Diabetes screening after gestational diabetes mellitus: poor performance of fasting plasma glucose

Gestational diabetes mellitus (GDM) is an established risk factor for the development of overt diabetes. Since the change in diagnostic criteria for diabetes in 1997, it is unclear whether there should be any preference for fasting or post-glucose challenge blood glucose in diagnosing diabetes after GDM. The study aimed at assessing the usefulness of both diagnostic methods in women after GDM. The study enrolled 193 women with previous GDM. Women who did not have a current diagnosis of diabetes were screened for impaired fasting glucose (IFG) and for glucose intolerance with an oral 75-g glucose tolerance test. A total of 45 (23.3%) subjects declared to be already diabetic. Of the 148 non-diabetic subjects, 141 (95.3%) had normal fasting plasma glucose, whereas four (2.8%) had IFG (i.e. FPG> or =6.1 and <7.0 mmol/l) and 3 (2.5%) had FPG> or =7.0 mmol/l. Upon OGTT, among the 141 subjects with normal FPG, 6 (4.3%) were diagnosed with diabetes and 23 (16.3%) with impaired glucose tolerance (IGT); the remaining 112 (79.5%) had normal glucose tolerance. Three out of four subjects with IFG had IGT. The sensitivities of fasting criteria for diagnosis of diabetes and IFG/IGT were 14.3% (95% CI, 8.0%-37.2%) and 17.1% (95% CI, 8.6%-19.8%), respectively. The specificities were 98.6% (95% CI, 97.9%-99.7%) and 99.1% (95% CI, 96.5%-100%), respectively. The kappa for diabetes diagnosis was 0.177 (95% CI, 0.018-0.507). For women with previous GDM, the sensitivity of the new criteria based upon fasting plasma glucose is unacceptably low. In addition, the two sets of criteria are not interchangeable. Therefore, we suggest full glucose tolerance diagnostic procedures in women after GDM, including assessment of post-glucose challenge values.

Psychomotor development in the children of mothers with type 1 diabetes mellitus or gestational diabetes mellitus

The purpose of this study was to examine psychomotor development in children born to mothers with type 1 diabetes mellitus (DM1) or gestational diabetes mellitus (GDM). The influence of metabolic control in pregnant diabetic mothers and complications during labor on their children's psychological and physical development was evaluated. The analysis included 59 children, 20 of mothers with GDM, 19 of mothers with DM1, and 20 children of healthy mothers. Clinical observations and medical history were recorded and children were assessed using the Brunet-Lezine Psychomotor Development Scale. Abnormalities were found more often in the children of mothers with DM1 whose illness was insufficiently controlled during pregnancy and of mothers with serious hypoglycemia while pregnant. Speech, eye-movement coordination and social aspects were affected.

Levels of mannose binding lectin in early pregnancy complicated by diabetes mellitus type 1--preliminary report

The complement system plays an important role as a product of innate and acquired immune reaction. It can be activated via three different routes: the classical pathway, the alternative pathway and the lectin pathway. MBL (mannose-binding lectin) is considered to be a pathogen recognising receptor (PRR), an important factor in recognising pathogen associated molecular pattern (PAMP). The aim of study was to evaluate MBL in early pregnancy of diabetic mothers. Higher values of MBL were observed in diabetic non-pregnant women compared to healthy non-pregnant. Subjects early pregnancy seems to decrease MBL values in both diabetic and healthy pregnant women.

[Peripheral blood neutrophils reactive oxygen intermediates (ROI) production in early pregnancy complicated by diabetes mellitus type I]

The components of maternal innate immune system are activated in pregnancy. Increased number of circulating neutrophils and monocytes, reactive oxygen intermediate production (ROI), increased expression of the adhesion molecules can be observed. The activation status and neutrophils response to stimulators in pregnant diabetic women's comprise, to some extend, both situations pregnancy and diabetes, combined effect of both seems to be very intriguing.

AIM OF STUDY

Evaluation production of ROI on peripheral blood neutrophils in early pregnancy of diabetic mothers.

MATERIAL

12 pregnant diabetic women demonstrating good glycemic control and without major complications before pregnancy were studied at 8-12 weeks of first gestation, 11 healthy pregnant women match for weeks of gestation, age and parity; 11 healthy non-diabetic women; 13 diabetic, non-pregnant women, were also studied.

METHODS

ROI production was evaluated with chemiluminescence method using standard stimuli fMLP, PMA, OZ and also after 15 min. priming with TNF-alpha. We used MLX Microtiter Plate Luminometr DYNEX, USA. with computer program Revelation 97. For statistic analysis Fisher, Kolmogorow-Smirnow and Wilcoxon tests were used (p < 0.05).

RESULTS

1. Peripheral blood neutrophils of healthy pregnant, diabetic and pregnant diabetic women independently from the stimuli used showed an increase in ROI production 2. Peripheral blood neutrophils change their activity, evaluate by ROI production during pregnancy, diabetes and pregnancy complicated by diabetes. 3. Peripheral blood neutrophils of pregnant diabetes women do not show expected impairment of their function.

CONCLUSIONS

Diabetes type 1 with good glycemic control and pregnancy, change the production of ROI by peripheral blood neutrophils but these events do not sum up in diabetic pregnancies.

[Studies on the incidence and clinical significance of the metabolic syndrome in postmenopausal women in Lodz region]

In menopausal period increased prevalence of lipid metabolism disorders, atherosclerosis, carbohydrate metabolism disorders, cardiovascular diseases is observed.

AIM OF STUDY

Evaluation of prevalence of obesity, overweight, hypertension, carbohydrate and lipid metabolism disorders in population of women aged 45-65, treated in Menopause Diagnostic and Treatment Center Polish Mother's Memorial Hospital--Research Institute in Lodz. 2081 women, aged 45-65 were studied. In all of them diseases history, body mass index (BMI), blood pressure (twice), total cholesterol, triglycerides, fasting blood glucose levels were obtained. The highest percentage of obese women was noted in small villages (39%), whereas 21% of women from cities have BMI > or = 30 kg/m2. On the other side only 18.4% women living in cities have normal body weight, although in small villages there are 34.6% women from this group. Overweighted women percentage is similar among women living in small villages and cities. Hypertension prevalence did not depend on place of living, but obese women have hypertension more frequently. In study group diabetes mellitus was diagnosed in 4.8% of women and impaired glucose tolerance in 7%. Almost 2/3 of diabetes mellitus cases was first time diagnosed. Fasting blood glucose (FBG) level > or = 125 mg/dl was noted in 62 women (3%), values 111-124 mg/dl in 124 (6%), and in other 1895 women (91%) FBG was < or = 110 mg/dl. FBG level over 124 mg/dl and diabetes mellitus was more frequent in obese women. Women with hypercholesterolemia mostly (63.2%) have BMI > 25 kg/m2. Our study revealed that hypercholesterolemia prevalence did not differ with no statistical significance between women living in cities, towns and small villages. Elevated triglycerides level over 2.26 mmol/l was noted in 14.5% studied women, whereas there was no correlation between triglycerides level and body weight and place of living. Main health problem of women in perimenopausal period is obesity and lipid metabolism disorders detected in significant number of studied patients. Most cases of undiagnosed diabetes mellitus indicate that complex evaluation of health status of women in perimenopausal period is obligatory procedure.

[Evaluation of selected X syndrome factors during hormonal replacement therapy]

Estrogen deficiency after menopause leads to characteristics changes in the hormonal profile, which may influence lipid carbohydrate and calcium-phosphate metabolism and some elements of homeostasis.

AIM OF STUDY

To evaluate the influence of hormone replacement therapy with 2 mg estradiol valerate and 0,15 mg levonorgestrel on carbohydrate and lipid metabolism in women after menopause during 12 months of follow-up. We examined 101 women, mean age 52.9 +/- 4.6 years (range from 44 to 65). HRT was applied in 67 women whereas 34 women were without treatment. All of them had no carbohydrate disturbances. All women underwent clinical examination, and body mass index (BMI), fasting blood glucose, insulin, total cholesterol and triglycerides levels were obtained. At 1 and 2 hours after 75 g glucose challenge (75OGTT) glucose and insulin levels were obtained. During hormone replacement therapy all women noted release or significant decrease of climacteric symptoms. Total cholesterol level was decreased, whereas triglycerides did not change. After 12 months of treatment there was also a significant decrease of all factors relating to carbohydrate metabolism--fasting glucose and insulin, insulin/glucose ratio and area under glucose and insulin curves. In our study--after 6 months of follow-up fasting insulin level, area under glucose and insulin curves were increased whereas fasting blood glucose level remained unchanged. Among women without HRT there were no significant changes in selected lipid parameters and BMI. Triglyceride levels decreased (albeit insignificantly) but, total cholesterol levels did not change. After 12 months glucose level did not change, although other carbohydrate parameters were increased. 1) In the study group there was a statistically significant decrease in total cholesterol levels whereas triglycerides remained unchanged. 2) HRT we significantly decreased of insulin resistance and fasting blood glucose levels as compared with non-group HRT. 3) The present results indicate HRT-induced improvement of lipid and carbohydrate metabolism. 4) Long-term HRT is necessary to improve carbohydrate metabolism.

[Pregnancy in women with diabetic nephropathy]

Among 244 pregnant with diabetes type 1 in 21 (8.61%) cases nephropathy was noticed, which was accompanied by such complications as: retinopathy--85.7%, H.A.--42.9%, PIH--28.6%, anaemia--42.9%. During the course of pregnancy statistically significant increase of biochemical parameters such as: proteinuria, serum urea and creatinine levels was noticed. Preterm delivery represented 66.6% (the average delivery time approximately 33 week of the pregnancy), IUGR appeared in 26.3% of cases, and neonatal mortality was equal 15.9%. The proteinuria amount was negatively correlated with neonatal birth weight similarly as the pregnant serum urea level was negatively correlated with Apgar score.

[Evaluation of some neutrophil adhesion molecules in pregnancy complicated by diabetes mellitus type 1]

The effective functions of human peripheral blood neutrophil are modulated by regulatory molecules depending on receptor agonists and adhesion molecules.

OBJECTIVES

Evaluation of percentage of neutrophil adhesion molecules in pregnancy of diabetic mothers as well as their expression on peripheral blood neutrophils.

MATERIAL

A-12 pregnant diabetic women at 7-13 and 34-36 weeks of first gestation, B-11 healthy pregnant women match for gestation, age and parity; C-11 healthy non-diabetic women; D-14 diabetic, non-pregnant women.

METHODS

MFI expression and percentage of CD18, CD11b, CD62L and CD54 were evaluated resting and activated by 30 min., fMLP preincubation using monoclonal antibodies anti-CD11b and anti-CD62L, employing Flow Cytometer FACSCalibur with computer program CELLquest.

RESULTS

Expression of CD11b and CD18 receptor on leukocyte of A, B, D groups was higher spontaneous and after stimulation by fMLP in I-st trimester compare to group C and then lowered in IIIrd. The significant difference in CD62L percentage was noticed resting and activated neutrophils in group A, which was lower compared to C and expression of CD62L on peripheral blood neutrophils was higher in group B compared to other studied groups in Ist trimester. There was an increase in expression of CD54 on resting neutrophils of group D when compared with C. A significant difference between Ist and IIIrd trimester was noticed in group A in expression of CD62L,CD62L/fMLP,CD54 on peripheral blood neutrophils, which were higher in the third trimester. Expression of CD62L was higher in the group A when compared to B.

CONCLUSIONS

Diabetes type 1 and pregnancy changed the percentage and MFI of neutrophil adhesion molecules.

[Prospective neurological analysis of development of children of mothers with IDDM]

Aim of the study was early diagnosis of CNS damage and dysfunction in the progeny of women with diabetes type 1 (DM1). Interdependencies between the course of diabetes in mothers and fetal-perinatal complications and neurological state of the progeny were also analysed. 35 children of mothers with DM1 and 109 in control group underwent neurological examinations at the age of 3, 6, 9, 12 and 18 months.

RESULTS

In the group of children of DM1 mothers four had symptoms of CNS damage such as cerebral palsy or psychomotor delay. In the remaining 9 children so-called "soft" neurological signs or minor neurological dysfunction were found. In control group 1 had a light form of cerebral palsy and 3 had symptoms of minor neurological dysfunction. The dependencies of frequency and gravity of neurological disorders in children on diabetes metabolic control and complications and hypoxemic-ischemic states, prematurity, macrosomia and hypoglycemia in newborns was observed.

CONCLUSION

The symptoms of CNS dysfunctions are more frequent and more serious in children of DM1 mothers than in control group.

[Usefulness of glycated hemoglobin (HbA1c) as a predictive factor in GDM pregnancies]

OBJECTIVES

The aim of the study was to examine if the glicated haemoglobin (HbA1C) is useful as an indicator of disturbances of the carbohydrate metabolism in women who suffered from Gestational Diabetes Mellitus (GDM), and for prediction of the macrosomic infants.

MATERIAL AND METHODS

The examination was performed on 163 GDM women, who were treated in Diabetic Care Unit (1996-98) in Research Institute CZMP in Lódź. GDM was diagnosed between 20 and 32 week of gestation, on the ground of 50 g Glucose Challenge Test (GCT) and 2-hour glucose tolerance test (75OGTT), according to WHO. HbA1C was examined during the first visit in hospital. All women were distributed into two groups: 120--treated with diet alone (G1), 43--treated also with insulin (G2). All the parameters were statistically analized.

RESULTS

Patients from G2 group were older and had higher glucose values in all diagnostic tests then patients from G1 group. The average HbA1C level in the whole GDM group was 5.9 +/- 1.0% (min. 4.3%; max 9.6%) and was substantially higher in G2 (6.5 +/- 0.9%) then G1 (5.7 +/- 1.0%): p < 0.05. The HbA1C level correlated with fasting glycemia and 1-hour 50GCT (p < 0.05) and did not correlated with 2-hour 75OGTT. We found the relationship between newborns body weight and 2-hour 75OGTT only in G2 group, but newborns body weight did not correlated with HbA1C level. There were no correlation between GDM duration and HbA1C level.

CONCLUSIONS

1. Glycosylated haemoglobin can not be the indicator of appearance the fetuses macrosomy. 2. The increased HbA1C level is predictive value for insulin treatment. 3. Body weight of children from insulin treated GDM mothers is connected with fasting and 2-hour 75OGTT glucose level.

[Bacterial flora in infections of the urinary system system in pregnant women with pre-gestational diabetes]

Urinary tract infections are accounted to serious complications, particularly in pregnancy complicated by diabetes. In this paper, cases of pregnancy have been analysed, affected by diabetes of type 1 and type 2, according to status of metabolic control and the type of urinary tract infection. In a group of 217 diabetic pregnant women, the incidence of urinary tract infections was 26.7%, 19.0% of them being recurrent. In the group with bad metabolic control, infections were statistically more frequent (17.4% vs. 37.3%, p = 0.001); bacteriuria without clinical demonstrations 10.4% vs. 19.6% (p > 0.05), pyelonephritis (7.0% vs. 17.7%, p = 0.001). The following types of pathogenic bacteria were found: E. coli--44.4%, Staphylococcous--28.9%, Enterococcocus--18.7%. A high frequency of Gram (+) bacteria was observed. A good metabolic control without chronic diabetic complications correlated with less frequent infections of the urinary tract.

[Evaluation of carbohydrate metabolism in women with previous gestational diabetes mellitus]

70 women with previous (1983-1993) history of gestational diabetes mellitus (GDM) were examined in order to assess their present carbohydrate metabolism. The through examination together with oral glucose tolerance test (OGTT) according to WHO were performed. Also the level of glycosylated hemoglobin HbA1c was measured. The following risk factors were analysed: obesity; arterial hypertension; family history of diabetes; number of past pregnancies; time that passed since the pregnancy with GDM; trimester in which GDM was diagnosed. In result 54% of all subjects were diagnosed as having diabetes mellitus, 19% had impaired glucose tolerance (IGT). The presence of diabetes or IGT significantly correlated with the number of past pregnancies, observation time and indirectly with family history of diabetes. Using both measurements of fasting blood glucose and glycosylated hemoglobin enables to diagnose nearly 80% of diabetes following GDM and as a diagnostic method is worth recommending for screening. Women who had GDM should be subjected to control examinations towards diabetes mellitus at least once a year.