Maternal Serum Fructosamine Level in Gestational Diabetes Mellitus: Prospective Cohort Study. Int J Womens Health 2022; 14:1465-1476. [PMID: 36277447 PMCID: PMC9586166 DOI: 10.2147/ijwh.s373087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) has an impact on fetal adrenal gland size and volume, which are greater in the GDM population. This study used 2D and 3D ultrasound scanning to determine the correlation of fetal adrenal gland size and volume with fructosamine levels, HbA1c levels, estimated fetal weight (EFW), and neonatal birth weight in GDM patients. METHODS This study included eighty singleton pregnant women diagnosed with GDM between 24-28 weeks of gestation. During weeks 32-34 of gestation, the length, width, and depth of the fetal zone and total adrenal gland were measured using transabdominal 2D ultrasound. Virtual organ computer-aided analysis (VOCAL) software was used to evaluate fetal zone and total adrenal gland volume in 3D ultrasound. All the participants were followed until delivery. Pearson's correlation analysis was conducted to examine the correlation between fetal adrenal gland ultrasound measurements and the factors of interest. RESULTS The study consisted of sixty-six (82.5%) pregnant women with diet-controlled GDM (GDMA1) and fourteen (17.5%) pregnant women with insulin-managed GDM (GDMA2). There was no difference in fetal adrenal gland measurements between the diet-controlled (GDMA1) and the insulin-managed (GDMA2) groups. All the participants had achieved optimal glucose levels at the time of ultrasound acquisition. The total adrenal gland length and fetal zone volume had statistically significant positive correlations with EFW (r = 0.69, p = 0.02 and r = 0.84, p = 0.01, respectively). After adjusting for EFW, only the fetal zone volume was significantly correlated with fructosamine levels (adjusted-OR = 2.4, 95% CI: 1.5, 3.9, p = 0.01) and HbA1c levels (adjusted-OR = 2.5, 95% CI: 1.6, 4.3, p = 0.01). CONCLUSION The fetal zone volume is correlated with EFW, fructosamine levels, and HbA1c levels. This non-invasive technique may be beneficial as an indirect marker for glycemic monitoring in GDM.
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Affiliation(s)
- Saowapak Junhasavasdikul
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Panyu Panburana
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Sommart Bumrungphuet
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand
| | - Wirada Dulyaphat
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Faculty of Medicine, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand,Correspondence: Wirada Dulyaphat, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand, Tel +66-873017028, Fax +66 02-2011416, Email
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Lin XL, Li QY, Zhao DH, Liu JH, Fan Q. Serum glycated albumin is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents: An observational study. Front Cardiovasc Med 2022; 9:943185. [PMID: 36237913 PMCID: PMC9551162 DOI: 10.3389/fcvm.2022.943185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies have confirmed the predicted value of serum glycated albumin (GA) in atherosclerotic cardiovascular disease. However, the relationship between GA and the development of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation has not been verified in patients with acute coronary syndrome (ACS). Materials and methods In this study, 797 patients diagnosed with ACS who underwent re-coronary angiography more than 6 months after the first successful DES-based percutaneous coronary intervention (PCI) were eventually included. Patients were categorized into two groups based on the median GA levels of 14.94%. Moreover, multivariate logistic regression analysis models and the net reclassification improvement and integrated differentiation improvement risk models were constructed to assess the relationship between the GA and DES-ISR in patients with ACS. Results The GA was significantly associated with an increased risk of DES-ISR, upon adjusting for confounding factors (as nominal variate: OR 1.868, 95% CI 1.191-2.932, P = 0.007; as continuous variate: OR 1.109, 95% CI 1.040-1.183, P = 0.002). The addition of GA to a baseline risk model had an incremental effect on the predictive value for DES-ISR (AUC: GA vs. baseline model, 0.714 vs. 0.692, comparison P = 0.017; category-free net reclassification improvement (NRI) 0.080, P = 0.035; integrated discrimination improvement (IDI) 0.023, P < 0.001). Conclusion GA level was significantly associated with a high risk of DES-ISR in patients with ACS treated with PCI. Moreover, the addition of the GA to a baseline risk model has an incremental effect on the predictive potential for DES-ISR.
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Affiliation(s)
| | | | | | | | - Qian Fan
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Bernier E, Lachance A, Plante AS, Lemieux P, Mourabit Amari K, Weisnagel SJ, Gagnon C, Michaud A, Tchernof A, Morisset AS. Trimester-Specific Serum Fructosamine in Association with Abdominal Adiposity, Insulin Resistance, and Inflammation in Healthy Pregnant Individuals. Nutrients 2022; 14:nu14193999. [PMID: 36235652 PMCID: PMC9572673 DOI: 10.3390/nu14193999] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to (1) characterize the variations in serum fructosamine across trimesters and according to pre-pregnancy BMI (ppBMI), and (2) examine associations between fructosamine and adiposity/metabolic markers (ppBMI, first-trimester adiposity, leptin, glucose homeostasis, and inflammation measurements) during pregnancy. Serum fructosamine, albumin, fasting glucose and insulin, leptin, adiponectin, interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations were measured at each trimester. In the first trimester, subcutaneous (SAT) and visceral (VAT) adipose tissue thicknesses were estimated by ultrasound. In the 101 healthy pregnant individuals included (age: 32.2 ± 3.5 y.o.; ppBMI: 25.5 ± 5.5 kg/m2), fructosamine concentrations decreased during pregnancy whereas albumin-corrected fructosamine concentrations increased (p < 0.0001 for both). Notably, fructosamine concentrations were inversely associated with ppBMI, first-trimester SAT, VAT, and leptin (r = −0.55, r = −0.61, r = −0.48, r = −0.47, respectively; p < 0.0001 for all), first-trimester fasting insulin and HOMA-IR (r = −0.46, r = −0.46; p < 0.0001 for both), and first-trimester IL-6 (r = −0.38, p < 0.01). However, once corrected for albumin, most of the correlations lost strength. Once adjusted for ppBMI, fructosamine concentrations were positively associated with third-trimester fasting glucose and CRP (r = 0.24, r = 0.27; p < 0.05 for both). In conclusion, serum fructosamine is inversely associated with adiposity before and during pregnancy, with markers of glucose homeostasis and inflammation, but the latter associations are partially influenced by albumin concentrations and ppBMI.
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Affiliation(s)
- Emilie Bernier
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
| | - Amélie Lachance
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie, Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - Anne-Sophie Plante
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
| | - Patricia Lemieux
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Département de Médecine, l’Université Laval, Québec, QC G1V 0A6, Canada
| | - Karim Mourabit Amari
- Département de Médecine de Laboratoire, CHU de Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - S. John Weisnagel
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Département de Médecine, l’Université Laval, Québec, QC G1V 0A6, Canada
| | - Claudia Gagnon
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Département de Médecine, l’Université Laval, Québec, QC G1V 0A6, Canada
| | - Andréanne Michaud
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie, Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - André Tchernof
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie, Québec-Université Laval, Québec, QC G1V 4G5, Canada
| | - Anne-Sophie Morisset
- École de Nutrition, l’Université Laval, Québec, QC G1V 0A6, Canada
- Centre Nutrition, Santé et Société (NUTRISS), l’Institut sur la Nutrition et les Aliments Fonctionnels (INAF), l’Université Laval, Québec, QC G1V 0A6, Canada
- Axe Endocrinologie et Néphrologie, Centre de Recherche, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
- Correspondence: ; Tel.: +1-418-656-2131 (ext. 13982)
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11
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Guo ZH, Tian HL, Zhang XQ, Zhang DH, Wang ZM, Wang K, Su WW, Chen F. Effect of anemia and erythrocyte indices on hemoglobin A1c levels among pregnant women. Clin Chim Acta 2022; 534:1-5. [PMID: 35803335 DOI: 10.1016/j.cca.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anemia is a common disorder among pregnant women; however, the effect of anemia on hemoglobin A1c (HbA1c) levels has not been adequately explored. We aim to examine the influence of anemia on the HbA1c concentration and investigate the relationship between erythrocyte indices and HbA1c levels during pregnancy. METHODS We performed a retrospective analysis of 1369 pregnant Chinese women. The clinical and analytical data were collected. Independent t-test and Analysis of Variance were used for comparative studies, and multiple linear regression analysis was used to identify the association between erythrocyte indices and HbA1c. RESULTS The differences in HbA1c between non-anemia and mild anemia were negligible, and the differences in HbA1c between non-anemia and moderate anemia were well within the allowable variability for clinical practice (≥0.5% absolute changes). Mean corpuscular hemoglobin (MCH) correlated with HbA1c significantly, independent of pregnancy, trimester, and anemia. The distinction of HbA1c levels between grades of Hb became no significant (P = 0.955), while differences between trimesters persisted after adjusting for MCH. CONCLUSION Mild and moderate anemia should not be the primary concern when using HbA1c to monitor blood glucose in pregnancy. MCH showed negative correlations with HbA1c independently, suggesting a previously unknown mechanism affecting HbA1c levels.
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Affiliation(s)
- Zong-Hui Guo
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China.
| | - Huai-Liang Tian
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Xiao-Qian Zhang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Deng-Han Zhang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Zhi-Min Wang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Kun Wang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Wen-Wen Su
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Fei Chen
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
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12
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Ekhzaimy A, Alkatari S, AlMaatouq M, Alotaibi D, Aljasser S, Aseeri A, Jammah A, Mujammami M, Fouda M, Alfadda AA, Sulaimani R. Fructosamine as an Index of Short-Term Glycemic Control in Pregnant Women with Diabetes: Before, During and After Ramadan. Int J Womens Health 2022; 14:435-444. [PMID: 35386939 PMCID: PMC8978904 DOI: 10.2147/ijwh.s351654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.
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Affiliation(s)
- Aishah Ekhzaimy
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Shadin Alkatari
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed AlMaatouq
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Daad Alotaibi
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sarah Aljasser
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amal Aseeri
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anwar Jammah
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mujammami
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mona Fouda
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Assim A Alfadda
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Obesity Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Riad Sulaimani
- Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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13
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Taguchi T, Suzuki A, Takano K. Increased glycated albumin levels in patients with acromegaly related to glucose fluctuation caused by growth hormone excess but not albumin metabolism. Endocr J 2022; 69:225-233. [PMID: 34588387 DOI: 10.1507/endocrj.ej21-0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acromegaly is often complicated by impaired glucose tolerance. The accuracy of glycated hemoglobin (HbA1c) and glycated albumin (GA) levels in representing glycemic profiles in patients with endocrine disorders, such as acromegaly, is unclear. This retrospective study reviewed data from patients whose GA levels had been recorded. 14 patients with acromegaly without diabetes mellitus (DM) (the acromegaly group), 15 patients with severe adult GH deficiency without DM (the growth hormone deficiency (GHD) group), and 55 nondiabetic patients (the control group) were included in this study. GA levels were significantly increased in the acromegaly group compared with the control and GHD groups, but no significant differences were observed between the control and GHD groups. The three groups were matched using propensity score matching (13 patients with acromegaly, 13 with GHD, and 13 control patients). Nonetheless, the results after matching were the same as those before matching. GA levels in the acromegaly group were significantly associated with plasma glucose (PG) levels at 0, 30, and 120 min after a 75-g oral glucose tolerance test (OGTT). Further, GH levels at 120 min after a 75-g OGTT in the acromegaly group were significantly correlated with GA levels and the difference in PG levels at baseline and 30 min. Our findings suggest that increases in PG levels attributable to excess GH after glucose loading are related to increases in GA levels in patients with acromegaly without DM. Hence, both HbA1c and GA should be checked to accurately assess impaired glucose tolerance in patients with acromegaly.
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Affiliation(s)
- Tomomi Taguchi
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Agena Suzuki
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
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14
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Morton A, Teasdale S. Physiological changes in pregnancy and their influence on the endocrine investigation. Clin Endocrinol (Oxf) 2022; 96:3-11. [PMID: 34724247 DOI: 10.1111/cen.14624] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Physiological changes in pregnancy may result in significant alterations in endocrine hormone profiles, serum and urine electrolytes and endocrine gland morphology on imaging. Pregnancy-specific pathophysiological processes may also affect the results for endocrine tests. Investigation of endocrine disorders in pregnancy requires knowledge of these changes and awareness of the safety of dynamic hormone testing and imaging for the mother and foetus. OBJECTIVE This review seeks to outline the important physiological changes in pregnancy affecting reference intervals of basal and dynamic endocrine tests in pregnancy and the scenarios in which these changes are clinically significant, the pregnancy-specific disorders that may affect the investigation of endocrine disorders, and the safety of dynamic testing and imaging. CONCLUSION Awareness of the effect of physiological changes, and the potential impact of pregnancy-specific disorders of endocrine tests, and the safety of imaging is crucial to the management of endocrine disorders in pregnancy.
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Affiliation(s)
- Adam Morton
- Departments of Endocrinology and Obstetric Medicine, Mater Health, Brisbane, Queensland, Australia
| | - Stephanie Teasdale
- Departments of Endocrinology and Obstetric Medicine, Mater Health, Brisbane, Queensland, Australia
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15
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Birati Y, Bloch JR, McKeever A, Chiatti BD. Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits. J Obstet Gynecol Neonatal Nurs 2021; 51:41-52. [PMID: 34742686 DOI: 10.1016/j.jogn.2021.10.004] [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] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits. DESIGN Exploratory descriptive secondary analysis of existing individual-level and neighborhood-level data. SETTING Philadelphia, Pennsylvania, United States. PARTICIPANTS Women who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264). METHODS We retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses. RESULTS We found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women's glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]). CONCLUSION It is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.
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16
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Kohzuma T, Tao X, Koga M. Glycated albumin as biomarker: Evidence and its outcomes. J Diabetes Complications 2021; 35:108040. [PMID: 34507877 DOI: 10.1016/j.jdiacomp.2021.108040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/01/2023]
Abstract
Glycemic control markers are important for the diagnosis and treatment of diabetes. Hemoglobin A1c (A1C) is an important marker that is mandatory in routine medical examinations; however, it is well known that it has some limitations. In this review, we focus on the limitation of A1C and introduce a relatively new marker, glycated albumin (GA), which can be used to complement A1C. First, for a better understanding of the characteristics of each marker, we sort the similarities and differences of glycemic control markers as well as the characteristics of each marker. Second, we point out the limitation of A1C, introduce GA as an alternative indicator, and discuss the limitations of GA. Finally, we summarize important evidence regarding the utility of GA. We hope that this review provides useful information that permits more effective usage of GA as well as other glycemic control markers.
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Affiliation(s)
| | - Xinran Tao
- Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, Hyogo, Japan
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17
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Alesi S, Ghelani D, Rassie K, Mousa A. Metabolomic Biomarkers in Gestational Diabetes Mellitus: A Review of the Evidence. Int J Mol Sci 2021; 22:ijms22115512. [PMID: 34073737 PMCID: PMC8197243 DOI: 10.3390/ijms22115512] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 12/14/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes, affecting between 2 to 38% of pregnancies worldwide, varying considerably depending on diagnostic criteria used and sample population studied. Adverse obstetric outcomes include an increased risk of macrosomia, and higher rates of stillbirth, instrumental delivery, and birth trauma. Metabolomics, which is a platform used to analyse and characterise a large number of metabolites, is increasingly used to explore the pathophysiology of cardiometabolic conditions such as GDM. This review aims to summarise metabolomics studies in GDM (from inception to January 2021) in order to highlight prospective biomarkers for diagnosis, and to better understand the dysfunctional metabolic pathways underlying the condition. We found that the most commonly deranged pathways in GDM include amino acids (glutathione, alanine, valine, and serine), carbohydrates (2-hydroxybutyrate and 1,5-anhydroglucitol), and lipids (phosphatidylcholines and lysophosphatidylcholines). We also highlight the possibility of using certain metabolites as predictive markers for developing GDM, with the use of highly stratified modelling techniques. Limitations for metabolomic research are evaluated, and future directions for the field are suggested to aid in the integration of these findings into clinical practice.
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Affiliation(s)
- Simon Alesi
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne 3168, Australia; (S.A.); (D.G.); (K.R.)
| | - Drishti Ghelani
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne 3168, Australia; (S.A.); (D.G.); (K.R.)
| | - Kate Rassie
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne 3168, Australia; (S.A.); (D.G.); (K.R.)
- Department of Diabetes, Monash Health, Melbourne 3168, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne 3168, Australia; (S.A.); (D.G.); (K.R.)
- Correspondence:
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18
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Shah KB, Chernausek SD, Teague AM, Bard DE, Tryggestad JB. Maternal diabetes alters microRNA expression in fetal exosomes, human umbilical vein endothelial cells and placenta. Pediatr Res 2021; 89:1157-1163. [PMID: 32663836 PMCID: PMC7854929 DOI: 10.1038/s41390-020-1060-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/28/2020] [Accepted: 06/22/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Exposure to diabetes in utero influences future metabolic health of the offspring. MicroRNAs (miRNA) are small noncoding RNAs that may contribute mechanistically to the effects on offspring imparted by diabetes mellitus (DM) during pregnancy. We hypothesized that exposure to DM during pregnancy influences select miRNAs in fetal circulation, in human umbilical vein endothelial cells (HUVEC), and placenta. METHODS miRNA abundance was quantified using real-time PCR from RNA isolated from umbilical cord serum exosomes, HUVEC, and placenta exposed to diabetes or normoglycemia during pregnancy. The abundance of each of these miRNAs was determined by comparison to a known standard and the relative expression assessed using the 2-ΔΔCt method. Multivariable regression models examined the associations between exposure to diabetes during pregnancy and miRNA expression. RESULTS miR-126-3p was highly abundant in fetal circulation, HUVEC, and placenta. Diabetes exposure during pregnancy resulted in lower expression of miR-148a-3p and miR-29a-3p in the HUVEC. In the placenta, for miR-126-3p, there was a differential effect of DM by birth weight between DM versus control group, expression being lower at the lower birth weight, however not different at the higher birth weight. CONCLUSION Exposure to DM during pregnancy alters miRNA expression in the offspring in a tissue-specific manner. IMPACT miRNAs are differentially expressed in fetal tissues from offspring exposed to in utero diabetes mellitus compared to those who were not exposed. miRNA expression differs among tissue types (human umbilical vein endothelial cells, placenta and circulation exosomes) and response to diabetes exposure varies according to tissue of origin. miRNA expression is also affected by maternal and infant characteristics such as infant birth weight, infant sex, maternal age, and maternal BMI. miRNAs might be one of the potential mechanisms by which offspring's future metabolic status may be influenced by maternal diabetes mellitus.
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Affiliation(s)
- Kruti B. Shah
- Department of Pediatrics, Section of Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Harold Hamm Diabetes Center, Oklahoma City, OK, USA
| | - Steven D. Chernausek
- Department of Pediatrics, Section of Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Harold Hamm Diabetes Center, Oklahoma City, OK, USA
| | - April M. Teague
- Department of Pediatrics, Section of Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Harold Hamm Diabetes Center, Oklahoma City, OK, USA
| | - David E. Bard
- Department of Pediatrics, University of Oklahoma Health Sciences Center Oklahoma City, OK, USA
| | - Jeanie B. Tryggestad
- Department of Pediatrics, Section of Diabetes/Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Harold Hamm Diabetes Center, Oklahoma City, OK, USA.,Corresponding author: Jeanie B. Tryggestad, Department of Pediatrics, Section of Diabetes/Endocrinology 1200 Children’s Ave Suite 4500, Oklahoma City, OK 73104, USA, Tel. 405-271-8001 ext. 43080, Fax 405-271-3093,
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19
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Liu N, Jin Y, Wang X, Xiang Z, Zhang L, Feng S. Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial. J Obstet Gynaecol Res 2021; 47:1272-1280. [PMID: 33403738 DOI: 10.1111/jog.14653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/04/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
AIM To investigate the safety and feasibility of taking low-concentration carbohydrate solution at 2 h before induction of anesthesia for gestational diabetes mellitus (GDM) patients. METHODS GDM patients undergoing cesarean section were randomly assigned to experimental group (n = 43) and control group (n = 42). Two hours before induction of anesthesia, participants in experimental group orally received 300 mL low-concentration carbohydrate solution, while those in control group received equivalent warm water. Blood glucose and serum insulin were measured at 2 h before induction of anesthesia, right before induction of anesthesia, and the morning of postoperative day 1. Neonatal blood glucose level was monitored at birth. Maternal gastrointestinal function and well-being were assessed perioperatively. RESULTS The levels of blood glucose and serum insulin right before induction of anesthesia in the experimental group were significantly higher than those in the control group. There were four cases with hypoglycemia in the experimental group and 19 cases in the control group right before induction of anesthesia (9.3% vs 45.2%, p < 0.001). The incidence of neonatal hypoglycemia was 2.3% in the experimental group and 7.1% in the control group with no significance. Hunger score of the participants between the two groups right before induction of anesthesia was significantly different. No aspiration, nausea, and vomiting occurred in both groups before, during, and after surgery. No significant difference was found in the time to the first flatus and abdominal distension between the two groups. CONCLUSION Taking low-concentration carbohydrate solution is safe and feasible for patients with GDM undergoing elective cesarean section.
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Affiliation(s)
- Ningning Liu
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jin
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - XiaoJuan Wang
- Medicine Department, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Xiang
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Le Zhang
- Obstetrics Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suwen Feng
- Nursing Department, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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20
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Copur S, Onal EM, Afsar B, Ortiz A, van Raalte DH, Cherney DZ, Rossing P, Kanbay M. Diabetes mellitus in chronic kidney disease: Biomarkers beyond HbA1c to estimate glycemic control and diabetes-dependent morbidity and mortality. J Diabetes Complications 2020; 34:107707. [PMID: 32861562 DOI: 10.1016/j.jdiacomp.2020.107707] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). Optimal glycemic control contributes to improved outcomes in patients with DM, particularly for microvascular damage, but blood glucose levels are too variable to provide an accurate assessment and instead markers averaging long-term glycemic load are used. The most established glycemic biomarker of long-term glycemic control is HbA1c. Nevertheless, HbA1c has pitfalls that limit its accuracy to estimate glycemic control, including the presence of altered red blood cell survival, hemoglobin glycation and suboptimal performance of HbA1c assays. Alternative methods to evaluate glycemic control in patients with DM include glycated albumin, fructosamine, 1-5 anhydroglucitol, continuous glucose measurement, self-monitoring of blood glucose and random blood glucose concentration measurements. Accordingly, our aim was to review the advantages and pitfalls of these methods in the context of CKD.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Emine M Onal
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040 Madrid, Spain
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, location VUMC, Amsterdam, the Netherlands
| | - David Z Cherney
- Toronto General Hospital Research Institute, UHN, Toronto, Canada; Departments of Physiology and Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
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Fetal and Placental Weight in Pre-Gestational Maternal Obesity (PGMO) vs. Excessive Gestational Weight Gain (EGWG)-A Preliminary Approach to the Perinatal Outcomes in Diet-Controlled Gestational Diabetes Mellitus. J Clin Med 2020; 9:jcm9113530. [PMID: 33142800 PMCID: PMC7693942 DOI: 10.3390/jcm9113530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Both pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) increase the risk of gestational diabetes mellitus (GDM). Here, we conducted a retrospective study to comparatively examine the relation between fetal birth weight (FW) and placental weight (PW) in PGMO (n = 100) compared to EGWG (n = 100) with respect to perinatal outcomes in diet-controlled GDM. The control group was made up of 100 healthy pregnancies. The mean FW and the mean PW in EGWG were correlated with lowered fetal weight/placental weight ratio (FW/PW ratio). The percentage of births completed by cesarean section accounted for 47%, 32%, and 18% of all deliveries (EGWG, PGMO, and controls, respectively), with the predominance of FW-related indications for cesarean section. Extended postpartum hospital stays due to neonate were more frequent in EGWG, especially due to neonatal jaundice (p < 0.05). The results indicate the higher perinatal risk in mothers with EGWG compared to PGMO during GDM-complicated pregnancy. Further in-depth comparative studies involving larger patient pools are needed to validate these findings, the intent of which is to formulate guidelines for GDM patients in respect to management of PGMO and EGWG.
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Yefet E, Twafra S, Shwartz N, Hissin N, Hasanein J, Colodner R, Mirsky N, Nachum Z. Inverse association between 1,5-anhydroglucitol and neonatal diabetic complications. Endocrine 2019; 66:210-219. [PMID: 31435861 DOI: 10.1007/s12020-019-02058-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/08/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE A glycemic control marker to predict neonatal diabetic complications is unavailable. We aimed to examine if 1,5-anhydroglucitol (1,5-AG) can predict neonatal complications in women with diabetes in pregnancy. METHODS Prospective observational study from December 2011 to August 2013. We recruited 105 women, 70 diabetic (gestational and pregestational) and 35 nondiabetic. 1,5-AG at birth was compared between the two groups. In the diabetic group 1,5-AG, HbA1c, and fructosamine were measured before glycemic control initiation (first visit), after 4-6 weeks (second visit), and at delivery. Women were divided to poor (1,5-AG values below median at birth) and good (1,5-AG values at median and above) glycemic control groups. Mean daily glucose charts were collected. The primary outcome was a composite of neonatal diabetic complications: respiratory distress, hypoglycemia, polycythemia, hyperbilirubinemia, and large for gestational age. RESULTS Mean 1,5-AG in the nondiabetic group was similar to that of the diabetic group without the composite outcome and was significantly higher than in the diabetic group with the composite outcome. The rate of the composite outcome was higher in the poor glycemic control group compared with the good glycemic control group (adjusted odds ratio (OR) 3.8 95% CI [1.2-12.3]). Only 1,5-AG was inversely associated with the composite outcome at all time points; the second visit was the only independent risk factor in multivariable logistic regression (OR 0.7 95% CI 0.54-0.91). The rest of the glycemic markers were not associated with neonatal composite outcome. CONCLUSIONS 1,5-AG is inversely associated with neonatal diabetic complications and is superior to other glycemic markers in predicting those complications.
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Affiliation(s)
- Enav Yefet
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel.
| | - Shams Twafra
- Department of Human Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
- Clinical Chemistry Laboratory, Emek Medical Center, Afula, Israel
| | - Neta Shwartz
- Clinical Chemistry Laboratory, Emek Medical Center, Afula, Israel
| | - Noura Hissin
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
| | - Jamal Hasanein
- Neonatology Department, Emek Medical Center, Afula, Israel
| | - Raul Colodner
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Molecular Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Neetsa Mirsky
- Department of Human Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Zohar Nachum
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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23
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Olmos PR, Borzone GR, Poblete A. Gestational Diabetes: Glycemic Control in the Last Two Weeks Before Delivery Contributes to Newborn Insulinemia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1445-1452. [PMID: 30473121 DOI: 10.1016/j.jogc.2018.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/15/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important during intrauterine life, a time when it can result in macrosomia, but also at delivery, since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question is, how long before delivery does maternal glycemic control contribute to newborn insulinemia in GDM? METHODS In 72 women with GDM, we calculated Spearman's rank (rs) correlations between umbilical cord blood C-peptide at birth (a biomarker of insulin secretion), and both maternal glycosylated hemoglobin (HbA1c) and mean blood glucose (MBG) recorded in the last two visits prior to delivery. Iterative correlations were done between umbilical cord blood C-peptide at birth, and maternal glucose control, at 0, 1, 2, 3, 4, and 5 weeks before delivery. RESULTS At an early visit (32.95 ± 1.8 weeks), rs = 0.353 (P = 0.07) between HbA1c and C-peptide, whereas rs = 0.244 (P = 0.186) between MBG and C-peptide. At the latest visit (35.04 ± 1.6 weeks), rs = 0.456 (P = 0.004) between HbA1c versus C-peptide, and rs = 0.359 (P = 0.023) between MBG versus C-peptide. Iterative correlations between MBG and C-peptide became significant at 2 weeks before delivery. CONCLUSION To further reduce the risk of hypoglycemia and hyperbilirubinemia in infants born to women with GDM, besides applying a strict in-patient glucose control protocol at delivery, it is necessary to improve even more the quality of maternal glucose control during the last 2 weeks prior to delivery.
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Affiliation(s)
- Pablo R Olmos
- First Center of Biomedical Engineering, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Obstetrics & Gynecology, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Nutrition, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Gisella R Borzone
- Department of Respiratory Diseases, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Poblete
- Department of Obstetrics & Gynecology, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Poupon P, Foussard N, Helmer C, Cougnard-Gregoire A, Rajaobelina K, Delcourt C, Lamireau T, Haissaguerre M, Blanco L, Alexandre L, Mohammedi K, Rigalleau V. Serum fructosamine predicts macrosomia in well-controlled hyperglycaemic pregnant women: An observational cross-sectional study. DIABETES & METABOLISM 2019; 46:219-222. [PMID: 31325500 DOI: 10.1016/j.diabet.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/29/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022]
Abstract
AIM While serum fructosamine may be a good marker of glucose control in pregnant women with diabetes, its relationship with macrosomia is still uncertain. METHODS In 130 hyperglycaemic women with singleton pregnancies (117 gestational diabetes mellitus, 13 pregestational diabetes), serum fructosamine and HbA1c levels were measured at 25±7 weeks of gestation. Levels in mothers of infants with and without macrosomic newborns (birth weight>4000g and/or large-for-gestational-age birth weight>90th percentile) were compared using logistic regression analysis adjusted for macrosomia risk factors. RESULTS These 130 pregnant women were 33±5 years old; their BMI before pregnancy was 27.7±6.9kg/m2, and they gained 7.5±5.1kg during the first 6 months of gestation. Glucose control was good according to HbA1c levels (5.3±0.3%; 34±2mmol/mol), yet 17/130 (13%) newborns had macrosomia: 3900±227g vs 3057±512g (P<0.001) in the others. These mothers were older and had higher parity, whereas their BMI scores before pregnancy and gestational weight gains did not differ. Fructosamine levels were also higher at 221±40μmol/L vs 192±22μmol/l (P<0.001), respectively, and remained significant even after adjusting for maternal age, BMI, parity, type of diabetes, antecedents of macrosomia and excessive gestational weight gain. By contrast, HbA1c did not differ between the two groups. In fact, nearly two-thirds (64.7%) of the mothers of macrosomic newborns had fructosamine levels>200μmol/l vs 31.9% of mothers with non-macrosomic newborns (P<0.05). CONCLUSION High fructosamine levels are associated with macrosomia in the newborns of well-controlled hyperglycaemic pregnant women.
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Affiliation(s)
- P Poupon
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France
| | - N Foussard
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France
| | - C Helmer
- Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France
| | - A Cougnard-Gregoire
- Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France
| | - K Rajaobelina
- Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France
| | - C Delcourt
- Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France
| | - T Lamireau
- Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France
| | - M Haissaguerre
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France
| | - L Blanco
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France
| | - L Alexandre
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France
| | - K Mohammedi
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France; Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France
| | - V Rigalleau
- Nutrition-Diabetology, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, F-33600 Pessac, France; Inserm U1219, Bordeaux Population Health Research Centre, F-33000 Bordeaux, France.
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25
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Mendes N, Alves M, Andrade R, Ribeiro RT, Papoila AL, Serrano F. Association between glycated albumin, fructosamine, and HbA1c with neonatal outcomes in a prospective cohort of women with gestational diabetes mellitus. Int J Gynaecol Obstet 2019; 146:326-332. [PMID: 31242319 DOI: 10.1002/ijgo.12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/23/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate whether glycated albumin, fructosamine, and hemoglobin A1c (HbA1c) are associated with neonatal complications in newborns of pregnant women with gestational diabetes mellitus (GDM). METHODS Between November 2016 and September 2017, women with a singleton pregnancy and GDM were enrolled in a prospective study in an obstetric Portuguese referral center. Glycemic markers were compared between mothers of newborns with and without complications. Multivariable logistic regression models and corresponding areas under the receiver operating characteristic curve (AUC) were used. RESULTS A total of 85 women participated in the study. Raised levels of glycated albumin and fructosamine were associated with at least one neonatal complication (OR- [odds ratio] estimate: 1.33, P=0.015; OR: 1.24, P=0.027, respectively) and with respiratory disorders at birth (OR 1.41, P=0.004; OR 1.26, P=0.014, respectively). HbA1c was not associated with these outcomes. All biomarkers were associated with large-for-gestational age (LGA) status (OR 1.61, P<0.001; OR 1.45, P<0.001; OR 3.62, P=0.032 for glycated albumin, fructosamine, and HbA1c, respectively). All had similar AUC for at least one neonatal complication (0.82; 0.81; 0.79, respectively). For newborn respiratory disorders, AUCs were 0.83, 0.81, and 0.76, respectively, and for LGA status were 0.81, 0.79, and 0.71, respectively. CONCLUSION Raised values of glycated albumin and fructosamine were associated with particular perinatal complications in newborns of mothers with GDM, better discriminating mothers of newborns with and without complications than HbA1c.
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Affiliation(s)
- Neuza Mendes
- Department of Maternal-Fetal Medicine, Central Lisbon Hospital Center, Lisbon, Portugal.,NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Marta Alves
- Epidemiology and Statistics Unit, Research Center, Central Lisbon Hospital Center, Lisbon, Portugal.,CEAUL (Center of Statistics and its Applications), University of Lisbon, Lisbon, Portugal
| | - Rita Andrade
- Education and Research Center (APDP-ERC), Portuguese Diabetes Association, Lisbon, Portugal.,CEDOC Chronic Diseases - NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rogério T Ribeiro
- Education and Research Center (APDP-ERC), Portuguese Diabetes Association, Lisbon, Portugal.,CEDOC Chronic Diseases - NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,UA-DCM - Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Luísa Papoila
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Epidemiology and Statistics Unit, Research Center, Central Lisbon Hospital Center, Lisbon, Portugal.,CEAUL (Center of Statistics and its Applications), University of Lisbon, Lisbon, Portugal
| | - Fátima Serrano
- Department of Maternal-Fetal Medicine, Central Lisbon Hospital Center, Lisbon, Portugal.,NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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26
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Matsha TE, Korf M, Erasmus RT, Hoffmann M, Mapfumo C, Smit F, Zemlin AE. Reference interval determination for glycated albumin in defined subgroups of a South African population. Ann Clin Biochem 2019; 56:480-487. [DOI: 10.1177/0004563219847234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Glycated proteins, such as glycated haemoglobin (HbA1c) and glycated albumin (GA%), are increasingly being used for glycaemic control assessment and the diagnosis of diabetes mellitus. GA% is an intermediate marker of glycaemic control that is not influenced by factors that affect HbA1c concentrations. The aim of this study was to determine reference intervals and assess confounding factors for glycated albumin in a well-characterized healthy population in South Africa. Methods We measured glycated albumin using an enzymatic method on stored serum samples of healthy individuals recruited in Cape Town, South Africa. Reference intervals (overall and specific for age, sex and ethnicity) were determined using non-parametric methods and confounding factors were assessed using multiple regression analysis. Results The reference interval (2.5th to 97.5th percentile) for glycated albumin of 663 healthy individuals (mean age, 34 years, 38.6% males) ranged from 10.7 to 15.2%. Sex, body mass index categories and ethnicity were significantly associated with the glycated albumin and were considered of practical importance because their standardized regression coefficients (Beta) were greater than a cut-off of 0.15, implying a stronger effect on glycated albumin ( P < 0.001). The glycated albumin reference intervals for subjects with body mass index <25 kg/m2 was 11.2–15.3%, for body mass index 25–30 kg/m2 it was 10.5–14.9% and 10.0–14.6% for body mass index >30 kg/m2 ( P = 0.0001). Conclusions The overall reference interval showed good correlation with reference intervals determined in other studies. However, sex, ethnicity and body mass index were statistically significant confounding factors that may influence the overall reference interval. Therefore, overall glycated albumin reference intervals should be used cautiously.
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Affiliation(s)
- Tandi E Matsha
- Department of Biomedical Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Marizna Korf
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Rajiv T Erasmus
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Mariza Hoffmann
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Cladnos Mapfumo
- Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Cape Town, South Africa
| | - Francois Smit
- PathCare Laboratories, Mediclinic Vergelegen, Somerset West, South Africa
| | - Annalise E Zemlin
- Department of Pathology, Chemical Pathology Division, National Health Laboratory Service (NHLS) and University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
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Xu Y, Wang W, Zhou J, Chen M, Huang X, Zhu Y, Xie X, Li W, Zhang Y, Kan H, Ying Z. Metabolomics analysis of a mouse model for chronic exposure to ambient PM 2.5. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 247:953-963. [PMID: 30823350 PMCID: PMC6536002 DOI: 10.1016/j.envpol.2019.01.118] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 05/04/2023]
Abstract
Chronic ambient fine particulate matter (PM2.5) exposure correlates with various adverse health outcomes. Its impact on the circulating metabolome-a comprehensive functional readout of the interaction between an organism's genome and environment-has not however been fully understood. This study thus performed metabolomics analyses using a chronic PM2.5 exposure mouse model. C57Bl/6J mice (female) were subjected to inhalational concentrated ambient PM2.5 (CAP) or filtered air (FA) exposure for 10 months. Their sera were then analyzed by liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS). These analyses identified 2570 metabolites in total, and 148 of them were significantly different between FA- and CAP-exposed mice. The orthogonal partial least-squares discriminant analysis (OPLS-DA) and heatmap analyses displayed evident clustering of FA- and CAP-exposed samples. Pathway analyses identified 6 perturbed metabolic pathways related to amino acid metabolism. In contrast, biological characterization revealed that 71 differential metabolites were related to lipid metabolism. Furthermore, our results showed that CAP exposure increased stress hormone metabolites, 18-oxocortisol and 5a-tetrahydrocortisol, and altered the levels of circadian rhythm biomarkers including melatonin, retinal and 5-methoxytryptophol.
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Affiliation(s)
- Yanyi Xu
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China.
| | - Wanjun Wang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Ji Zhou
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China.
| | - Minjie Chen
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Xingke Huang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Yaning Zhu
- Department of Pathology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.
| | - Xiaoyun Xie
- Department of Interventional & Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Weihua Li
- Reproductive and Developmental Research Institute of Fudan University, Shanghai, 200032, China.
| | - Yuhao Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Zhekang Ying
- Department of Medicine Cardiology Division, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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Yao H, Xu D, Zhu Z, Wang G. Gestational diabetes mellitus increases the detection rate and the number of oral bacteria in pregnant women. Medicine (Baltimore) 2019; 98:e14903. [PMID: 30882709 PMCID: PMC6426525 DOI: 10.1097/md.0000000000014903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the present study, we aimed to investigate the association between gestational diabetes mellitus (GDM) and the oral microbial imbalance in the second trimester of pregnancy.Three hundred thirtyone women in the second trimester of pregnancy who underwent prenatal examinations at the Third Affiliated Hospital of Soochow University from February 2018 to August 2018 were included in this study. Personal parameters including the age, education level, and body mass index (BMI) at 28 weeks of gestation were recorded. Gestational diabetes mellitus (GDM) was diagnosed according to the Standards of Medical Care in Diabetes-2011 recommended by American Diabetes Association (ADA). After the significant difference of each parameter was erased by a propensity-score matched (PSM) analysis at a 1:1 ratio, the oral health conditions and the oral flora in pregnant women with GDM were compared with those in nondiabetic pregnant women.Our data demonstrated that 65 of the 331 pregnant women (19.6%) were diagnosed with GDM. Results from the matched data including 59 matched pairs of pregnant women showed that the gingival index (GI), plaque index (PI), tooth mobility degree (TMD), probing depth (PD), and bleeding on probing (BOP) of pregnant women with GDM were higher or more severe than those of nondiabetic pregnant women (P < .05). The detection rate of tuberculosis bacilli, Black-pigmented bacteria, and Capnocytophaga in pregnant women with GDM was higher than those in nondiabetic pregnant women (P = .000, P = .026, and P = .030, respectively). In addition, pregnant women with GDM had fewer oral streptococci (P = .000) and lactobacilli (P = .000) and more oral anaerobic bacteria (P = .000), tuberculosis bacilli (P = .000), Black-pigmented bacteria (P = .007), Capnocytophaga (P = .000), and actinomycetes (P = .000).The detection rate and the number of oral bacteria in pregnant women with GDM were higher than those in nondiabetic pregnant women in the second trimester of pregnancy.
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Pramodkumar TA, Jayashri R, Gokulakrishnan K, Velmurugan K, Pradeepa R, Venkatesan U, Saravanan P, Uma R, Anjana RM, Mohan V. 1,5 Anhydroglucitol in gestational diabetes mellitus. J Diabetes Complications 2019; 33:231-235. [PMID: 30594413 DOI: 10.1016/j.jdiacomp.2018.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/17/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE 1,5 Anhydroglucitol (1,5 AG) is reported to be a more sensitive marker of glucose variability and short-term glycemic control (1-2 weeks) in patients with type1 and type 2 diabetes. However, the role of 1,5 AG in gestational diabetes mellitus (GDM) is not clear. We estimated the serum levels of 1,5 AG in pregnant women with and without GDM. METHODS We recruited 220 pregnant women, 145 without and 75 with GDM visiting antenatal clinics in Tamil Nadu in South India. Oral glucose tolerance tests (OGTTs) were carried out using 82.5 g oral glucose (equivalent to 75 g of anhydrous glucose) and GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Group criteria. Serum 1,5 AG levels were measured using an enzymatic, colorimetric assay kit (Glycomark®, New York, NY). Receiver operating characteristic (ROC) curves were used to identify 1,5 AG cut-off points to identify GDM. RESULTS The mean levels of the 1,5 AG were significantly lower in women with GDM (11.8 ± 5.7 μg/mL, p < 0.001) compared to women without GDM (16.2 ± 6.2 μg/mL). In multiple logistic regression analysis, 1.5 AG showed a significant association with GDM (odds ratio [OR]: 0.876, 95% confidence interval [CI]: 0.812-0.944, p < 0.001) after adjusting for potential confounders. 1,5 AG had a C statistic of 0.693 compared to Fructosamine (0.671) and HbA1c (0.581) for identifying GDM. A 1,5 AG cut-off of 13.21 μg/mL had a C statistic of 0.6936 (95% CI: 0.6107-0.7583, p < 0.001), sensitivity of 67.6%, and specificity of 65.3% to identify GDM. CONCLUSION 1,5AG levels are lower in pregnant women with GDM compared to individuals without GDM.
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Affiliation(s)
- Thyparambil Aravindakshan Pramodkumar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ramamoorthy Jayashri
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Kuppan Gokulakrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Kaliyaperumal Velmurugan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ponnusamy Saravanan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ram Uma
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India.
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Teasdale S, Morton A. Changes in biochemical tests in pregnancy and their clinical significance. Obstet Med 2018; 11:160-170. [PMID: 30574177 PMCID: PMC6295771 DOI: 10.1177/1753495x18766170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/22/2018] [Indexed: 12/11/2022] Open
Abstract
Interpretation of laboratory investigations relies on reference intervals. Physiological changes in pregnancy may result in significant changes in normal values for many biochemical assays, and as such results may be misinterpreted as abnormal or mask a pathological state. The aims of this review are as follows: 1. To review the major physiological changes in biochemical tests in normal pregnancy. 2. To outline where these physiological changes are important in interpreting laboratory investigations in pregnancy. 3. To document the most common causes of abnormalities in biochemical tests in pregnancy, as well as important pregnancy-specific causes.
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Affiliation(s)
- Stephanie Teasdale
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
| | - Adam Morton
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
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Yeh T, Yeung M, Mendelsohn Curanaj FA. Inpatient Glycemic Management of the Pregnant Patient. Curr Diab Rep 2018; 18:73. [PMID: 30112679 DOI: 10.1007/s11892-018-1045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW There is a rising prevalence of type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) in pregnancy. Reaching and maintaining glycemic targets during and after this time are important for both the health of the mother and her baby. RECENT FINDINGS Based on recently published guidelines from various societies, we review the diagnosis of diabetes in pregnancy, types of therapies available to maintain euglycemia, important keys to management of T1DM, T2DM, and GDM, and strategies for reaching inpatient glycemic targets during the peripartum period. Care for pregnant patients with T1DM is especially challenging, and providers should be aware of the varying insulin requirements at different stages of pregnancy and how to reduce hypoglycemia and avoid diabetic ketoacidosis. Insulin sensitivity fluctuates throughout pregnancy due to physiologic changes, especially during labor and delivery and immediately post-partum. We review recommendations regarding how to manage this dynamic time and present our own institution's inpatient management protocol. Finally, we review management of diabetes post-partum, including medications, breast-feeding, and continued monitoring and screening. With the collaborative efforts of the patient and an interdisciplinary team and in-depth knowledge of the most up-to-date management principles, it is possible to achieve euglycemia during this critical time of a mother and baby's life.
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Affiliation(s)
- Tiffany Yeh
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA
| | - Michele Yeung
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA
| | - Felicia A Mendelsohn Curanaj
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA.
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Vince K, Poljičanin T, Brkić M, Rodin U, Matijević R. Prevalence of diabetes five years after having gestational diabetes during pregnancy - Croatian national study. Prim Care Diabetes 2018; 12:325-330. [PMID: 29519626 DOI: 10.1016/j.pcd.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 01/11/2023]
Abstract
AIMS The aim of this study was to determine the prevalence of diabetes among women 5 years after having gestational diabetes during pregnancy. Also, we sought to determine whether women who develop diabetes after GD during pregnancy differ from women who do not develop diabetes after GD during pregnancy. METHODS This longitudinal study was performed using data from medical birth certificates and CroDiab diabetes registry. Women burdened with gestational diabetes in Croatia in 2011 were followed up until year 2016. Those registered in CroDiab registry were recognised as new patients with diabetes. RESULTS Among 40,641 deliveries in 2011, gestational diabetes was reported in 1181 (2.9%) women. Among them 853 (72.23%) were followed up in CroDiab diabetes registry and 32 (3.75%) were identified as new patients with diabetes. Median time from childbirth to onset of diabetes was 29.12 months. The diabetes group did not significantly differ to the group without diabetes according to age (p=0.587), level of education (p=0.549) or marital status (p=0.849) except that the diabetes group was significantly more obese than the group without diabetes (p=0.002). CONCLUSIONS Based on CroDiab diabetes registry data prevalence of diabetes 5 years after pregnancy complicated with gestational diabetes is 3.75% in Croatia. Women with gestational diabetes during pregnancy, and especially those with higher BMIs, are an important risk group for developing diabetes later in life so screening and preventive measures should be oriented toward them in primary care settings.
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Affiliation(s)
- Katja Vince
- University Hospital Merkur, Zajčeva 19, 10000 Zagreb, Croatia.
| | - Tamara Poljičanin
- Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia.
| | - Marko Brkić
- Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia.
| | - Urelija Rodin
- Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia.
| | - Ratko Matijević
- University Hospital Merkur, Zajčeva 19, 10000 Zagreb, Croatia.
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Rasekaba TM, Furler J, Young D, Liew D, Gray K, Blackberry I, Lim WK. Using technology to support care in gestational diabetes mellitus: Quantitative outcomes of an exploratory randomised control trial of adjunct telemedicine for gestational diabetes mellitus (TeleGDM). Diabetes Res Clin Pract 2018; 142:276-285. [PMID: 29885390 DOI: 10.1016/j.diabres.2018.05.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/18/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
AIMS The increasing incidence and prevalence of gestational diabetes mellitus (GDM) on a background of limited resources calls for innovative approaches healthcare provision. Our aim was to explore the effects of telemedicine supported GDM care on a range of health service utilisation and maternal and foetal outcomes. METHODS An exploratory randomised controlled trial of adjunct telemedicine support in the management of insulin-treated GDM compared to usual care control. Outcomes included health service use, maternal and foetal clinical outcomes as well as costs. Groups were compared on outcomes and Poisson and Cox regression analysis were performed for predictors of health service utilisation, glycaemic control and costs. RESULTS 95 participants were recruited (intervention n = 61, control n = 34). There were no differences between the groups in number of face-to-face appointments (median (IQR) intervention = 8(7), control = 8(6), p = 0.843), rates of caesareans, macrosomia, large for gestational age, special care nursery admission or newborn birth-weight. The intervention had no impact on total (IRR = 1.04, p = 0.596) or face-to-face (IRR = 1.09, p = 0.257) clinic appointments or service provider costs. Participants receiving the intervention reached optimum glycaemic control quicker: mean (SD) 4.3(4.2) weeks vs. 7.6(4.5) weeks, p = 0.0001). Telemedicine was a significant predictor of better glycaemic control (HR = 1.71(95%CI: 1.11, 2.65, p = 0.015). CONCLUSIONS Telemedicine support for GDM care showed no impact on service utilisation and costs. The intervention produced similar GDM clinical outcomes as usual care and posed no added risk to clinical quality of care. The intervention may be associated with fewer insulin dose titrations and participants achieved optimum glycaemic control sooner.
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Affiliation(s)
- Tshepo M Rasekaba
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia; Northern Clinical Research Centre, The Northern Hospital, Epping, Australia.
| | - John Furler
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Doris Young
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Danny Liew
- Melbourne EpiCentre Royal Melbourne Hospital and Department of Public Health and Preventive Medicine, Monash University, Prahran, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, The University of Melbourne, Parkville, Victoria, Australia
| | - Irene Blackberry
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia; John Richards Centre, La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Wen Kwang Lim
- Northern Clinical Research Centre, The Northern Hospital, Epping, Australia; Department of Medicine, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
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George JA, Erasmus RT. Haemoglobin A1c or Glycated Albumin for Diagnosis and Monitoring Diabetes: An African Perspective. Indian J Clin Biochem 2018; 33:255-261. [PMID: 30072824 DOI: 10.1007/s12291-018-0755-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/24/2018] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) has reached epidemic proportions across the globe with the largest increases seen in sub-Saharan Africa. Those that are diagnosed are largely poorly controlled. This review summarizes the limitations of the use of glycated haemoglobin (HBA1c) in Africa and current knowledge on the utility of glycated albumin and fructosamine in African patients. The diagnosis and monitoring of DM in African patients may be compromised by associated conditions like sickle cell anaemia, chronic kidney disease and HIV infection. Glycated albumin reflects short term glycaemia and is not affected by many conditions that alter HbA1c. It can be measured enzymatically, and this review discusses methods for analysis, and discusses the advantages and limitations in specific situations with an emphasis on conditions that also affect HbA1c.
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Affiliation(s)
- J A George
- 1Department of Chemical Pathology, National Health Laboratory Services and University of Witwatersrand, Johannesburg, South Africa
| | - R T Erasmus
- 2Department of Chemical Pathology, National Health Laboratory Services and University of Stellenbosch, Stellenbosch, South Africa
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Mendes N, Tavares Ribeiro R, Serrano F. Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus. J OBSTET GYNAECOL 2018; 38:762-769. [PMID: 29620435 DOI: 10.1080/01443615.2017.1412409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.
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Affiliation(s)
- Neuza Mendes
- a Department of Maternal-Fetal Medicine , Maternidade Dr. Alfredo da Costa, Central Lisbon Hospital Center , Lisbon , Portugal.,b NOVA Medical School , Universidade NOVA de Lisboa , Lisbon , Portugal
| | - Rogério Tavares Ribeiro
- c Education and Research Center (APDP-ERC) , Portuguese Diabetes Association , Lisboa , Portugal.,d CEDOC Chronic Diseases , NOVA Medical School , Lisbon , Portugal
| | - Fátima Serrano
- a Department of Maternal-Fetal Medicine , Maternidade Dr. Alfredo da Costa, Central Lisbon Hospital Center , Lisbon , Portugal.,b NOVA Medical School , Universidade NOVA de Lisboa , Lisbon , Portugal
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Schindler C, Birkenfeld AL, Hanefeld M, Schatz U, Köhler C, Grüneberg M, Tschöpe D, Blüher M, Hasslacher C, Bornstein SR. Intravenous Ferric Carboxymaltose in Patients with Type 2 Diabetes Mellitus and Iron Deficiency: CLEVER Trial Study Design and Protocol. Diabetes Ther 2018; 9:37-47. [PMID: 29134606 PMCID: PMC5801218 DOI: 10.1007/s13300-017-0330-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION HbA1c is the gold standard for glycemic control in pre-diabetes and diabetes. However, its validity has been questioned, especially in the presence of imbalanced iron homeostasis. The CLEVER trial aims to evaluate the relationship between iron deficiency and HbA1c (a biomarker for the diagnosis and therapeutic monitoring of type 2 diabetes) in a randomized, placebo-controlled, multicenter clinical trial. METHODS The CLEVER (intravenous ferric CarboxymaLtosE for improVement of mEtabolic parameters in type 2 diabetes patients with iRon deficiency) trial is a randomized, single-blind, proof-of-concept study with two treatment arms. 140 men and women diagnosed with type 2 diabetes and iron deficiency will receive either placebo or ferric carboxymaltose (500 or 1000 mg) as intravenous infusions. The primary outcome measure is the change in HbA1c level between baseline and after 12 weeks of treatment. Secondary endpoints include change of iron status and metabolic markers as well as treatment safety and tolerability. Furthermore, the potential clinical improvement in quality of life and the reliability of HbA1c measurement in patients with type 2 diabetes and iron deficiency will be investigated. RESULTS Both excessive iron and iron deficiency are associated with metabolic disorders; excessive iron is a risk factor for the development of diabetes, whereas iron deficiency is associated with obesity and insulin resistance. It has been suggested that iron increases insulin secretion in pancreatic beta-cells. CLEVER is the first study to investigate the hypothesis that intravenous substitution with ferric carboxymaltose reduces HbA1c levels in patients with type 2 diabetes and iron deficiency, thereby improving metabolic status and quality of life. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01513369). FUNDING GWT-TUD GmbH acts as sponsor of the clinical trial. Financial support is provided by Vifor Pharma.
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Affiliation(s)
- Christoph Schindler
- Clinical Research Center Hannover and Center for Pharmacology and Toxicology, Hannover Medical School, Hannover, Germany.
| | - Andreas L Birkenfeld
- Medical Clinic and Policlinic III at the University Hospital Dresden, Dresden, Germany
- Centre for Metabolic Vascular Medicine, GWT-TUD, Dresden, Germany
| | - Markolf Hanefeld
- Centre for Metabolic Vascular Medicine, GWT-TUD, Dresden, Germany
| | - Ulrike Schatz
- Medical Clinic and Policlinic III at the University Hospital Dresden, Dresden, Germany
| | | | | | - Diethelm Tschöpe
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Matthias Blüher
- Department of Medicine at the University Hospital Leipzig, Leipzig, Germany
| | - Christoph Hasslacher
- Diabetesinstitut Heidelberg and Department of Clinical Studies, St. Josefskrankenhaus Heidelberg, Heidelberg, Germany
| | - Stefan R Bornstein
- Medical Clinic and Policlinic III at the University Hospital Dresden, Dresden, Germany
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Zhu J, Chen Y, Li C, Tao M, Teng Y. The diagnostic value of glycated albumin in gestational diabetes mellitus. J Endocrinol Invest 2018; 41:121-128. [PMID: 28589381 PMCID: PMC5754373 DOI: 10.1007/s40618-016-0605-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 12/27/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Our objective was to compare the diagnostic performance of glycated hemoglobin (HbA1c), GA, and fasting plasma glucose (FPG) for the diagnosis of GDM. METHODS Women at their late second or early third trimesters seen from October 2011 to April 2012 were studied. GDM was diagnosed based on oral glucose tolerance test results, and GA and HbA1c were measured at the same time. Patients were divided into two groups (with and without GDM), and areas under the receiver-operating characteristic curves (AUCs) were calculated to determine the diagnostic value of FPG, GA, and HbA1c. RESULTS A total of 698 women were included, of which 232 (33.2%) had GDM. Overall, FPG had the highest AUC for the detection of GDM, and was significantly higher than that of GA (0.692 vs. 0.568, p < 0.001) and HbA1c (0.692 vs. 0.619, p = 0.014). The AUC of FPG was significantly greater than that of GA and HbA1c. At 24-28 weeks' gestation, the AUCs of FPG were significantly greater than those of GA and HbA1c. CONCLUSIONS These results do not support the use of GA as a screening tool for GDM.
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Affiliation(s)
- Jieping Zhu
- Department of Obstetrics and Gynecology, Shanghai 6th People's Hospital, No 600 Yishan Road, Shanghai, 200233, China
| | - Yu Chen
- Department of Obstetrics and Gynecology, Shanghai 6th People's Hospital, No 600 Yishan Road, Shanghai, 200233, China
| | - Changbin Li
- Department of Obstetrics and Gynecology, Shanghai 6th People's Hospital, No 600 Yishan Road, Shanghai, 200233, China
| | - Minfang Tao
- Department of Obstetrics and Gynecology, Shanghai 6th People's Hospital, No 600 Yishan Road, Shanghai, 200233, China.
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, Shanghai 6th People's Hospital, No 600 Yishan Road, Shanghai, 200233, China
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Ducarme G, Desroys Du Roure F, Le Thuaut A, Grange J, Dimet J, Crepin-Delcourt I. Efficacy of maternal and biological parameters at the time of diagnosis of gestational diabetes mellitus in predicting neonatal morbidity. Eur J Obstet Gynecol Reprod Biol 2017; 221:113-118. [PMID: 29278829 DOI: 10.1016/j.ejogrb.2017.12.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is independently associated with an increased risk of maternal-fetal complications. Improved glycemic control allows reducing perinatal morbidity and mortality and, specifically, the risk of macrosomia and shoulder dystocia which are the most common complications associated with GDM. Nonetheless, a need for early antenatal predictor of neonatal morbidity in women suffering from GDM is required. The objective of the study was to evaluate the efficacy of different maternal, biological, and antenatal parameters at the time of diagnosis of GDM or perinatal variables as predictors of neonatal morbidity. STUDY DESIGN This was a prospective observational study recruited all pregnant women with diagnosis of GDM at first- or second-trimester in a tertiary care hospital from July 2014 to October 2015. Different antenatal parameters (maternal weight, weight gain during pregnancy, history of GDM, history of macrosomia, serum fructosamine, HbA1c) were obtained at the time of diagnosis of GDM. Mode of delivery was also analyzed. Neonatal morbidity was defined by at least one of the following criteria: preterm birth <37 weeks, macrosomia, shoulder dystocia, respiratory distress syndrome, 5-min Apgar score <7, pH < 7.10 and admission to the NICU (neonatal intensive care unit) for 24 h. Univariate and logistic regression analyses were performed to determine independent antenatal predictors of neonatal morbidity. RESULTS Two hundred pregnant women with diagnosis of GDM were included. The mean gestational age at the time of diagnosis of GDM was 22 ± 6 weeks. Insulin was required in 72/200 (36%) women for glycemic control during pregnancy. Neonatal morbidity occurred in 21% (n = 42). In the univariate analysis, neonatal morbidity was associated with nulliparity (50% compared to 32%, p = 0.03), induction of labor (36% compared to 27%, p = 0.03) and cesarean section (36% compared to 12%, p < 0.01). Multivariable logistic regression analysis found a significant association between nulliparity and neonatal morbidity (adjusted odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.7). Cesarean delivery was also significantly associated with neonatal morbidity (aOR 7.6, 95% CI 2.9-20). CONCLUSION This suggests that nulliparity was an efficient antenatal predictor of neonatal morbidity at the time of diagnosis of GDM. Cesarean section was also associated with neonatal morbidity in women with GDM.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France.
| | | | - Aurélie Le Thuaut
- Clinical Research Center, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Joséphine Grange
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Jérôme Dimet
- Clinical Research Center, Centre Hospitalier Departemental, La Roche sur Yon, France
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Nawaz MS, Shah KU, Khan TM, Rehman AU, Rashid HU, Mahmood S, Khan S, Farrukh MJ. Evaluation of current trends and recent development in insulin therapy for management of diabetes mellitus. Diabetes Metab Syndr 2017; 11 Suppl 2:S833-S839. [PMID: 28709853 DOI: 10.1016/j.dsx.2017.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Diabetes mellitus is a major health problem in developing countries. There are various insulin therapies to manage diabetes mellitus. This systematic review evaluates various insulin therapies for management of diabetes mellitus worldwide. This review also focuses on recent developments being explored for better management of diabetes mellitus. RESEARCH DESIGN AND METHOD We reviewed a number of published articles from 2002 to 2016 to find out the appropriate management of diabetes mellitus. The paramount parameters of the selected studies include the insulin type & its dose, type of diabetes, duration and comparison of different insulin protocols. In addition, various newly developed approaches for insulin delivery with potential output have also been evaluated. RESULTS A great variability was observed in managing diabetes mellitus through insulin therapy and the important controlling factors found for this therapy include; dose titration, duration of insulin use, type of insulin used and combination therapy of different insulin. CONCLUSION A range of research articles on current trends and recent advances in insulin has been summarized, which led us to the conclusion that multiple daily insulin injections or continuous subcutaneous insulin infusion (insulin pump) is the best method to manage diabetes mellitus. In future perspectives, development of the oral and inhalant insulin would be a tremendous breakthrough in Insulin therapy.
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Affiliation(s)
- Muhammad Sarfraz Nawaz
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Kifayat Ullah Shah
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia.
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan,47500 Bandar SunwaySelangor DarulEhsan, Malaysia
| | - Asim Ur Rehman
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Haroon Ur Rashid
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Sajid Mahmood
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Shahzeb Khan
- Department of Pharmacy, University of Malakand, KPK, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Muhammad Junaid Farrukh
- Department of Pharmacy, University of Malakand, KPK, Pakistan; Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia
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Hedrington MS, Davis SN. The care of pregestational and gestational diabetes and drug metabolism considerations. Expert Opin Drug Metab Toxicol 2017; 13:1029-1038. [PMID: 28847172 DOI: 10.1080/17425255.2017.1372423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Normal pregnancy development involves gradual decline in insulin sensitivity, which sometimes requires pharmacotherapy. Insulin is the drug of choice for gestational and pregestational diabetes. Metabolism of traditional insulins results in inadequate onset and duration of action and marked peak activity. These properties increase risk of excessive glucose excursions, which are especially undesirable during pregnancy. Insulin analogs have been emerging as a safer and more effective treatment of diabetes during pregnancy. Areas covered: This manuscript reviews currently used antihyperglycemic agents: fast and long-acting insulins, metformin and glyburide. Trials demonstrating their efficacy and safety during pregnancy are described. Certain drug metabolism considerations (e.g. affinity to IGF-1) are emphasized. Expert opinion: The theories that insulin analogs bind to immunoglobulin and cross placenta have been disproved. Lispro, aspart, glargine and detemir do not transfer across the placenta and do not result in adverse maternal and neonatal outcomes. In addition, favorable pharmacokinetic profiles (rapid onset and 24-hour near peakless activity) substantially reduce blood glucose variability including hypoglycemia. We believe that insulin analogs should be given strong consideration for the treatment of diabetes during pregnancy. Metformin has also proven to be safe and may be considered as an initial single agent for milder gestational diabetes.
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Affiliation(s)
- Maka S Hedrington
- a Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stephen N Davis
- a Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
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Dell'Edera D, Sarlo F, Allegretti A, Simone F, Lupo MG, Epifania AA. The influence of D- chiro-inositol and D- myo-inositol in pregnant women with glucose intolerance. Biomed Rep 2017; 7:169-172. [PMID: 28804631 DOI: 10.3892/br.2017.939] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of the present study was to demonstrate that the use of inositol and folic acid from the first trimester of pregnancy, counteracts the onset of gestational diabetes mellitus (GDM) in women at risk, preserving the infants from macrosomia, hypoglycemia and preterm delivery. The authors collected data from the pregnant women at the laboratory (Unit of Cytogenic and Molecular Genetics), from January 2014 to April 2016, all with first trimester fasting plasma glucose (FPG) >92 mg/dl. A total of 40 women were treated with 250 mg/day D-chiro-inositol, 1.75 g/day D-myo-inositol, 12.5 mg/day zinc, 10 mg/day methylsulfonylmethane, 400 µg/day 5-methyltetrahydrofolic acid. The other 43 women (control group) were treated with only 400 µg/day folic acid. The primary outcome measure was the incidence of maternal GDM. The secondary outcome measures were the incidence of fetal macrosomia, preterm delivery and neonatal hypoglycemia. At the 24th week of pregnancy, the incidence of maternal GDM was recorded in 18 women in the control group and in 5 women in the treated group [relative risk (RR)=3.35; 95% confidence interval (CI)=1.37-8.17; P=0.0028). A significant difference was observed between treated and control groups in terms of risk of macrosomia. A total of seven infants in the control group, and two in the treated group, weighed >4,000 g (RR=5,12; 95% CI=1.21-21.68; P=0.0099). No significant difference was identified between two groups, regarding the other two secondary outcomes, neonatal hypoglycemia (RR=4.650; 95% CI=0.57-38.11; P=0.1086) and preterm delivery (RR=1.74; 95% CI=0.83-3.66; P=0.1301). The current study demonstrated the potential benefit of supplementation with the association of D-chiro-inositol and D-myo-inositol in pregnant 'at risk' women, with first trimester FPG >92 mg/dl, in preventing the onset of maternal GDM and macrosomia in newborns.
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Affiliation(s)
- Domenico Dell'Edera
- Unit of Cytogenetic and Molecular Genetics, 'Madonna delle Grazie' Hospital, 75100 Matera, Italy
| | - Francesca Sarlo
- Unit of Cytogenetic and Molecular Genetics, 'Madonna delle Grazie' Hospital, 75100 Matera, Italy
| | - Arianna Allegretti
- Unit of Cytogenetic and Molecular Genetics, 'Madonna delle Grazie' Hospital, 75100 Matera, Italy
| | - Francesca Simone
- Unit of Cytogenetic and Molecular Genetics, 'Madonna delle Grazie' Hospital, 75100 Matera, Italy
| | - Maria Giovanna Lupo
- Unit of Cytogenetic and Molecular Genetics, 'Madonna delle Grazie' Hospital, 75100 Matera, Italy
| | - Annunziata Anna Epifania
- Unit of Cytogenetic and Molecular Genetics, 'Madonna delle Grazie' Hospital, 75100 Matera, Italy
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Freitas PAC, Ehlert LR, Camargo JL. Glycated albumin: a potential biomarker in diabetes. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:296-304. [PMID: 28699985 PMCID: PMC10118799 DOI: 10.1590/2359-3997000000272] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/13/2017] [Indexed: 11/22/2022]
Abstract
Diabetes mellitus (DM) is a chronic and metabolic disease that presents a high global incidence. Glycated hemoglobin (A1C) is the reference test for long-term glucose monitoring, and it exhibits an association with diabetic chronic complications. However, A1C is not recommended in clinical situations which may interfere with the metabolism of hemoglobin, such as in hemolytic, secondary or iron deficiency anemia, hemoglobinopathies, pregnancy, and uremia. The glycated albumin (GA) is a test that reflects short-term glycemia and is not influenced by situations that falsely alter A1C levels. GA is the higher glycated portion of fructosamine. It is measured by a standardized enzymatic methodology, easy and fast to perform. These laboratory characteristics have ensured the highlight of GA in studies from the last decade, as a marker of monitoring and screening for DM, as well as a predictor of long-term outcomes of the disease. The aim of this review was to discuss the physiological and biochemistry characteristics of the GA, as well as its clinical utility in DM.
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Affiliation(s)
| | | | - Joíza Lins Camargo
- Universidade Federal do Rio Grande do Sul, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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Kalaria TR, Sirajwala HB, Gohel MG. Serum fructosamine, serum glycated albumin and serum glycated β-lipoprotein in type 2 diabetes mellitus patients with and without microvascular complications. J Diabetes Metab Disord 2016; 15:53. [PMID: 27896233 PMCID: PMC5117551 DOI: 10.1186/s40200-016-0276-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/14/2016] [Indexed: 11/23/2022]
Abstract
Background Glycation of serum proteins has been proposed as an important mechanism of complications of diabetes but whether there are differences in glycation of different serum proteins and whether it has any correlation with development of microvascular complications has not been studied in depth. This study aimed to assess level of serum fructosamine, glycated albumin and glycated β-lipoprotein in type 2 diabetes mellitus patients with and without microvascular complications and to find out their correlation with diabetes complications. Methods Case–control study involving 150 individuals at a tertiary care hospital in western India. Fifty participants were healthy controls (group 1), 50 were type 2 diabetes patients without any evident microvascular complication (group 2) and 50 were type 2 diabetes patients with one or more microvascular complications (group 3). Serum fructosamine, FBS, PP2BS and other biochemical parameters were measured. Glycated albumin and glycated β-lipoprotein were measured by agarose gel electrophoresis followed by NBT staining. Unpaired t-test was used to find out significance of difference between two groups and correlation coefficient to find out statistical correlation between two variables. Results Type 2 diabetes patients with one or more microvascular complications had poor glycemic control as indicated by markers of short and mid-term glycemia. Differences between the groups for fructosamine, glycated albumin and glycated β-lipoprotein were significant (p < 0.001). Glycated albumin correlated with FBS, PP2BS and fructosamine in all diabetic patients (group 2 and 3) whereas glycated β-lipoprotein correlated with these parameters only in group 3 and it was markedly elevated in group 3. Conclusion Serum glycated β-lipoprotein was disproportionately elevated compared to fructosamine and glycated albumin in diabetes patients with microvascular complications (group 3) and it correlated with rest of glycemic markers only in this group. Glycated β-lipoprotein might help in identifying diabetic individuals at high future risk of developing microvascular complications.
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Gilfillan C, Naidu P, Gunawan F, Hassan F, Tian P, Elwood N. Leukocyte Telomere Length in the Neonatal Offspring of Mothers with Gestational and Pre-Gestational Diabetes. PLoS One 2016; 11:e0163824. [PMID: 27736899 PMCID: PMC5063329 DOI: 10.1371/journal.pone.0163824] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022] Open
Abstract
Aims Telomeres undergo shortening with cell division, accelerated by increased oxidative stress. We aimed to demonstrate shortened telomeres in the offspring of mothers who have diabetes as a consequence of exposure to increased oxidative stress during intrauterine development. Methods We examined the level of glycaemia (glucose, HbA1c, fructosamine), oxidative stress (lipid peroxidation) and the levels of antioxidant enzymes (Superoxide dismutase (SOD) and Selenium dependent glutathione peroxidase) and correlate these findings with mean telomere length (TL) in maternal and foetal blood in groups of pregnant women with pre-gestational diabetes (PGD), gestational diabetes (GD) and a euglycaemic control group. Results Foetal and maternal glucose, maternal HbA1c, and foetal insulin and C-peptide were higher in the PGD group with the GD group being intermediate. Markers of oxidative stress did not vary between groups with the exception of foetal SOD activity that was highest in the GD group. There were no detectable differences in maternal or foetal TL between study groups. An exploratory analysis looking at correlations between glycaemic and oxidative stress parameters and TL revealed a negative correlation between maternal and foetal glucose and TL across the whole study population. This relationship held for the short-term marker of glycaemic control, fructosamine. Conclusions We were unable to show significant telomere shortening in the offspring of mothers with PGD or GD. Exploratory analysis revealed a relationship between foetal TL and short-term glycaemia particularly in PGD. It is possible that increased telomerase activity can compensate for long-term increased oxidative stress but not for short-term dysglycaemia.
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Affiliation(s)
- Christopher Gilfillan
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- * E-mail:
| | - Pratyusha Naidu
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Florence Gunawan
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Fadwa Hassan
- Peninsula Health, Frankston, Victoria, Australia
| | - Pei Tian
- Cord Blood Stem Cell Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Ngaire Elwood
- Cord Blood Stem Cell Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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Yang A, Zhao J, Lu M, Gu Y, Zhu Y, Chen D, Fu J. Expression of Hepcidin and Ferroportin in the Placenta, and Ferritin and Transferrin Receptor 1 Levels in Maternal and Umbilical Cord Blood in Pregnant Women with and without Gestational Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E766. [PMID: 27483296 PMCID: PMC4997452 DOI: 10.3390/ijerph13080766] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/05/2016] [Accepted: 07/19/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Regulation of iron transfer from mother to fetus via the placenta is not fully understood and the relationship between stored iron status in the mothers' serum and gestational diabetes (GDM) in case-control studies is controversial. The present study aimed to detect circulating soluble transferrin receptor (sTfR) and ferritin levels in maternal and umbilical cord blood. We also examined the expression of hepcidin (Hep), transferrin receptor (TfR1), and ferroportin (FPN) in the placenta in pregnant women with and without GDM at full term. METHODS Eighty-two women participated (42 with GDM and 40 without GDM [controls]). Maternal samples were collected at 37-39 weeks' gestation. Umbilical cord blood was collected at birth. Ferritin and sTfR levels in maternal serum and umbilical cord blood, and Hep, TfR1, and FPN protein expression in plac enta were compared between the GDM and non-GDM groups. Serum ferritin (SF) was measured by electrochemiluminescence assay and sTfR was measured by ELISA. Hep, TfR1, and FPN expression was measured by immunohistochemistry. RESULTS Maternal serum sTfR levels were significantly elevated in the GDM group compared with the non-GDM group (p = 0.003). SF levels in cord blood in the GDM group were significantly higher than those in the non-GDM group (p = 0.003). However, maternal hemoglobin and SF, and umbilical cord sTfR levels were not different between the groups. In placental tissue, FPN expression was higher and hepcidin expression was lower in the GDM group compared with the non-GDM group (p = 0.000 and p = 0.044, respectively). There was no significant difference in TfR1 between the groups (p = 0.898). CONCLUSIONS Women with GDM transport iron more actively than those without GDM at term pregnancy. Maternal iron metabolism in GDM may play a role in fetal/placental iron demand and in the overall outcome of pregnancy.
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Affiliation(s)
- Anqiang Yang
- Department of Pathology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Jun Zhao
- Clinical Laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Minhua Lu
- Department of Pathology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Ying Gu
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Yunlong Zhu
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Daozhen Chen
- Clinical Laboratory, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
| | - Jinyan Fu
- Department of Pathology, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
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Fujibayashi K, Hayashi M, Yokokawa H, Naito T. Changes in antidiabetic prescription patterns and indicators of diabetic control among 200,000 patients over 13 years at a single institution in Japan. Diabetol Metab Syndr 2016; 8:72. [PMID: 27843494 PMCID: PMC5103499 DOI: 10.1186/s13098-016-0187-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We examined the long-term changes in the management of diabetes at a single institution in Japan. METHODS Two repeated cross-sectional studies and a retrospective cohort study were conducted among patients who visited our institution between 2001 and 2013. We examined the changes in glycated hemoglobin (HbA1c) and glycated albumin levels, the prescription frequencies, and the daily doses of each antidiabetic agent among patients treated regularly for diabetes during the 13-year study period. The trends in control and treatment parameters were analyzed using Spearman's rank correlation coefficient. RESULTS In the first repeated cross-sectional studies, 200,298 patients had their glucose metabolism indicators measured, and diabetologists prescribed medications to 193, 445 patients. Of these, 170 patients were included in the retrospective cohort study. The patients' diabetic control tended to improve over the study period. The mean HbA1c level improved from 7.9 to 7.6% (from 63 to 60 mmol/mol) (rs = -0.11, p < 0.01) in the cross-sectional study, corresponding to a change from 8.2 to 7.7% (from 66 to 61 mmol/mol) (rs = -0.22, p < 0.01) in the retrospective study. The mean GA level improved from 22.7 to 20.7% (rs = -0.13, p < 0.01) in the cross-sectional study and from 23.5 to 21.5% (rs = -0.14, p < 0.01) in the retrospective study. Over the study period, prescription frequencies and daily doses of antidiabetic agents changed as treatment guidelines were altered. CONCLUSIONS The present study revealed a tendency toward long-term improvements in diabetic control, with changes in the prescription patterns consistent with research and guideline evidence.
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Affiliation(s)
- Kazutoshi Fujibayashi
- Department of General Medicine, School of Medicine, Juntendo University, 3-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421 Japan
| | - Michio Hayashi
- Endocrinology and Metabolism Division, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 Japan
| | - Hirohide Yokokawa
- Department of General Medicine, School of Medicine, Juntendo University, 3-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421 Japan
| | - Toshio Naito
- Department of General Medicine, School of Medicine, Juntendo University, 3-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421 Japan
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Huang Y, Hu Y, Ma YU, Ye G. Glycated albumin is an optimal biomarker for gestational diabetes mellitus. Exp Ther Med 2015; 10:2145-2149. [PMID: 26668607 PMCID: PMC4665611 DOI: 10.3892/etm.2015.2808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/15/2015] [Indexed: 12/14/2022] Open
Abstract
Gestational diabetes mellitus (GDM) refers to abnormal glucose tolerance, which is a common complication that occurs in some women for the first time during the gestation period. However, the relationship between onset of GDM and factors including advanced age and a family history of diabetes remains to be determined. The study aimed to examine the clinical significance of the detection of glycated albumin (GA) in pregnant women with GDM. A total of 893 cases of pregnant women with GDM were included, with 661 healthy pregnant women serving as the normal controls. A conditional logistic regression model was used to analyze the univariate and multivariate data to estimate the odds ratio (OR) and 95% confidence interval (95% CI). As the gestational weeks increased, the fasting blood glucose (FGP) concentration and GA-L value of the pregnant women in the normal control group gradually decreased whereas those of pregnant women with GDM greatly increased. The univariate analysis revealed that the impact factors on the occurrence of early-onset neonatal sepsis included, mother's age >35 years, complication of pregnancy hypertension, family history of hypertension, family history of diabetes, cesarean delivery, height, BMI, GA-L, and FGP. The multivariate logistic regression analysis revealed that the complication of pregnancy hypertension (OR=3.302; 95% CI, 1.705–6.394), family history of hypertension (OR=2.970; 95% CI, 1.520–5.801), GA-L (OR=1.556; 95% CI, 0.940–2.012) and FGP (OR=5.431; 95% CI, 4.097–7.198) were the main factors for pregnant women with GDM. In conclusion, pregnant women with GDM may be affected by various factors. Additionally, GA may be applied to reflect the recent blood glucose control on pregnant women with GDM.
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Affiliation(s)
- Yaping Huang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yongwei Hu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Y U Ma
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Guangyong Ye
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
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