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Bellido V, Aguilera E, Cardona-Hernandez R, Diaz-Soto G, González Pérez de Villar N, Picón-César MJ, Ampudia-Blasco FJ. Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes. J Diabetes Sci Technol 2023; 17:1326-1336. [PMID: 35470692 PMCID: PMC10563535 DOI: 10.1177/19322968221088601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New metrics for assessing glycemic control beyond HbA1c have recently emerged due to the increasing use of continuous glucose monitoring (CGM) in diabetes clinical practice. Among them, time in range (TIR) has appeared as a simple and intuitive metric that correlates inversely with HbA1c and has also been newly linked to the risk of long-term diabetes complications. The International Consensus on Time in Range established a series of target glucose ranges (TIR, time below range and time above range) and recommendations for time spent within these ranges for different diabetes populations. These parameters should be evaluated together with the ambulatory glucose profile (AGP). Using standardized visual reporting may help people with diabetes and healthcare professionals in the evaluation of glucose control in frequent clinical situations. The objective of the present review is to provide practical insights to quick interpretation of patient-centered metrics based on flash glucose monitoring data, as well as showing some visual examples of common clinical situations and giving practical recommendations for their management.
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Affiliation(s)
- Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Aguilera
- Endocrinology and Nutrition Department, Health Sciences Research Institute and University, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Gonzalo Diaz-Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
| | | | - María J. Picón-César
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Javier Ampudia-Blasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Research Foundation, Valencia, Spain
- CIBERDEM, Madrid, Spain
- Universitat de Valencia, Valencia, Spain
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Picón-César MJ, González-Romero S. Reply: regarding "MeDiGes study: a brief subanalysis on women diagnosed with gestational diabetes mellitus since the 24th gestational week". Am J Obstet Gynecol 2022; 226:590-592. [PMID: 34666052 DOI: 10.1016/j.ajog.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/01/2022]
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Molina-Vega M, Picón-César MJ, Gutiérrez-Repiso C, Fernández-Valero A, Lima-Rubio F, González-Romero S, Moreno-Indias I, Tinahones FJ. Metformin action over gut microbiota is related to weight and glycemic control in gestational diabetes mellitus: A randomized trial. Biomed Pharmacother 2021; 145:112465. [PMID: 34844107 DOI: 10.1016/j.biopha.2021.112465] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Metformin, which is known to produce profound changes in gut microbiota, is being increasingly used in gestational diabetes mellitus (GDM). The aim of this study was to elucidate the differences in gut microbiota composition and function in women with GDM treated with metformin compared to those treated with insulin. METHODS From May to December 2018, 58 women with GDM were randomized to receive insulin (INS; n = 28) or metformin (MET; n = 30) at the University Hospital Virgen de la Victoria, Málaga, Spain. Basal visits, with at least 1 follow-up visit and prepartum visit, were performed. At the basal and prepartum visits, blood and stool samples were collected. The gut microbiota profile was determined through 16S rRNA analysis. RESULTS Compared to INS, women on MET presented a lower mean postprandial glycemia and a lower increase in weight and body mass index (BMI). Firmicutes and Peptostreptococcaceae abundance declined, while Proteobacteria and Enterobacteriaceae abundance increased in the MET group. We found inverse correlations between changes in the abundance of Proteobacteria and mean postprandial glycemia (p = 0.023), as well as between Enterobacteriaceae and a rise in BMI and weight gain (p = 0.031 and p = 0.036, respectively). Regarding the metabolic profile of gut microbiota, predicted metabolic pathways related to propionate degradation and ubiquinol biosynthesis predominated in the MET group. CONCLUSION Metformin in GDM affects the composition and metabolic profile of gut microbiota. These changes could mediate, at least in part, its clinical effects. Studies designed to assess how these changes influence metabolic control during and after pregnancy are necessary.
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Affiliation(s)
- María Molina-Vega
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, Málaga, Spain
| | - María J Picón-César
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Carolina Gutiérrez-Repiso
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
| | - Andrea Fernández-Valero
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Fuensanta Lima-Rubio
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, Málaga, Spain
| | - Stella González-Romero
- Department of Endocrinology and Nutrition, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Isabel Moreno-Indias
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain.
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, Madrid, Spain
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Picón-César MJ, Molina-Vega M, Suárez-Arana M, González-Mesa E, Sola-Moyano AP, Roldan-López R, Romero-Narbona F, Olveira G, Tinahones FJ, González-Romero S. Metformin for gestational diabetes study: metformin vs insulin in gestational diabetes: glycemic control and obstetrical and perinatal outcomes: randomized prospective trial. Am J Obstet Gynecol 2021; 225:517.e1-517.e17. [PMID: 33887240 DOI: 10.1016/j.ajog.2021.04.229] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gestational diabetes that is not properly controlled with diet has been commonly treated with insulin. In recent years, several studies have published that metformin can lead to, at least, similar obstetrical and perinatal outcomes as insulin. Nevertheless, not all clinical guidelines endorse its use, and clinical practice is heterogeneous. OBJECTIVE This study aimed to test whether metformin could achieve the same glycemic control as insulin and similar obstetrical and perinatal results, with a good safety profile, in women with gestational diabetes that is not properly controlled with lifestyle changes. STUDY DESIGN The metformin for gestational diabetes study was a multicenter, open-label, parallel arms, randomized clinical trial performed at 2 hospitals in Málaga (Spain), enrolling women with gestational diabetes who needed pharmacologic treatment. Women at the age of 18 to 45 years, in the second or third trimesters of pregnancy, were randomized to receive metformin or insulin (detemir or aspart). The main outcomes were (1) glycemic control (mean glycemia, preprandial and postprandial) and hypoglycemic episodes and (2) obstetrical and perinatal outcomes and complications (hypertensive disorders, type of labor, prematurity, macrosomia, large for gestational age, neonatal care unit admissions, respiratory distress syndrome, hypoglycemia, jaundice). Outcomes were analyzed on an intention-to-treat basis. RESULTS Between October 2016 and June 2019, 200 women were randomized, 100 to the insulin-treated group and 100 to the metformin-treated group. Mean fasting and postprandial glycemia did not differ between groups, but postprandial glycemia was significantly better after lunch or dinner in the metformin-treated-group. Hypoglycemic episodes were significantly more common in the insulin-treated group (55.9% vs 17.7% on metformin; odds ratio, 6.118; 95% confidence interval, 3.134-11.944; P=.000). Women treated with metformin gained less weight from the enrollment to the prepartum visit (36-37 gestational weeks) (1.35±3.21 vs 3.87±3.50 kg; P=.000). Labor inductions (45.7% [metformin] vs 62.5% [insulin]; odds ratio, 0.506; 95% confidence interval, 0.283-0.903; P=.029) and cesarean deliveries (27.6% [metformin] vs 52.6% [insulin]; odds ratio, 0.345; 95% confidence interval, 0.187-0.625; P=.001) were significantly lower in the metformin-treated group. Mean birthweight, macrosomia, and large for gestational age and babies' complications were not different between treatment groups. The lower cesarean delivery rate for women treated with metformin was not associated with macrosomia, large or small for gestational age, or other complications of pregnancy. CONCLUSION Metformin treatment was associated with a better postprandial glycemic control than insulin for some meals, a lower risk of hypoglycemic episodes, less maternal weight gain, and a low rate of failure as an isolated treatment. Most obstetrical and perinatal outcomes were similar between groups.
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Affiliation(s)
- María J Picón-César
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - María Molina-Vega
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - María Suárez-Arana
- Department of Obstetrics and Gynecology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Ernesto González-Mesa
- Department of Obstetrics and Gynecology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain
| | - Ana P Sola-Moyano
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Reyes Roldan-López
- Department of Neonatology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Francisca Romero-Narbona
- Department of Neonatology, Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Gabriel Olveira
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas, Madrid, Spain.
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; Universidad de Málaga, Málaga, Spain; CIBER de Fisiopatología de la Obesidad y la Nutrición, Madrid, Spain.
| | - Stella González-Romero
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain; CIBER de Diabetes y Enfermedades Metabólicas, Madrid, Spain
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Molina-Vega M, Gutiérrez-Repiso C, Lima-Rubio F, Suárez-Arana M, Linares-Pineda TM, Cobos Díaz A, Tinahones FJ, Morcillo S, Picón-César MJ. Impact of the Gestational Diabetes Diagnostic Criteria during the Pandemic: An Observational Study. J Clin Med 2021; 10:4904. [PMID: 34768425 PMCID: PMC8585066 DOI: 10.3390/jcm10214904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To analyze the effect of applying alternative diagnostic criteria for gestational diabetes mellitus (GDM) during the COVID-19 pandemic on GDM prevalence and obstetrical and perinatal outcomes, in comparison to usual diagnostic approaches. METHODS Data from women referred to GDM diagnosis from 1 September to 30 November 2019 were retrospectively collected (2019-group). The same data from the same period in 2020 were prospectively collected (2020-group). In both cases, a two-step diagnostic approach was used, the first step being a screening test (1 h 50 goral glucose tolerance test, OGTT). In 2019 it was followed by a 100 gr OGTT for diagnosis. In 2020, this was replaced by a blood test for the measurement of plasma glucose and HbA1c, according to alternative GDM diagnostic criteria during the COVID-19 pandemic. RESULTS From 237 women in the 2019 group, 40 (16.9%) were diagnosed with GDM, while from 255 women in the 2020 group, 37 (14.5%) had GDM (p = 0.470). More women in the 2020 group, in comparison to the 2019 group, were nulligravid (41.9% vs. 47.2%, p = 0.013), had a personal history of GDM (11.4% vs. 4.6%, p = 0.013) and had macrosomia in previous pregnancies (10.2% vs. 2.1%, p = 0.001). Obstetrical and perinatal outcomes were similar when comparing women with GDM to non-GDM women in the 2019 and 2020 groups and between GDM women and non-GDM women. CONCLUSION In a Spanish population, GDM prevalence during the COVID-19 pandemic using the alternative diagnostic criteria was similar to that found in 2019 using the usual diagnostic criteria. Despite women referred for GDM diagnosis during the pandemic having more GDM risk factors, obstetrical and perinatal outcomes were comparable to those observed before the pandemic.
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Affiliation(s)
- María Molina-Vega
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
| | - Carolina Gutiérrez-Repiso
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Fuensanta Lima-Rubio
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
| | - María Suárez-Arana
- Departmento de Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, IBIMA, 29009 Málaga, Spain;
| | - Teresa María Linares-Pineda
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Andrés Cobos Díaz
- Laboratorio de Análisis Clínico, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Francisco J. Tinahones
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Sonsoles Morcillo
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - María J. Picón-César
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
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Picón-César MJ, Molina-Vega M, González-Romero S. Gestational diabetes, metformin, and risk of hypoglycemia. Am J Obstet Gynecol 2021; 225:352-353. [PMID: 34051168 DOI: 10.1016/j.ajog.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- María J Picón-César
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - María Molina-Vega
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Stella González-Romero
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya 84, 29019 Málaga, Spain; CIBER Diabetes and Associated Metabolic Diseases, Madrid, Spain.
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