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van Poppel M, Corcoy R, Simmons D, Desoye G, Mendizabal L, Zulueta M. Interaction between MTNR1B polymorphisms and lifestyle intervention on pregnancy outcomes. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Interactions between polymorphisms of the melatonin receptor 1B gene (MTNR1B) and lifestyle intervention for gestational diabetes have been described. Whether these are specific for physical activity or healthy eating intervention is unknown.
Objectives
To assess the interaction between MTNR1B rs10830962 and rs10830963 polymorphisms and lifestyle interventions during pregnancy.
Methods
Women with a BMI of ≥ 29 kg/m2 (n = 436) received counseling on healthy eating (HE), physical activity (PA) or both. The control group received usual care. The analysis had a factorial design with comparison of HE versus no HE and PA versus no PA. Maternal outcomes at 24-28 weeks were gestational weight gain (GWG), maternal fasting glucose, insulin, insulin resistance (HOMA-IR), and development of GDM. Interaction between receiving either HE or PA intervention and genotypes of both rs10830962 and rs10830963 was assessed using multilevel regression analysis.
Results
GDM risk was increased in women homozygous for the G allele of rs10830962 or rs10830963 (OR 2.60 [95% CI 1.34, 5.06] and 2.83 [1.24, 6.47], respectively). Significant interactions between rs10830962 and interventions were found: In women homozygous for the G allele, but not in the other genotypes, the PA intervention reduced maternal fasting insulin (beta -0.16 [95%CI -0.33, 0.02], p = 0.08) and HOMA-IR (-0.17 [-0.35, 0.01], p = 0.06). In heterozygous women, HE intervention had no effect, whereas in women homozygous for the C allele, HE intervention reduced GWG (-1.6 kg [-2.4, -0.8]).
Discussion
In women homozygous for the risk allele of MTNR1B rs10830962, GDM risk was increased and PA intervention might be more beneficial than HE intervention for reducing maternal insulin resistance.
Key messages
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Affiliation(s)
- M van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz , Graz, Austria
| | - R Corcoy
- Institut de Recerca de ĺHospital de la Santa Creu , Barcelona, Spain
| | - D Simmons
- Western Sydney University , Campbelltown, Australia
| | - G Desoye
- Department of Obstetrics and Gynecology, Medical Universit , Graz, Austria
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Mateu-Salat M, Asla Q, Chico A, Martínez MC, Martínez MJ, López A, Pujol I, Corcoy R. Feasibility of maintaining near-normal glucose control in pregnant women with type 1 diabetes during COVID-19 lockdown. Acta Diabetol 2022; 59:977-979. [PMID: 35230539 PMCID: PMC8886860 DOI: 10.1007/s00592-022-01862-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 11/12/2022]
Affiliation(s)
- M Mateu-Salat
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
| | - Q Asla
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
| | - A Chico
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M C Martínez
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
| | - M J Martínez
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
| | - A López
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
| | - I Pujol
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain
| | - R Corcoy
- Department of Endocrinology and Nutrition, Hospital de La Santa Creu I Sant Pau, C/Sant Quintí 89, 08042, Barcelona, Spain.
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
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Acosta-Manzano P, Leopold-Posch B, Simmons D, Devlieger R, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Tanvig M, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill DJ, Snoek FJ, Jelsma J, Desoye G, van Poppel M. The unexplored role of sedentary time and physical activity in glucose and lipid metabolism-related placental mRNAs in pregnant women who are obese: the DALI lifestyle randomised controlled trial. BJOG 2022; 129:708-721. [PMID: 34559946 DOI: 10.1111/1471-0528.16945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We aimed to explore: (i) the association of sedentary time (ST) and physical activity (PA) during pregnancy with the placental expression of genes related to glucose and lipid metabolism in pregnant women who are obese; (ii) maternal metabolic factors mediating changes in these placental transcripts; and (iii) cord blood markers related to the mRNAs mediating neonatal adiposity. DESIGN Multicentre randomised controlled trial. SETTING Hospitals in nine European countries. POPULATION A cohort of 112 pregnant women with placental tissue. METHODS Both ST and moderate-to-vigorous PA (MVPA) levels were measured objectively using accelerometry at three time periods during pregnancy. MAIN OUTCOME MEASURES Placental mRNAs (FATP2, FATP3, FABP4, GLUT1 and PPAR-γ) were measured with NanoString technology. Maternal and fetal metabolic markers and neonatal adiposity were assessed. RESULTS Longer periods of ST, especially in early to middle pregnancy, was associated with lower placental FATP2 and FATP3 expression (P < 0.05), whereas MVPA at baseline was inversely associated with GLUT1 mRNA (P = 0.02). Although placental FATP2 and FATP3 expression were regulated by the insulin-glucose axis (P < 0.05), no maternal metabolic marker mediated the association of ST/MVPA with placental mRNAs (P > 0.05). Additionally, placental FATP2 expression was inversely associated with cord blood triglycerides and free fatty acids (FFAs; P < 0.01). No cord blood marker mediated neonatal adiposity except for cord blood leptin, which mediated the effects of PPAR-γ on neonatal sum of skinfolds (P < 0.05). CONCLUSIONS In early to middle pregnancy, ST is associated with the expression of placental genes linked to lipid transport. PA is hardly related to transporter mRNAs. Strategies aimed at reducing sedentary behaviour during pregnancy could modulate placental gene expression, which may help to prevent unfavourable fetal and maternal pregnancy outcomes. TWEETABLE ABSTRACT Reducing sedentary behaviour in pregnancy might modulate placental expression of genes related to lipid metabolism in women who are obese.
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Affiliation(s)
- P Acosta-Manzano
- PA-HELP 'Physical Activity for Health Promotion, CTS-1018' Research Group, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
- Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - B Leopold-Posch
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - D Simmons
- Western Sydney University, Campbelltown, New South Wales, Australia
| | - R Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - S Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - R Corcoy
- CIBER Bioengineering, Biomaterials and Nanomedicine, Instituto de Salud Carlos III, Zaragoza, Spain
| | - J M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Dunne
- Galway Diabetes Research Centre (GDRC) and National University of Ireland, Galway, Ireland
| | - J Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - P Damm
- Departments of Endocrinology and Obstetrics, Rigshospitalet and Department of Clinical Medicine, Centre for Pregnant Women with Diabetes, University of Copenhagen, Copenhagen, Denmark
| | - E R Mathiesen
- Departments of Endocrinology and Obstetrics, Rigshospitalet and Department of Clinical Medicine, Centre for Pregnant Women with Diabetes, University of Copenhagen, Copenhagen, Denmark
| | - D M Jensen
- Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - L L Andersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - M Tanvig
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - A Lapolla
- Department of Medical and Surgical Sciences, Università degli Studi di Padova, Padua, Italy
| | - M G Dalfra
- Department of Medical and Surgical Sciences, Università degli Studi di Padova, Padua, Italy
| | - A Bertolotto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poznan, Poland
| | - A Zawiejska
- Chair of Medical Education, Department of Medical Simulation, Poznan University of Medical Sciences, Poznan, Poland
| | - D J Hill
- Lawson Health Research Institute, London, Ontario, Canada
| | - F J Snoek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, VU University, Amsterdam, the Netherlands
| | - Jgm Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - G Desoye
- Department of Obstetrics and Gynaecology, Medical University Graz, Graz, Austria
| | - Mnm van Poppel
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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Mateu-Salat M, Corcoy R. Labetalol and hypoglycaemia unawareness: two case reports and considerations about its use as an antihypertensive drug for women with diabetes and pregnancy. Acta Diabetol 2021; 58:817-818. [PMID: 33638710 DOI: 10.1007/s00592-021-01688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Affiliation(s)
- M Mateu-Salat
- Endocrinology and Nutrition Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - R Corcoy
- Endocrinology and Nutrition Department, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
- CIBER-BBN, Barcelona, Spain.
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Immanuel J, Simmons D, Harreiter J, Desoye G, Corcoy R, Adelantado JM, Devlieger R, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Dunne FP, Damm P, Mathiesen ER, Jensen DM, Andersen LLT, Hill DJ, Jelsma JGM, Kautzky-Willer A, Galjaard S, Snoek FJ, van Poppel MNM. Metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes. Diabet Med 2021; 38:e14413. [PMID: 32991758 DOI: 10.1111/dme.14413] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
AIMS To describe the metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes. METHODS We performed a post hoc analysis using data from the Vitamin D And Lifestyle Intervention for gestational diabetes prevention (DALI) trial conducted across nine European countries (2012-2014). In women with a BMI ≥29 kg/m2 , insulin resistance and secretion were estimated from the oral glucose tolerance test values performed before 20 weeks, using homeostatic model assessment of insulin resistance and Stumvoll first-phase indices, respectively. Women with early gestational diabetes, defined by the International Association of Diabetes and Pregnancy Study Groups criteria, were classified into three groups: GDM-R (above-median insulin resistance alone), GDM-S (below-median insulin secretion alone), and GDM-B (combination of both) and the few remaining women were excluded. RESULTS Compared with women in the normal glucose tolerance group (n = 651), women in the GDM-R group (n = 143) had higher fasting and post-load glucose values and insulin levels, with a greater risk of having large-for-gestational age babies [adjusted odds ratio 3.30 (95% CI 1.50-7.50)] and caesarean section [adjusted odds ratio 2.30 (95% CI 1.20-4.40)]. Women in the GDM-S (n = 37) and GDM-B (n = 56) groups had comparable pregnancy outcomes with those in the normal glucose tolerance group. CONCLUSIONS In overweight and obese women with early gestational diabetes, higher degree of insulin resistance alone was more likely to be associated with adverse pregnancy outcomes than lower insulin secretion alone or a combination of both.
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Affiliation(s)
- J Immanuel
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
| | - D Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
| | - J Harreiter
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - G Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
| | - R Corcoy
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
| | - J M Adelantado
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
| | - A Lapolla
- Universita Degli Studi di Padova, Padua, Italy
| | - M G Dalfra
- Universita Degli Studi di Padova, Padua, Italy
| | - A Bertolotto
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - E Wender-Ozegowska
- Department of Reproduction, Poznan University of Medical Sciences, Poland
| | - A Zawiejska
- Department of Reproduction, Poznan University of Medical Sciences, Poland
| | - F P Dunne
- National University of Ireland, Galway, Ireland
| | - P Damm
- Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - E R Mathiesen
- Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - L L T Andersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - D J Hill
- Recherche en Santé Lawson SA, St. Gallen, Switzerland
- Lawson Health Research Institute, London, Ontario, Canada
| | - J G M Jelsma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - A Kautzky-Willer
- Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
- Gender Institute Gars am Kamp, Vienna, Austria
| | - S Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Belgium
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - F J Snoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - M N M van Poppel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
- Institute of Sport Science, University of Graz, Graz, Austria
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Yamamoto JM, Corcoy R, Donovan LE, Stewart ZA, Tomlinson G, Beardsall K, Feig DS, Murphy HR. Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial. Diabet Med 2019; 36:1046-1053. [PMID: 31107983 DOI: 10.1111/dme.13988] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants. METHODS A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose. RESULTS Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA1c [48 ± 7 (6.6 ± 0.6) vs. 45 ± 7 (6.2 ± 0.6); P = 0.0009 and 50 ± 7 (6.7 ± 0.6) vs. 46 ± 7 (6.3 ± 0.6); P = 0.0001] and lower continuous glucose monitoring time-in-range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C-peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P ≤ 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia. CONCLUSIONS Modest increments in continuous glucose monitoring time-in-target (5-7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period.
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Affiliation(s)
- J M Yamamoto
- Departments of Medicine and Obstetrics and Gynaecology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, Calgary, Canada
| | - R Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER-BBN, Madrid, Spain
| | - L E Donovan
- Departments of Medicine and Obstetrics and Gynaecology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Z A Stewart
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - G Tomlinson
- Department of Medicine, University Health Network, Toronto, Canada
| | - K Beardsall
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- Neonatal Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D S Feig
- Department of Medicine, University of Toronto, Toronto, Canada
- Mount Sinai Hospital, Sinai Health System, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - H R Murphy
- Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Women's Health Academic Centre, Division of Women's and Children's Health, King's College London, London, UK
- Norwich Medical School, Floor 2, Bob Champion Research and Education Building, James Watson Road, University of East Anglia, Norwich Research Park, Norwich, UK
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Chico A, Herranz L, Corcoy R, Ramírez O, Goya M, Bellart J, González-Romero S, Codina M, Sánchez P, Cortázar A, Acosta D, Picón M, Rubio J, Megía A, Sancho M, Balsells M, Solá E, González N, López-López J. Glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes according to the type of basal insulin. Eur J Obstet Gynecol Reprod Biol 2016; 206:84-91. [DOI: 10.1016/j.ejogrb.2016.07.490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 07/08/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
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Aulinas A, Colom C, García Patterson A, Ubeda J, María MA, Orellana I, Adelantado JM, de Leiva A, Corcoy R. Smoking affects the oral glucose tolerance test profile and the relationship between glucose and HbA1c in gestational diabetes mellitus. Diabet Med 2016; 33:1240-4. [PMID: 26416345 DOI: 10.1111/dme.12966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
AIMS Current smokers in the general population have a lower 2 h plasma glucose after an oral glucose tolerance test (OGTT) and a higher HbA1c than non-smokers, but the relationships between OGTT/HbA1c and smoking status have not been addressed in pregnancy. We analysed glycaemic measurements in women with gestational diabetes mellitus in relation to smoking status. METHODS We performed a review of the prospectively collected database of the diabetes and pregnancy clinic. We included women with gestational diabetes mellitus and a singleton pregnancy who delivered between 1986 and 2006. Bivariate and multivariate analyses were used to evaluate patient characteristics in relation to smoking status. RESULTS A total of 2361 women met the inclusion criteria: 556 (23.5%) were active smokers, 266 (11.3%) quit during pregnancy and 1539 (65.2%) were non-smokers. Most baseline characteristics were similar across groups. Diagnostic OGTT was performed at a gestational age of [median (25th, 75(th) centiles)] 29 weeks (26, 33). Women who smoked at the beginning of pregnancy had a higher 1-h plasma glucose than non-smokers [11.8 (11, 12.7), 11.6 (11, 12.6) and 11.5 (10.8, 12.5) mmol/l, for active smokers, those who quit during pregnancy and non-smokers, respectively, P < 0.001] and a lower 3-h plasma glucose [7.3 (5.9, 8.4), 7.6 (6.4, 8.7) and 8.0 (6.8, 9.0) mmol/l, respectively, P < 0.001]. HbA1c was higher in women who smoked at the beginning of pregnancy. Multiple regression analysis confirmed the independent association of smoking status with HbA1c and OGTT plasma glucose. CONCLUSIONS In women with gestational diabetes mellitus who smoke at the beginning of pregnancy, the shape of the OGTT is consistent with accelerated glucose absorption, and HbA1c is higher than expected for glycaemic values.
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Affiliation(s)
- A Aulinas
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Colom
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A García Patterson
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Ubeda
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M A María
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Orellana
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J M Adelantado
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A de Leiva
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - R Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
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Ramos A, Caimari F, Pujol I, García-Patterson A, Ginovart G, Adelantado J, Corcoy R. In women with gestational diabetes mellitus factors influencing growth have a larger effect on placental weight than on birth weight. Eur J Obstet Gynecol Reprod Biol 2016; 202:60-5. [DOI: 10.1016/j.ejogrb.2016.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/28/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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Caimari F, Ramos A, Pujol I, García-Patterson A, Adelantado JM, Corcoy R. Gestational diabetes mellitus in women with multiple pregnancies: is the metabolic abnormality milder? J Matern Fetal Neonatal Med 2015; 29:2485-9. [PMID: 26440703 DOI: 10.3109/14767058.2015.1090424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to compare maternal characteristics and dysglycemia after delivery in women with gestational diabetes mellitus (GDM) according to pregnancy being multiple (MP) or singleton (SP). The hypothesis was that women with GDM and MP would have a milder glycemic abnormality before and after pregnancy than those with SP. METHODS We performed a cohort study of 2908 women giving birth between 1986 and 2009. Logistic regression was performed to discriminate between MP and SP after anamnestic pre-pregnancy characteristics. Kaplan-Meier and Cox regression analyses were performed to assess if MP was independently associated with both impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and diabetes after delivery. RESULTS Family history of diabetes was the only independent anamnestic pre-pregnancy characteristic discriminating MP versus SP, OR 2.04 (95% CI 1.12, 3.70, p 0.019). The median time to progress to IFG/IGT was 7.52 years in SP (95% CI 6.92, 8.13) and 7.41 in MP (95% CI 3.84, 10.98), ns and the progression to DM did not differ. In addition, MP was not associated to IFG/IGT or to DM in the Cox regression analysis. CONCLUSIONS In this cohort of women with GDM, those with MP did not demonstrate a lesser degree of dysglycemia after controlling for other pregnancy characteristics and pregnancy-independent factors.
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Affiliation(s)
- F Caimari
- a Department of Endocrinology and Nutrition , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain
| | - A Ramos
- a Department of Endocrinology and Nutrition , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain
| | - I Pujol
- a Department of Endocrinology and Nutrition , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain
| | - A García-Patterson
- a Department of Endocrinology and Nutrition , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain
| | - J M Adelantado
- b Department of Gynecology and Obstetrics , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain .,c Department of Pediatrics , Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma De Barcelona , Bellaterra , Spain .,d Department of Medicine , Universitat Autònoma De Barcelona , Bellaterra , Spain , and
| | - R Corcoy
- a Department of Endocrinology and Nutrition , Hospital De La Santa Creu I Sant Pau , Barcelona , Spain .,d Department of Medicine , Universitat Autònoma De Barcelona , Bellaterra , Spain , and.,e CIBER Bioengineering, Biomaterials and Nanotechnology (CIBER-BBN), Instituto De Salud Carlos III , Madrid , Spain
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Buckley BS, Harreiter J, Damm P, Corcoy R, Chico A, Simmons D, Vellinga A, Dunne F. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabet Med 2012; 29:844-54. [PMID: 22150506 DOI: 10.1111/j.1464-5491.2011.03541.x] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. METHODS The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. RESULTS Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. CONCLUSIONS Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis.
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Affiliation(s)
- B S Buckley
- School of Medicine, National University of Ireland, Galway, Ireland.
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12
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Vellinga A, Zawiejska A, Harreiter J, Buckley B, Di Cianni G, Lapolla A, Corcoy R, Simmons D, Adelantado JM, Damm P, Desoye G, Devlieger R, Hill D, Kautzky-Willer A, Klemetti M, Mathiesen E, Rebollo P, Snoek F, Tikkanen M, Timmerman D, van Assche A, van Poppel M, Wender-Oegowska E, Dunne F. Associations of Body Mass Index (Maternal BMI) and Gestational Diabetes Mellitus with Neonatal and Maternal Pregnancy Outcomes in a Multicentre European Database (Diabetes and Pregnancy Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention). ISRN Obes 2012; 2012:424010. [PMID: 24527262 PMCID: PMC3914269 DOI: 10.5402/2012/424010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/04/2012] [Indexed: 11/23/2022]
Abstract
Objective. Assess the impact of Gestational Diabetes Mellitus (GDM) and obesity on neonatal and maternal pregnancy outcomes. Methods. Cross-sectional data (3343 pregnancies) from seven European centres were included in a multilevel analysis of the association between GDM/obesity and caesarean section, macrosomia and neonatal morbidities. Results. Comparison of databases identified reporting differences between countries due to the inclusion of true population based samples or pregnancies from specialised tertiary centres, resulting in higher prevalences of GDM for some countries. The analysis showed that obesity and GDM were independent risk factors of perinatal complications. Only BMI had a dose-dependent effect on the risk of macrosomia and caesarean section. Both obesity (BMI > 30 kg/m2) and GDM were independent risk factors of neonatal morbidities. Conclusions. Obesity and GDM were independent risk factors of perinatal complications. The effect of the worldwide obesity and diabetes epidemic is extending to the next generation.
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Affiliation(s)
- Akke Vellinga
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - A Zawiejska
- Akademia Medyczna im Karola Marcinkowskiego, 60-512 Poznan, Poland
| | - J Harreiter
- Department of Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - B Buckley
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland
| | - G Di Cianni
- Dipartimento di Endocrinologia e Malattie del Metabolismo, Università di Pisa, 56126 Pisa, Italy
| | - A Lapolla
- Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Padova, 35122 Padova, Italy
| | - R Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - D Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - J M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | - P Damm
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - G Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria
| | - R Devlieger
- University Hospitals Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - D Hill
- Recherche en Sante Lawson, 9552 Bronschhofen, Switzerland
| | - A Kautzky-Willer
- Department of Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - M Klemetti
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - E Mathiesen
- Department of Obstetrics, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - P Rebollo
- BAP Health Outcomes Research, S.L, 33010 Oviedo, Spain
| | - F Snoek
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center Amsterdam, 1007 MB Amsterdam, The Netherlands
| | - M Tikkanen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - D Timmerman
- University Hospitals Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - A van Assche
- University Hospitals Leuven, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - M van Poppel
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center Amsterdam, 1007 MB Amsterdam, The Netherlands
| | | | - F Dunne
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Ireland
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13
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García-Patterson A, Aulinas A, Sojo L, Ginovart G, Adelantado JM, de Leiva A, Corcoy R. Poorer perinatal outcome in male newborns of women with pregestational diabetes mellitus. Diabet Med 2011; 28:436-9. [PMID: 21392065 DOI: 10.1111/j.1464-5491.2011.03227.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To assess perinatal outcome in women with pregestational diabetes mellitus according to the sex of the fetus. METHODS A retrospective review of all singleton pregnancies of women with pregestational diabetes progressing to a gestational age of 22 weeks or more who attended the diabetes and pregnancy clinic from 1981 to 2006 (n=455). We compared maternal characteristics and perinatal outcomes (perinatal mortality, major congenital malformations, small and large for gestational age newborns, preterm birth and a composite of the former) according to the sex of the fetus. A logistic regression analysis was performed using the composite perinatal outcome as the dependent variable and all maternal variables and sex of fetus as potential predictors. RESULTS Maternal characteristics did not differ in mothers of male and female newborns. In the whole cohort, the composite perinatal outcome was significantly higher in male fetuses; adjusted OR 1.61 (95% CI 1.04-2.50). CONCLUSIONS In women with pregestational diabetes, perinatal outcome was poorer in male newborns despite similar maternal characteristics.
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Affiliation(s)
- A García-Patterson
- Servei d'Endocrinologia i Nutrició Servei de Pediatria Servei de Ginecologia i Obstetricia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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14
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García-Patterson A, Gich I, Amini SB, Catalano PM, de Leiva A, Corcoy R. Insulin requirements throughout pregnancy in women with type 1 diabetes mellitus: three changes of direction. Diabetologia 2010; 53:446-51. [PMID: 20013109 DOI: 10.1007/s00125-009-1633-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 11/16/2009] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to analyse the insulin requirements of women with type 1 diabetes mellitus throughout pregnancy. METHODS We have examined the weekly mean blood glucose (mmol/l), insulin requirements (U kg(-1) day(-1)) and total insulin requirements (U/day) in 65 women with type 1 diabetes mellitus and tight metabolic control since before pregnancy (HbA(1c) < or =6.0%). RESULTS Both insulin requirement and total insulin requirement displayed a peak in week 9, a nadir in week 16 and a second peak in week 37. For the change in insulin requirement (4.08% per week) and in total insulin requirement (5.19% per week), the sharpest slope was observed from week 16 to week 37. However, two changes of direction took place in the first 11 weeks and eight out of nine episodes of severe hypoglycaemia requiring treatment with glucagon or i.v. glucose took place in the first 16 weeks. CONCLUSIONS/INTERPRETATION Pregnant women with type 1 diabetes mellitus and tight metabolic control since before pregnancy displayed changes in insulin requirement and total insulin requirement with successive changes of direction. The sharpest slope was observed between 16 and 37 weeks, but insulin requirements were more unstable in the first 16 weeks. This information could help patients and physicians to react to changes in glycaemic pattern in a prompt and adequate way.
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Affiliation(s)
- A García-Patterson
- Department of Endocrinology and Nutrition, Hospital de Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain
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15
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de Leiva A, Hernando ME, Rigla M, Capel I, Brugués E, Pons B, Erdozain L, Prados A, Corcoy R, Gómez EJ, García-Sáez G, Martínez-Sarriegui I, Rodríguez-Herrero A, Pérez-Gandía C, del Pozo F. Telemedical artificial pancreas: PARIS (Pancreas Artificial Telemedico Inteligente) research project. Diabetes Care 2009; 32 Suppl 2:S211-6. [PMID: 19875554 PMCID: PMC2811476 DOI: 10.2337/dc09-s313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alberto de Leiva
- EDUAB-HSP: Research Group, Department of Endocrinology, Diabetes and Nutrition, Universitat Autònoma de Barcelona - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Alberto de Leiva,
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16
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Balsells M, García-Patterson A, Gich I, Corcoy R. Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J Clin Endocrinol Metab 2009; 94:4284-91. [PMID: 19808847 DOI: 10.1210/jc.2009-1231] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Glycemic disturbance is usually less severe in pregnant women with type 2 than in those with type 1 diabetes mellitus (DM). Nevertheless, a worse perinatal outcome in women with type 2 DM has been reported in some studies. OBJECTIVE Our objective was to review maternal and fetal outcomes in pregnant women with type 2 vs. type 1 DM. STUDY SELECTION We conducted a systematic review of papers providing original data on pregnancy outcomes in both type 2 and type 1 DM (Medline search of the period January 1, 1987, to June 30, 2008). Two independent investigators considered papers for eligibility, and a third one solved discrepancies. DATA EXTRACTION Metaanalysis tools were used to compare four main outcomes (major congenital malformations, stillbirth, and neonatal and perinatal mortality) and 15 secondary ones (five maternal, 10 fetal). Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were used to assess quality. DATA SYNTHESIS Thirty-three studies qualified for inclusion of 3743 citations retrieved. Women with type 2 DM had lower glycated hemoglobin (HbA1c) at booking and throughout pregnancy but a higher risk of perinatal mortality [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.15-1.96] without significant differences in the rates of major congenital malformations, stillbirth, and neonatal mortality. As to secondary outcomes, women with type 2 DM had less diabetic ketoacidosis (OR 0.09, 95% CI 0.02-0.34) and cesarean section (OR 0.80, 95% CI 0.59-0.94) without differences in other outcomes. CONCLUSIONS Despite a milder glycemic disturbance, women with type 2 DM had no better perinatal outcomes than those with type 1, indicating that type 2 DM in pregnancy is a serious condition.
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Affiliation(s)
- Montserrat Balsells
- Servei d'Endocrinologia i Nutrició, Hospital Mútua de Terrassa, Terrassa 08221, Spain.
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Ricart W, López J, Mozas J, Pericot A, Sancho MA, González N, Balsells M, Luna R, Cortázar A, Navarro P, Ramírez O, Flández B, Pallardo LF, Hernández A, Ampudia J, Fernández-Real JM, Hernández-Aguado I, Corcoy R. Maternal glucose tolerance status influences the risk of macrosomia in male but not in female fetuses. J Epidemiol Community Health 2008; 63:64-8. [PMID: 18718980 DOI: 10.1136/jech.2008.074542] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To elucidate whether the risk of macrosomia, large for gestational age (LGA) and small for gestational age (SGA) is influenced by maternal body mass index and glucose tolerance differently in male and female fetuses. METHODS A population study was conducted in 16 general hospitals from the Spanish National Health Service that included 9270 consecutive women with singleton pregnancies and without a former diagnosis of diabetes mellitus who delivered 4793 male and 4477 female newborns. Logistic regression analyses were performed to predict the effect of body mass index (BMI) category and glucose tolerance on macrosomia, large for gestational age newborns (LGA) and small for gestational age newborns (SGA) Separate analyses according to foetal sex were carried out for each outcome. The results were adjusted for maternal age, gestational age and pregnancy-induced hypertension. RESULTS There were significant differences between males and females in the percentage of infants who had macrosomia, LGA or SGA. Maternal BMI category was positively associated with the risk of macrosomia and LGA in both male and female newborns. In addition, there was a negative association between maternal BMI and SGA that only reached significance in males. In contrast, gestational diabetes was only a predictor of macrosomia exclusively in male fetuses (OR 1.67, 95% CI 1.12 to 2.49) CONCLUSIONS There is sexual dimorphism in the risk of abnormal birth weight attributed to maternal glucose tolerance status. A closer surveillance of foetal growth might be warranted in pregnant women with abnormal glucose tolerance carrying a male fetus.
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Affiliation(s)
- W Ricart
- Hospital Universitari de Girona Doctor Josep Trueta, Girona, IdlBGi, CIBER Fisiopatologia de la Obesidad y Nutrició, Spain.
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Abstract
OBJECTIVE To report a patient with autoimmune adrenal disease and increased ACTH with longstanding hyperpigmentation as an isolated symptom. METHODS A 49-year-old woman requested a diagnostic work-up for hyperpigmentation initiated 9 years before, associated with increased ACTH. She was receiving replacement therapy for autoimmune hypothyroidism. Basal and dynamic tests of glucocorticoid axis, basal investigation of mineralocorticoid axis and measurement of organ specific autoantibodies were performed. RESULTS Plasma ACTH (143 pmol/l; normal <13.2 pmol/l) and antibodies against 21-hydroxylase (115 UI/ml; normal <1) were remarkably high, thyroid peroxidase and parietal cell antibodies were positive at low titer and all additional tests were normal. CONCLUSION Autoimmune adrenal disease can have a very long preclinical period even with high concomitant ACTH and specific antibody titers.
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Affiliation(s)
- S Torrejón
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Autonomous University of Barcelona, 08025 Barcelona, Spain.
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19
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20
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Ricart W, López J, Mozas J, Pericot A, Sancho MA, González N, Balsells M, Luna R, Cortázar A, Navarro P, Ramírez O, Flández B, Pallardo LF, Hernández-Mijas A, Ampudia J, Fernández-Real JM, Corcoy R. Body mass index has a greater impact on pregnancy outcomes than gestational hyperglycaemia. Diabetologia 2005; 48:1736-42. [PMID: 16052327 DOI: 10.1007/s00125-005-1877-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS We evaluated diabetes-related pregnancy outcomes in a cohort of Spanish women in relation to their glucose tolerance status, prepregnancy BMI and other predictive variables. METHODS The present paper is part of a prospective study to evaluate the impact of American Diabetes Association (2000) criteria in the Spanish population. A total of 9,270 pregnant women were studied and categorised as follows according to prepregnancy BMI quartiles and glucose tolerance status: (1) negative screenees; (2) false-positive screenees; (3) gestational diabetes mellitus (GDM) according to American Diabetes Association criteria only; and (4) GDM according to National Diabetes Data Group criteria (NDDG). We evaluated fetal macrosomia, Caesarean section and seven secondary outcomes as diabetes-related pregnancy outcomes. The population-attributable and population-prevented fractions of predictor variables were calculated after binary logistic regression analysis with multiple predictors. RESULTS Both prepregnancy BMI and abnormal glucose tolerance categories were independent predictors of pregnancy outcomes. The upper quartile of BMI accounted for 23% of macrosomia, 9.4% of Caesarean section, 50% of pregnancy-induced hypertension and 17.6% of large-for-gestational-age newborns. In contrast, NDDG GDM accounted for 3.8% of macrosomia, 9.1% of pregnancy-induced hypertension and 3.4% of preterm births. CONCLUSIONS/INTERPRETATION In terms of population impact, prepregnancy maternal BMI exhibits a much stronger influence than abnormal blood glucose tolerance on macrosomia, Caesarean section, pregnancy-induced hypertension and large-for-gestational-age newborns.
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Affiliation(s)
- W Ricart
- Unit of Diabetes, Endocrinology and Nutrition, University Hospital Doctor Josep Trueta, Avgda. de frança s.n., 17007, Girona, Spain.
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21
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Ricart W, López J, Mozas J, Pericot A, Sancho MA, González N, Balsells M, Luna R, Cortázar A, Navarro P, Ramírez O, Flández B, Pallardo LF, Hernández A, Ampudia J, Fernández-Real JM, Corcoy R. Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain. Diabetologia 2005; 48:1135-41. [PMID: 15889233 DOI: 10.1007/s00125-005-1756-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 01/28/2005] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS This study was carried out to determine the impact of American Diabetes Association (ADA) 2000 criteria for the diagnosis of gestational diabetes mellitus (GDM) in the Spanish population. METHODS Pregnant women were assigned to one of four categories: negative screenees, false-positive screenees, ADA-only-GDM (untreated) and GDM according to National Diabetes Data Group (NDDG) criteria (treated). Fetal macrosomia and Caesarean section were defined as primary outcomes, with seven additional secondary outcomes. RESULTS Of 9,270 pregnant women screened for GDM, 819 (8.8%) met NDDG criteria. If the threshold for defining GDM had been lowered to ADA criteria, an additional 2.8% of women would have been defined as having the condition (relative increase of 31.8%). Maternal characteristics of women with ADA-only-GDM were between those of false-positive screenees and women with NDDG-GDM. The risk of diabetes-associated complications was slightly elevated in the individuals who would have been classified as abnormal only after the adoption of ADA criteria. In addition, the ADA-only-GDM contribution to morbidity was lower than that of other variables, especially BMI. CONCLUSIONS/INTERPRETATION Use of the ADA criteria to identify GDM would result in a 31.8% increase in prevalence compared with NDDG criteria. However, as the contribution of these additionally diagnosed cases to adverse GDM outcomes is not substantial, a change in diagnostic criteria is not warranted in our setting.
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Affiliation(s)
- W Ricart
- Unit of Diabetes, Endocrinology and Nutrition, Hospital Universitari de Girona Doctor Josep Trueta, Avgda. de França s.n., 17007, Girona, Spain.
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22
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Sojo L, Wägner AM, Ordóñez J, Corcoy R. Hemolyzed plasma samples in diabetic ketoacidosis (DKA). J Endocrinol Invest 2005; 28:296-7. [PMID: 15952417 DOI: 10.1007/bf03345389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Corcoy R, García-Patterson A, Pau E, Pascual E, Altirriba O, Adelantado JM, de Leiva A. Is selective screening for gestational diabetes mellitus worthwhile everywhere? Acta Diabetol 2004; 41:154-7. [PMID: 15660197 DOI: 10.1007/s00592-004-0159-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2002] [Accepted: 07/16/2004] [Indexed: 11/25/2022]
Abstract
We assessed if selective screening for gestational diabetes mellitus (GDM) as recommended by the Fourth Workshop on GDM is worthwhile in our centre. Detection is performed using universal screening in three pregnancy periods using the tests recommended by the first three Workshops. We have analysed the prevalence of low-risk characteristics for GDM in the 917 women delivering in the centre in 1992 and in the whole cohort of 1635 women with GDM delivering between 1986 and 1998. The rate of women with all low risk characteristics was 7.0% among the general pregnant population and 1.3% in the cohort of women with GDM (p<0.001). We conclude that in our population, selective screening of GDM is reliable in identifying women at low risk of GDM, but since only a negligible subset of the pregnant population would not need to be screened, adherence to these guidelines would make the screening policy unnecessarily complicated.
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Affiliation(s)
- R Corcoy
- Department of Endocrinology, Hospital de Sant Pau, Sant Antoni Ma Claret 167, Barcelona 08025, Spain.
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Abstract
Reproducibility of diabetes mellitus (DM) diagnosis has been recognized as non-optimal and a few studies have analyzed its reproducibility using new diagnostic criteria. Our aim was to evaluate the reproducibility of WHO 1999 criteria for DM diagnosis in women. A total of 696 caucasian women with previous gestational diabetes mellitus (GDM) underwent an OGTT at a median of 6.2 years (interquartile range, 0.5-7.3) after delivery. When OGTT was diagnostic of DM, a second test was scheduled and performed after a median of 3 months (interquartile range, 1.6-10.6). At the second test, 35 women were diagnosed with DM (12 by fasting plasma glucose (FPG) alone, 10 by isolated post-challenge hyperglycemia (IPH), 10 by fasting and 2-h plasma glucose, 3 by symptoms of hyperglycemia plus measurement of plasma glucose). DM was confirmed in 56.3% of women diagnosed without symptoms. In this subgroup, reproducibility according to the abnormality at the first test was: 33.3% in those diagnosed by FPG alone, 40% in those diagnosed by IPH, and 100% in those diagnosed by both fasting and 2-h plasma glucose ( p<0.05 vs. the two previous groups). In women with former GDM, the reproducibility of DM diagnosis by FPG alone or IPH is similar and lower than the diagnosis made by abnormality in both values.
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Affiliation(s)
- M Albareda
- Department of Endocrinology, Hospital de Sant Pau, Autonomous University of Barcelona, 167 Sant Antoni Maria Claret, 08025, Barcelona, Spain
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García-Patterson A, Erdozain L, Ginovart G, Adelantado JM, Cubero JM, Gallo G, de Leiva A, Corcoy R. In human gestational diabetes mellitus congenital malformations are related to pre-pregnancy body mass index and to severity of diabetes. Diabetologia 2004; 47:509-514. [PMID: 14770278 DOI: 10.1007/s00125-004-1337-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Revised: 11/18/2003] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS This study analysed the relationship between congenital malformations (CM) and severity of gestational diabetes mellitus. METHODS A cohort of 2060 infants of mothers with gestational diabetes was studied. Universal screening and 3(rd) Workshop-Conference criteria were used to diagnose gestational diabetes. The severity of diabetes was assessed on the basis of previous hyperglycaemia, blood glucose values in diagnostic OGTT, area under the glucose curve, gestational age and HbA(1)c at diagnosis, insulin requirements during pregnancy, and OGTT after delivery. Potentially confounding variables (age, pre-pregnancy BMI, smoking) were considered. The relationship of potential predictors with CM was analysed with several multivariate logistic regression analyses. RESULTS The rate of CM was 6% for minor and 3.8% for major malformations (1.4% heart, 0.8% renal/urinary, 0.7% skeletal, 0.3% hypospadias, 0.2% central nervous system, 0.2% cleft lip/palate, 0.1% digestive tract, 0.3% other). In the final models, forward logistic regression analysis identified pre-pregnancy BMI as the predictor of CM (area under receiver operating characteristic curve 0.616); in the backward analysis additional predictors were 1-h blood glucose in diagnostic OGTT and gestational age at diagnosis (area under receiver operating characteristic curve 0.646). Both BMI and severity of gestational diabetes were predictors of heart and minor CM, whereas BMI predicted renal/urinary CM and severity of diabetes predicted skeletal CM. CONCLUSIONS/INTERPRETATION In these infants of mothers with gestational diabetes, severity of diabetes and pre-pregnancy BMI were predictors of CM, in accordance with the well-documented pathogenic role of BMI (in the general population) and hyperglycaemia (in diabetic pregnancy). BMI was the main predictor of more prevalent CM.
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Affiliation(s)
- A García-Patterson
- Department of Endocrinology and Nutrition, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Avinguda Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - L Erdozain
- Department of Endocrinology and Nutrition, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Avinguda Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - G Ginovart
- Department of Pediatrics, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Spain
| | - J M Adelantado
- Department of Gynecology and Obstetrics, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Spain
| | - J M Cubero
- Department of Endocrinology and Nutrition, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Avinguda Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - G Gallo
- Department of Endocrinology and Nutrition, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Avinguda Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
| | - A de Leiva
- Department of Endocrinology and Nutrition, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Avinguda Sant Antoni Mª Claret, 167, Barcelona 08025, Spain
- Centre Network of the Carlos III Health Institute, Madrid, Spain
| | - R Corcoy
- Department of Endocrinology and Nutrition, Hospital of the Holy Cross and St. Paul, Autonomous University of Barcelona, Avinguda Sant Antoni Mª Claret, 167, Barcelona 08025, Spain.
- Centre Network of the Carlos III Health Institute, Madrid, Spain.
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Cubero JM, Rodríguez-Espinosa J, Gelpi C, Estorch M, Corcoy R. Thyroglobulin autoantibody levels below the cut-off for positivity can interfere with thyroglobulin measurement. Thyroid 2003; 13:659-61. [PMID: 12964972 DOI: 10.1089/105072503322240013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Antithyroglobulin antibodies can interfere with the measurement of thyroglobulin yielding spuriously high or low levels depending on the method used. Interference is unrelated to the antibody concentration and can occur at very low concentrations. We report a patient in whom antithyroglobulin antibodies below the cut-off for positivity nearly led to an incorrect diagnosis of thyrotoxicosis factitia.
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Affiliation(s)
- J M Cubero
- Serveis d'Endocrinologia i Nutrició, Hospital de Sant Pau, Barcelona, Spain
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Bellazzi R, Larizza C, Montani S, Riva A, Stefanelli M, d'Annunzio G, Lorini R, Gomez EJ, Hernando E, Brugues E, Cermeno J, Corcoy R, de Leiva A, Cobelli C, Nucci G, Del Prato S, Maran A, Kilkki E, Tuominen J. A telemedicine support for diabetes management: the T-IDDM project. Comput Methods Programs Biomed 2002; 69:147-161. [PMID: 12100794 DOI: 10.1016/s0169-2607(02)00038-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In the context of the EU funded Telematic Management of Insulin-Dependent Diabetes Mellitus (T-IDDM) project, we have designed, developed and evaluated a telemedicine system for insulin dependent diabetic patients management. The system relies on the integration of two modules, a Patient Unit (PU) and a Medical Unit (MU), able to communicate over the Internet and the Public Switched Telephone Network. Using the PU, patients are allowed to automatically download their monitoring data from the blood glucose monitoring device, and to send them to the hospital data-base; moreover, they are supported in their every day self monitoring activity. The MU provides physicians with a set of tools for data visualization, data analysis and decision support, and allows them to send messages and/or therapeutic advice to the patients. The T-IDDM service has been evaluated through the application of a formal methodology, and has been used by European patients and physicians for about 18 months. The results obtained during the project demonstration, even if obtained on a pilot study of 12 subjects, show the feasibility of the T-IDDM telemedicine service, and seem to substantiate the hypothesis that the use of the system could present an advantage in the management of insulin dependent diabetic patients, by improving communications and, potentially, clinical outcomes.
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Affiliation(s)
- R Bellazzi
- Dipartimento di Informatica e Sistemistica, Università di Pavia, via Ferrata 1, I-27100 Pavia, Italy.
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Gómez EJ, Hernando ME, García A, Del Pozo F, Cermeño J, Corcoy R, Brugués E, De Leiva A. Telemedicine as a tool for intensive management of diabetes: the DIABTel experience. Comput Methods Programs Biomed 2002; 69:163-177. [PMID: 12100795 DOI: 10.1016/s0169-2607(02)00039-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6+/-7.7); days between communications (5.4+/-2.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care.
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Affiliation(s)
- E J Gómez
- Grupo de Bioingeniería y Telemedicina, ETSI Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain.
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Abstract
A diabetic acromegalic man, not cured after surgery and radiosurgery, received lanreotide i.m. with great clinical and biochemical improvement. He required NPH insulin (76 to 84 units/day) to control his diabetes mellitus. Thirty-six hours after changing to LAR-octreotide (20 mg i.m/month) he presented symptomatic hypoglycemia, repeated at 48 and 72 h (50 mg/dL), despite reducing insulin to 26 Units/day. Thereafter, he reduced insulin by 30 to 50% for the first week after each LAR-octreotide injection, and gradually increased it again over the next 3 weeks. This situation persists after every injection 3 years later; this consistent behavior supports a specific effect of LAR-octreotide, and not a by chance phenomenon. No marked changes in circulating GH, IGF-1, immunoreative insulin, C-peptide, testosterone and glucose were observed prior to, and 3, 7, 14, 21, and 28 days after LAR-octreotide; however, there was 28% fall in plasma glucagon after 7 days, which rose thereafter. C-peptide (< 1.8 ng/mL) was indicative of decreased beta-cell function. To our knowledge, this is the first report of such a distinct differential behaviour of blood glucose and insulin requirements with different somatostatin analogs, and is worth recalling when starting an insulin-treated diabetic patient on this treatment. It may be related to a preferential binding of LAR-octreotide to subtype 2 somatostatin receptors in the pancreas, while lanreotide preferentially binds to subtype 5, not expressed in this tissue; this would explain the fall in glucagon, in parallel to the decrease in insulin requirements after LAR-octreotide; however, a contribution of differences in the effect of both somatostatin analogues on postreceptor signalling systems and/or intestinal carbohydrate absorption cannot be entirely ruled out.
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Affiliation(s)
- S M Webb
- Department of Endocrinology, Hospital de Sant Pau, Autonomous University of Barcelona, Spain.
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Albareda M, Rodríguez-Espinosa J, Murugo M, de Leiva A, Corcoy R. Assessment of insulin sensitivity and beta-cell function from measurements in the fasting state and during an oral glucose tolerance test. Diabetologia 2000; 43:1507-11. [PMID: 11151759 DOI: 10.1007/s001250051561] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS We aimed to find if the relation between insulin sensitivity and beta-cell function assessed from fasting and OGTT measurements has a physiological shape (hyperbolic with the reference methods). METHODS Healthy women without diabetic first-degree relatives underwent a 75 g OGTT with plasma glucose and insulin (n = 35) concentrations being measured at 0, 30, 60 and 120 min. Beta-cell function and insulin sensitivity were estimated using previously described indices from fasting (1 for beta-cell function, 6 for insulin sensitivity) and OGTT measurements (3 for beta-cell function and 5 for insulin sensitivity). A hyperbolic relation was tested for the 21 beta-cell function-insulin sensitivity pairs using a non-lineal regression method. RESULTS The assessment of beta-cell function from OGTT was impossible in seven women and one had outlier indices. For the remaining 27 women, only 8 combinations adjusted to a hyperbolic relation. The best adjustment was achieved using the fasting glucose to insulin ratio as the estimation of insulin sensitivity and the homeostasis model assessment (HOMA) index (single fasting sample) as the estimation of beta-cell function (r2 0.802, k 869.71, p < 0.001). CONCLUSION/INTERPRETATION In this group of healthy women, the estimation of insulin sensitivity and beta-cell function by most methods using OGTT-derived glucose and insulin measurements did not adjust to a hyperbolic relation but all fasting indices combinations did. Beta-cell function estimated with the HOMA index and insulin sensitivity with fasting glucose to insulin ratio had the best adjustment.
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Affiliation(s)
- M Albareda
- Department of Endocrinology and Nutrition, Hospital of Sant Pau, Barcelona, Spain
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Albareda M, Gallart L, Mato ME, Ortiz A, Puig-Domingo M, de Leiva A, Corcoy R. Mitochondrial gene transfer ribonucleic acid (tRNA)Leu(UUR) 3243 is not a common cause of gestational diabetes mellitus in Spanish women. Endocr J 2000; 47:805-6. [PMID: 11228058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Balsells M, Corcoy R, Adelantado JM, García-Patterson A, Altirriba O, de Leiva A. Gestational diabetes mellitus: metabolic control during labour. Diabetes Nutr Metab 2000; 13:257-62. [PMID: 11105967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The purpose of this study was to assess, in women with gestational diabetes mellitus (GDM): 1) metabolic control during labour using a standardised protocol; 2) the influence of therapy during pregnancy in intrapartum metabolic control and insulin requirements; and 3) the impact of maternal glycaemia during labour on neonatal hypoglycaemia. An observational study of 85 women with GDM (54 insulin-treated) was performed. Intrapartum metabolic management included i.v. glucose and insulin infusions, urinary ketone measurement and hourly capillary blood glucose (CBG) monitoring. Mean CBG from arrival to delivery was 4.7 +/- 1.1 mmol/l with 83% of mean CBG values within the target range (2.8-6.9 mmol/l). Mean CBG and insulin requirements were unrelated to therapy during pregnancy, but hypoglycaemia (CBG<2.8 mmol/l) was more frequent in women receiving insulin during pregnancy (40.7 vs 19.4 %, p<0.01). In several logistic regression models, CBG during labour was predictive of neonatal hypoglycaemia. We conclude that in women with GDM, the use of a standardised intrapartum management protocol is associated to fair metabolic control, that insulin requirements during labour are unrelated to therapy during pregnancy and that high CBG during labour increases the risk of neonatal hypoglycaemia.
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Affiliation(s)
- M Balsells
- Serveis d'Endocrinologia i Nutrició, Hospital de Sant Pau, Barcelona, Spain
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34
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Hernando ME, Gómez EJ, Corcoy R, del Pozo F. Evaluation of DIABNET, a decision support system for therapy planning in gestational diabetes. Comput Methods Programs Biomed 2000; 62:235-248. [PMID: 10837909 DOI: 10.1016/s0169-2607(00)00070-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
DIABNET is a knowledge-based system designed to aid doctors with therapy planning in gestational diabetes. The system core is a qualitative model, implemented by a Causal Probabilistic Network, that is able to detect the insulin effectiveness on a daily basis. DIABNET analyses monitoring data and proposes quantitative changes in insulin therapy and qualitative diet modifications. This paper proposes an evaluation methodology to assess the system performance when working in a real scenario. The methodology manages the absence of a gold standard and includes: a subjective analysis based on questionnaires and an objective analysis based on a quantitative comparison of the system's and experts' proposals. The paper also shows the results of two experiments in which expert diabetologists evaluated the therapeutical advice provided by DIABNET during the follow up of 9 patients with gestational diabetes. DIABNET detected the need of a therapy modification in 92% of the cases showing its appropriateness for automatic alarm generation. Around 80% of the proposals were accepted by experts. The evaluation results are encouraging and allow characterisation of the system's performance when proposing therapy modifications. Evaluation in its turn helps to refine the knowledge managed by DIABNET and enables us to look towards the further clinical use of DIABNET as a decision tool in gestational diabetes integrated in a telemedicine service.
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Affiliation(s)
- M E Hernando
- ETSI Telecomunicacion, Grupo de Bioingeniería y Telemedicina, Universidad Politécnica de Madrid, 28040, Madrid, Spain.
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Mauricio D, Corcoy R, Morales J, Vidaller A, Adelantado JM, García-Patterson A, de la Calle O, de Leiva A. Association of Takayasu's disease and autoimmune gestational diabetes mellitus. Endocr J 2000; 47:203-4. [PMID: 10943746 DOI: 10.1507/endocrj.47.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Corcoy R, García-Patterson A, Albareda M, de Leiva A. Poor performance of American Diabetes Association criteria in women with gestational diabetes. Diabetes Care 2000; 23:430-1. [PMID: 10868888 DOI: 10.2337/diacare.23.3.430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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40
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Caixàs A, Albareda M, García-Patterson A, Rodríguez-Espinosa J, de Leiva A, Corcoy R. Postpartum thyroiditis in women with hypothyroidism antedating pregnancy? J Clin Endocrinol Metab 1999; 84:4000-5. [PMID: 10566640 DOI: 10.1210/jcem.84.11.6144] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In women with hypothyroidism, levothyroxine (LT) requirements after delivery are assumed to return to prepregnancy values. The occasional observation of discordances prompted this study. Forty-one women (31 receiving LT replacement therapy and 10 receiving suppressive therapy for thyroid carcinoma) were followed during the first year after delivery. A control group of 31 nonpregnant women with hypothyroidism (n = 21) or thyroid carcinoma (n = 10) were also followed during a similar period. Twenty-three patients of 41 (56.1%) had discordant requirements at follow-up after delivery vs. 3 of 31 in the control group (9.7%; P < 0.001). The patterns of discordance in the postdelivery group were hyperthyroidism in 12, increase in LT dose in 5, hyper- and hypothyroidism in 5, and recurrence of Graves' disease in 1 women. Those in the control group were increase in LT dose, hyperthyroidism, and hypo- and hyperthyroidism. The rate of patients with discordant prepregnancy-postpartum LT doses was higher in the noncarcinoma subgroup (67.7% vs. 20.0%; P < 0.01), whereas in the control group, both subgroups displayed a similar rate of discordance (9.5% vs. 10%; P = NS). In conclusion, this study documents that women with hypothyroidism antedating pregnancy display changes in LT requirements in the first year after delivery that suggest postpartum thyroiditis.
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Affiliation(s)
- A Caixàs
- Servei d'Endocrinologia i Nutrició, Hospital de Sant Pau, Barcelona, Spain
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41
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Wägner AM, Rigla M, Ordóñez J, Corcoy R. Low cholesterol in severe hypothyroidism? Endocr J 1999; 46:347-8. [PMID: 10460022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
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43
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Albareda MM, Corcoy R. Reversible impairment of renal function associated with enalapril in a diabetic patient. CMAJ 1998; 159:1279-81. [PMID: 9861226 PMCID: PMC1229824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Acute renal failure and hyperkalemia due to angiotensin-converting enzyme inhibitors have been described in diabetic patients with other predisposing conditions. The case reported here involves a patient with type 1 diabetes mellitus, microalbuminuria and normal renal function who was treated with enalapril. Two years after initiation of this therapy, at a time when glycemic control was poor, he presented with symptomatic hyperkalemia and impaired renal function accompanied by hyporeninemic hypoaldosteronism. This case illustrates that reversible impairment of renal function and hyperkalemia can present after 2 years of treatment with angiotensin-converting enzyme inhibitors in patients with precipitating factors.
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Affiliation(s)
- M M Albareda
- Servei d'Endocrinologia, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Spain
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Albareda MM, Wägner A, Puig M, Corcoy R. Is diabetic ketoacidosis a cause of meningeal syndrome? Case report. Diabetes Care 1998; 21:1572-3. [PMID: 9727915 DOI: 10.2337/diacare.21.9.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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46
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García-Patterson A, Corcoy R, Balsells M, Altirriba O, Adelantado JM, Cabero L, de Leiva A. In pregnancies with gestational diabetes mellitus and intensive therapy, perinatal outcome is worse in small-for-gestational-age newborns. Am J Obstet Gynecol 1998; 179:481-5. [PMID: 9731857 DOI: 10.1016/s0002-9378(98)70383-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study analyzed the relationship between birth weight and perinatal outcome among women with gestational diabetes mellitus. STUDY DESIGN The relationship between perinatal outcome and birth weight was analyzed for 821 pregnancies of women with gestational diabetes mellitus attended in a tertiary hospital and receiving intensive metabolic therapy (normocaloric diet, self-monitoring of blood glucose level and individually tailored insulin regimen when needed). The Mantel-Haenszel test was used to adjust for preterm delivery. RESULTS Seven percent of neonates were small for gestational age, 85% were appropriate for gestational age, and 8% were large for gestational age. After adjustment for preterm delivery the rates of adverse fetal outcome, low 1-minute Apgar score, and hypoglycemia were greater among small for gestational age neonates than among appropriate and large for gestational age infants (odds ratios 3.08, 2.51, and 3.17, respectively). CONCLUSION Among women with gestational diabetes mellitus who are receiving intensive therapy, perinatal outcome is worse for small for gestational age neonates than for appropriate and large for gestational age neonates.
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Affiliation(s)
- A García-Patterson
- Endocrinology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Spain
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47
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Caballero A, Corcoy R, Negredo E, Rodriguez-Espinosa J. Authors' Reply. Ann Clin Biochem 1998. [DOI: 10.1177/000456329803500422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Caballero
- Departments of Endocrinology and Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Corcoy
- Departments of Endocrinology and Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Negredo
- Departments of Endocrinology and Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Rodriguez-Espinosa
- Departments of Endocrinology and Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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García-Patterson A, Corcoy R, Rigla M, Caballero A, Adelantado JM, Altirriba O, de Leiva A. Does preconceptional counselling in diabetic women influence perinatal outcome? Ann Ist Super Sanita 1998; 33:333-6. [PMID: 9542258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We aimed to assess the impact of a preconceptional clinic (PC) on the perinatal outcome (PO) of diabetic pregnancies attended in our centre. We studied 185 pregnancies attended in the 1986-1996 period (152 in women with insulin dependent diabetes mellitus (IDDM) and 33 with non insulin-dependent diabetes mellitus (NIDDM)) and we analysed the perinatal outcome for both mother and fetus. Sixty-six women (36.1%) had enrolled in the PC, 41.4% for IDDM and 9.1% for NIDDM pregnancies, p < 0.01. First pregnancy HbA1c (in SD around the mean) was 3.98 +/- 3.00 in non-attenders (NA) vs 2.57 +/- 2.41 in attenders (A), p < 0.01. The final HbA1c was in the normal range in both groups. D-R class according to White classification was 33.0% for NA vs 54.5% for A, p < 0.01. There were no differences in the rates of abortion and major malformations (8.8% NA vs 3.6% A, ns). Both groups differed in the rate of cesarean sections (54.9% NA vs 71.0% A, p < 0.05) and in the rate of small for gestational age infants (SGA) (8.7% NA vs 1.8% A, p < 0.05). There were no differences between groups in maternal or neonatal outcomes. In this group of diabetic women with a moderate although less than optimal metabolic control at the beginning of pregnancy, the impact of PC on PO is less evident than described.
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Affiliation(s)
- A García-Patterson
- Endocrinology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Spain
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Albareda MM, Mariages MT, Corcoy R. [Bilateral ischemic optic neuropathy in a diabetic patient]. Rev Clin Esp 1998; 198:258-9. [PMID: 9633216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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