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Weir TL, Majumder M, Glastras SJ. A systematic review of the effects of maternal obesity on neonatal outcomes in women with gestational diabetes. Obes Rev 2024:e13747. [PMID: 38679418 DOI: 10.1111/obr.13747] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 10/03/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Maternal obesity and gestational diabetes mellitus (GDM) prevalence are increasing, with both conditions associated with adverse neonatal outcomes. This review aimed to determine the risk of adverse outcomes in women with obesity and GDM, compared with women with obesity alone. A systematic search identified 28 eligible articles. Meta-analysis was conducted using a random effects model, to generate pooled estimates (odds ratios, OR, or mean difference, MD). Compared with normal-weight controls, women with obesity had increased risks of large for gestational age (LGA, OR 1.98, 95% CI: 1.56, 2.52) and macrosomia (OR 2.93, 95% CI: 1.71, 5.03); the latter's risk almost double in women with obesity than GDM. Birth weight (MD 113 g, 95% CI: 69, 156) and shoulder dystocia (OR 1.23, 95% CI: 0.85, 1.78) risk was also higher. GDM significantly amplified neonatal risk in women with obesity, with a three- to four-fold risk of LGA (OR 3.22, 95% CI: 2.17, 4.79) and macrosomia (OR 3.71, 95% CI: 2.76, 4.98), as well as higher birth weights (MD 176 g, 95% CI: 89, 263), preterm delivery (OR 1.49, 95% CI: 1.25, 1.77), and shoulder dystocia (OR 1.99, 95% CI: 1.31, 3.03), when compared with normal-weight controls. Our findings demonstrate that maternal obesity increases serious neonatal adverse risk, magnified by the presence of GDM. Effective strategies are needed to safeguard against neonatal complications associated with maternal obesity, regardless of GDM status.
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Affiliation(s)
- Tessa L Weir
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Department of Endocrinology, Nepean-Blue Mountains Hospital, Kingswood, New South Wales, Australia
| | - Monica Majumder
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sarah J Glastras
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Glastras SJ, Pollock CA. Targeted identification of risk and treatment of diabetic kidney disease. Nat Rev Nephrol 2024; 20:75-76. [PMID: 38040863 DOI: 10.1038/s41581-023-00796-9] [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] [Indexed: 12/03/2023]
Affiliation(s)
- Sarah J Glastras
- Renal Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Carol A Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.
- North Precinct, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
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Purcell AR, Rodrigo N, Cao Q, Joseph O, Gill AJ, Saad S, Pollock CA, Glastras SJ. Maternal Weight Intervention in the Perinatal Period Improves Liver Health in the Offspring of Mothers with Obesity. Nutrients 2023; 16:109. [PMID: 38201940 PMCID: PMC10780988 DOI: 10.3390/nu16010109] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Early-life exposure to maternal obesity predisposes offspring to metabolic-associated fatty liver disease (MAFLD). This study aimed to determine if peripartum weight loss, either through dietary intervention or pharmacological intervention, improved adverse liver health outcomes in the offspring of mothers with obesity. C57Bl/6 dams were fed a chow diet or a high-fat diet (HFD) for 8 weeks. HFD-fed mice either continued HFD, transitioned to a chow diet, or were administered liraglutide for 4 weeks. Pregnancy was induced following a one-week washout of liraglutide during which all animals remained on their respective diets. A proportion of HFD-fed mice transitioned to a chow diet during pregnancy. All offspring were weaned to the HFD. Offspring anthropometric, metabolic, and hepatic outcomes were assessed at postnatal week 12. The offspring of mothers with obesity had phenotypic changes consistent with MAFLD. The offspring of mothers that had weight loss with perinatal dietary intervention had reduced insulin resistance (p < 0.001) and hepatic expression of markers of inflammation (p < 0.001), oxidative stress (p < 0.05), and fibrosis (p < 0.05). A similar phenotype was observed in the offspring of mothers with pre-pregnancy weight loss via liraglutide despite ongoing consumption of the HFD during pregnancy. All methods and timing of maternal weight intervention were effective at ameliorating adverse liver effects in the offspring.
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Affiliation(s)
- Amanda R. Purcell
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
| | - Natassia Rodrigo
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, NSW 2065, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Department of Diabetes and Endocrinology, Nepean Hospital, Sydney, NSW 2747, Australia
| | - Qinghua Cao
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
| | - Olivia Joseph
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
| | - Anthony J. Gill
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, NSW 2065, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Sonia Saad
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
| | - Carol A. Pollock
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, NSW 2065, Australia
| | - Sarah J. Glastras
- Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, NSW 2065, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Evans CJF, Glastras SJ, Tang O, Figtree GA. Therapeutic Potential for Beta-3 Adrenoreceptor Agonists in Peripheral Arterial Disease and Diabetic Foot Ulcers. Biomedicines 2023; 11:3187. [PMID: 38137408 PMCID: PMC10740412 DOI: 10.3390/biomedicines11123187] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Annually, peripheral arterial disease is estimated to cost over USD 21 billion and diabetic foot disease an estimated at USD 9-13 billion. Mirabegron is a TGA-approved beta-3 adrenoreceptor agonist, shown to be safe and effective in the treatment of overactive bladder syndrome by stimulating bladder smooth muscle relaxation. In this review, we discuss the potential use of beta-3 adrenoreceptor agonists as therapeutic agents repurposed for peripheral arterial disease and diabetic foot ulcers. The development of both conditions is underpinned by the upregulation of oxidative stress pathways and consequential inflammation and hypoxia. In oxidative stress, there is an imbalance of reactive oxygen species and nitric oxide. Endothelial nitric oxide synthase becomes uncoupled in disease states, producing superoxide and worsening oxidative stress. Agonist stimulation of the beta-3 adrenoreceptor recouples and activates endothelial nitric oxide synthase, increasing the production of nitric oxide. This reduces circulating reactive oxygen species, thus decreasing redox modification and dysregulation of cellular proteins, causing downstream smooth muscle relaxation, improved endothelial function and increased angiogenesis. These mechanisms lead to endothelial repair in peripheral arterial disease and an enhanced perfusion in hypoxic tissue, which will likely improve the healing of chronic ulcers.
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Affiliation(s)
- Cameron J. F. Evans
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Sarah J. Glastras
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW 2065, Australia
| | - Owen Tang
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Gemma A. Figtree
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW 2065, Australia
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Larkin BP, Nguyen LT, Hou M, Glastras SJ, Chen H, Faiz A, Chen J, Wang R, Pollock CA, Saad S. Low-dose hydralazine reduces albuminuria and glomerulosclerosis in a mouse model of obesity-related chronic kidney disease. Diabetes Obes Metab 2022; 24:1939-1949. [PMID: 35635331 PMCID: PMC9544807 DOI: 10.1111/dom.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/09/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
AIM To determine, using a mouse model of obesity, whether low-dose hydralazine prevents obesity-related chronic kidney disease (CKD). METHODS From 8 weeks of age, male C57BL/6 mice received a high-fat diet (HFD) or chow, with or without low-dose hydralazine (25 mg/L) in drinking water, for 24 weeks. Biometric and metabolic variables, renal function and structural changes, renal global DNA methylation, DNA methylation profile and markers of renal fibrosis, injury, inflammation and oxidative stress were assessed. RESULTS The HFD-fed mice developed obesity, with glucose intolerance, hyperinsulinaemia and dyslipidaemia. Obesity increased albuminuria and glomerulosclerosis, which were significantly ameliorated by low-dose hydralazine in the absence of a blood pressure-lowering effect. Obesity increased renal global DNA methylation and this was attenuated by low-dose hydralazine. HFD-induced changes in methylation of individual loci were also significantly reversed by low-dose hydralazine. Obese mice demonstrated increased markers of kidney fibrosis, inflammation and oxidative stress, but these markers were not significantly improved by hydralazine. CONCLUSION Low-dose hydralazine ameliorated HFD-induced albuminuria and glomerulosclerosis, independent of alterations in biometric and metabolic variables or blood pressure regulation. Although the precise mechanism of renoprotection in obesity is unclear, an epigenetic basis may be implicated. These data support repurposing hydralazine as a novel therapy to prevent CKD progression in obese patients.
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Affiliation(s)
- Benjamin P. Larkin
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Long T. Nguyen
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Miao Hou
- Department of CardiologyChildren′s Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Sarah J. Glastras
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
- Department of DiabetesEndocrinology and Metabolism, Royal North Shore HospitalSydneyAustralia
| | - Hui Chen
- School of Life Sciences, Faculty of ScienceUniversity of Technology SydneySydneyAustralia
| | - Alen Faiz
- School of Life Sciences, Faculty of ScienceUniversity of Technology SydneySydneyAustralia
| | - Jason Chen
- Department of Anatomical PathologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Rosy Wang
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Carol A. Pollock
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical ResearchUniversity of SydneySydneyAustralia
- School of Life Sciences, Faculty of ScienceUniversity of Technology SydneySydneyAustralia
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Verheyden MJ, Rodrigo N, Gill AJ, Glastras SJ. A case series and literature review of necrobiosis lipoidica. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0185. [PMID: 36001014 PMCID: PMC9422228 DOI: 10.1530/edm-21-0185] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 12/05/2022] Open
Abstract
Summary Necrobiosis lipoidica (NL) is a rare and chronic disease characterised by yellow-brown, atrophic, telangiectatic plaques usually located on the lower extremities, with pathological features of collagen necrobiosis and dermal inflammation. Most cases are seen in those with diabetes mellitus, particularly type 1 diabetes (T1DM), and many without diabetes have evidence of abnormal glucose tolerance or family history of autoimmune disease. In this study, we describe four patients with NL and T1DM. A common theme is late identification and delay in diagnosis. Hence, we discuss the clinical features, need for clinicopathological correlation, and the management and prognostic implications for this distinctive entity. While most remain relatively asymptomatic, others progress to debilitating disease with pruritus, dysesthesia, and pain. Pain is often intense in the presence of ulcerated plaques, a morbid complication of NL. Diagnosis requires the integration of both clinical and histopathological findings. NL has proven a challenging condition to treat, and despite the numerous therapeutic modalities available, there is no standard of care. Hence, in this study, we provide an overview of current management strategies available for NL. Learning points Necrobiosis lipoidica (NL) is classically seen in patients with type 1 diabetes. Koebner phenomenon, defined as the appearance of new skin lesions on previously unaffected skin secondary to trauma, is a well-recognised feature in NL. Background skin phototype contributes to variable yellow appearance of lesions in NL. Diagnosis of NL requires careful clinicopathological correlation. NL is a chronic disease often refractory to treatment leading to significant morbidity for the patient and a management conundrum for the multidisciplinary healthcare team. No standard therapeutic regimen has been established for the management of NL.
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Affiliation(s)
- Matthew J Verheyden
- Department of Diabetes, Metabolism and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Natassia Rodrigo
- Department of Diabetes, Metabolism and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Metabolism and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Rodrigo N, Saad S, Pollock C, Glastras SJ. Diet Modification before or during Pregnancy on Maternal and Foetal Outcomes in Rodent Models of Maternal Obesity. Nutrients 2022; 14:2154. [PMID: 35631295 PMCID: PMC9146671 DOI: 10.3390/nu14102154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
The obesity epidemic has serious implications for women of reproductive age; its rising incidence is associated not just with health implications for the mother but also has transgenerational ramifications for the offspring. Increased incidence of diabetes, cardiovascular disease, obesity, and kidney disease are seen in both the mothers and the offspring. Animal models, such as rodent studies, are fundamental to studying maternal obesity and its impact on maternal and offspring health, as human studies lack rigorous controlled experimental design. Furthermore, the short and prolific reproductive potential of rodents enables examination across multiple generations and facilitates the exploration of interventional strategies to mitigate the impact of maternal obesity, both before and during pregnancy. Given that obesity is a major public health concern, it is important to obtain a greater understanding of its pathophysiology and interaction with reproductive health, placental physiology, and foetal development. This narrative review focuses on the known effects of maternal obesity on the mother and the offspring, and the benefits of interventional strategies, including dietary intervention, before or during pregnancy on maternal and foetal outcomes. It further examines the contribution of rodent models of maternal obesity to elucidating pathophysiological pathways of disease development, as well as methods to reduce the impact of obesity on the mothers and the developing foetus. The translation of these findings into the human experience will also be discussed.
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Affiliation(s)
- Natassia Rodrigo
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney 2065, Australia;
- Kolling Institute of Medical Research, Sydney 2065, Australia; (S.S.); (C.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Sonia Saad
- Kolling Institute of Medical Research, Sydney 2065, Australia; (S.S.); (C.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney 2065, Australia; (S.S.); (C.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Sydney 2065, Australia
| | - Sarah J. Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney 2065, Australia;
- Kolling Institute of Medical Research, Sydney 2065, Australia; (S.S.); (C.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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Rodrigo N, Chen H, Pollock CA, Glastras SJ. Preconception weight loss improves fertility and maternal outcomes in obese mice. J Endocrinol 2022; 253:27-38. [PMID: 35080198 DOI: 10.1530/joe-21-0399] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 11/08/2022]
Abstract
Women with obesity have higher incidences of infertility, with longer time to conception and increased risk of pregnancy complications compared to women with normal body weight. There is a lack of evidence demonstrating the benefit of preconception maternal weight loss on fertility and pregnancy outcomes. We aimed to determine if preconception weight loss, either with diet modification or glucose-like peptide 1 receptor agonist liraglutide, improves maternal weight, fertility, and pregnancy outcomes. C57BL/6 female mice were fed either a high-fat diet (HFD) or chow for 8 weeks. HFD-fed dams were administered liraglutide (0.3 mg/kg, s.c., for 4 weeks) or switched to chow to induce weight loss. Prior to mating, liraglutide was ceased and mice continued on HFD. Mice in the 'diet switch' group continued on chow. Pregnancy rates were recorded. Maternal anthropometry and glucose tolerance were measured before and after the intervention and at late gestation. Offspring outcomes were assessed. Liraglutide or diet switch led to weight reduction, improved insulin resistance (P< 0.001), and enhanced fertility, particularly in the liraglutide group (P< 0.005). Liraglutide-treated mice had significantly higher gestational weight gain (GWG) compared to the diet switch group (P< 0.05), with similar weight and glucose tolerance in late gestation to HFD mice. In contrast, diet switch maintained similar weight and glucose tolerance in late gestation to control mice. Pre-pregnancy weight intervention with liraglutide was effective at restoring fertility. Diet modification also improved fertility and avoided catch up weight gain in pregnancy. Liraglutide may be a therapeutic strategy for weight loss to prepare for pregnancy. However, our study provides caution about the potential for excessive GWG without diet intervention in pregnancy.
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Affiliation(s)
- Natassia Rodrigo
- Renal Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Department of Diabetes and Endocrinology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Carol A Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Renal Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- North Precinct, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Abstract
INTRODUCTION Obesity in pregnancy is a known risk factor for adverse maternal and neonatal outcomes. Few studies have compared adverse pregnancy-related outcomes according to obesity severity. Hence, we aimed to examine the impact of obesity class on maternal and perinatal outcomes. METHODS We retrospectively analysed data from all singleton births from mothers with obesity from 2013-2017 in Northern Sydney Local Health District in Sydney, Australia. Women were categorised into obesity class I (BMI 30-34.9kg/m2), class II (BMI 35-39.9 kg/m2) or class III (BMI 40+ kg/m2). Across BMI classes, we compared maternal outcomes including mode of delivery, gestational diabetes mellitus (GDM), and preeclampsia, and neonatal outcomes including large- and small-for-gestational age (SGA, LGA), neonatal hypoglycaemia, birth defects and timing of birth. Logistic analyses were performed to explore the impact of maternal obesity class on these outcomes, adjusting for maternal age, country of birth, parity, diabetes (both pre-existing and gestational) and hypertension. RESULTS There were 2466 births to women with obesity, class (69.1%), class II (21.8%), and class III (9.2%). 42.5% delivered by Caesarean section, 22.3% developed GDM and 11.2% had a hypertensive disorder in pregnancy, and Caesarean section and GDM were more common in women with higher class obesity. LGA occurred in 27.3% and SGA occurred in 4.0% of women across all classes of obesity. LGA rates were 49% more likely in women with class III compared to women with class I obesity (OR=1.49, CI 1.06-2.09, p=0.02). The presence of diabetes in the index pregnancy did not significantly impact risk of neonatal LGA between maternal obesity classes. Other neonatal adverse outcomes such as stillbirth and birth defects were more common in women with higher class obesity. SGA, neonatal hypoglycaemia, gestational age at delivery, APGAR 5-minute score and NICU admissions were similar across obesity classes, after adjustment for covariates. CONCLUSIONS Obesity class increases the risk of many adverse maternal and neonatal outcomes. Obesity class is independently associated with LGA incidence in the neonate, independent of maternal factors including GDM. Ongoing efforts must be made to reduce obesity incidence in women of reproductive age to circumvent the adverse perinatal outcomes associated with obesity.
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Affiliation(s)
- Kirsten Neal
- Department of Medicine, Central Australian Health Service, Alice Springs, NT, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sarah J. Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
- Kolling Institute, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Sarah J. Glastras, ; orcid.org/0000-0002-9317-1348
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Zaky A, Glastras SJ, Wong MYW, Pollock CA, Saad S. The Role of the Gut Microbiome in Diabetes and Obesity-Related Kidney Disease. Int J Mol Sci 2021; 22:9641. [PMID: 34502562 PMCID: PMC8431784 DOI: 10.3390/ijms22179641] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetic kidney disease (DKD) is a progressive disorder, which is increasing globally in prevalence due to the increased incidence of obesity and diabetes mellitus. Despite optimal clinical management, a significant number of patients with diabetes develop DKD. Hence, hitherto unrecognized factors are likely to be involved in the initiation and progression of DKD. An extensive number of studies have demonstrated the role of microbiota in health and disease. Dysregulation in the microbiota resulting in a deficiency of short chain fatty acids (SCFAs) such as propionate, acetate, and butyrate, by-products of healthy gut microbiota metabolism, have been demonstrated in obesity, type 1 and type 2 diabetes. However, it is not clear to date whether such changes in the microbiota are causative or merely associated with the diseases. It is also not clear which microbiota have protective effects on humans. Few studies have investigated the centrality of reduced SCFA in DKD development and progression or the potential therapeutic effects of supplemental SCFAs on insulin resistance, inflammation, and metabolic changes. SCFA receptors are expressed in the kidneys, and emerging data have demonstrated that intestinal dysbiosis activates the renal renin-angiotensin system, which contributes to the development of DKD. In this review, we will summarize the complex relationship between the gut microbiota and the kidney, examine the evidence for the role of gut dysbiosis in diabetes and obesity-related kidney disease, and explore the mechanisms involved. In addition, we will describe the role of potential therapies that modulate the gut microbiota to prevent or reduce kidney disease progression.
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Affiliation(s)
- Amgad Zaky
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia; (A.Z.); (S.J.G.); (M.Y.W.W.); (C.A.P.)
| | - Sarah J. Glastras
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia; (A.Z.); (S.J.G.); (M.Y.W.W.); (C.A.P.)
- Royal North Shore Hospital, St. Leonards, NSW 2065, Australia
| | - May Y. W. Wong
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia; (A.Z.); (S.J.G.); (M.Y.W.W.); (C.A.P.)
- Royal North Shore Hospital, St. Leonards, NSW 2065, Australia
| | - Carol A. Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia; (A.Z.); (S.J.G.); (M.Y.W.W.); (C.A.P.)
- Royal North Shore Hospital, St. Leonards, NSW 2065, Australia
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia; (A.Z.); (S.J.G.); (M.Y.W.W.); (C.A.P.)
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Larkin BP, Nguyen LT, Hou M, Glastras SJ, Chen H, Wang R, Pollock CA, Saad S. Novel Role of Gestational Hydralazine in Limiting Maternal and Dietary Obesity-Related Chronic Kidney Disease. Front Cell Dev Biol 2021; 9:705263. [PMID: 34485290 PMCID: PMC8416283 DOI: 10.3389/fcell.2021.705263] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/30/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Maternal obesity is a risk factor for chronic kidney disease (CKD) in offspring, underpinning the theory of the developmental origins of health and disease. DNA methylation has been implicated in the programming of adult chronic disease by maternal obesity, therefore, DNA demethylating agents may mitigate offspring risk of disease. In rodent models, low-dose hydralazine has previously been shown to reduce renal fibrosis via DNA demethylation. We used mouse models of maternal obesity and offspring obesity to determine whether administration of low-dose hydralazine during gestation can prevent fetal programming of CKD in offspring. METHODS Female C57BL/6 mice received high fat diet (HFD) or chow prior to mating, during gestation and lactation. During gestation, dams received subcutaneous hydralazine (5 mg/kg) or saline thrice-weekly. Male offspring weaned to HFD or chow, which continued until endpoint at 32 weeks. Biometric and metabolic parameters, renal global DNA methylation, renal functional and structural changes, and renal markers of fibrosis, inflammation and oxidative stress were assessed at endpoint. RESULTS Offspring exposed to maternal obesity or diet-induced obesity had significantly increased renal global DNA methylation, together with other adverse renal effects including albuminuria, glomerulosclerosis, renal fibrosis, and oxidative stress. Offspring exposed to gestational hydralazine had significantly reduced renal global DNA methylation. In obese offspring of obese mothers, gestational hydralazine significantly decreased albuminuria, glomerulosclerosis, and serum creatinine. Obese offspring of hydralazine-treated lean mothers displayed reduced markers of renal fibrosis and oxidative stress. CONCLUSION Gestational hydralazine decreased renal global DNA methylation and exerted renoprotective effects in offspring. This supports a potential therapeutic effect of hydralazine in preventing maternal obesity or dietary obesity-related CKD, through an epigenetic mechanism.
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Affiliation(s)
- Benjamin P. Larkin
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Long T. Nguyen
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Miao Hou
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, China
| | - Sarah J. Glastras
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Hui Chen
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Rosy Wang
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Carol A. Pollock
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sonia Saad
- Renal Research Laboratory, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
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12
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Randall DA, Morris JM, Kelly P, Glastras SJ. Are newly introduced criteria for the diagnosis of gestational diabetes mellitus associated with improved pregnancy outcomes and/or increased interventions in New South Wales, Australia? A population-based data linkage study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002277. [PMID: 34183322 PMCID: PMC8240580 DOI: 10.1136/bmjdrc-2021-002277] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The incidence of gestational diabetes mellitus (GDM) is increasing in Australia, influenced by changed diagnostic criteria. We aimed to identify whether the diagnostic change was associated with improved outcomes and/or increased obstetric interventions using state-wide data in New South Wales (NSW), Australia. RESEARCH DESIGN AND METHODS Perinatal and hospital data were linked for singleton births, 33-41 weeks' gestation, 2006-2015, NSW. An adjusted Poisson model was used to split pregnancies from 2011 onwards into those that would have been diagnosed under the old criteria ('previous GDM') and newly diagnosed cases ('additional GDM'). We compared actual rates of total and early (<39 weeks) planned births, cesareans, and maternal and neonatal adverse outcomes for GDM-diagnosed pregnancies using three predicted scenarios, where the 'additional GDM' group was assumed to have the same rates as: the 'previous GDM' group <2011 (scenario A); the 'non-GDM' group <2011 (scenario B); or the 'non-GDM' group ≥2011 (scenario C). RESULTS GDM incidence more than doubled over the study period, with an inflection point observed at 2011. For those diagnosed with GDM since 2011, the actual incidence of interventions (planned births and cesareans) and macrosomia was consistent with scenario A, which meant higher intervention rates, but lower rates of macrosomia, than those with no GDM. Incidence of neonatal hypoglycemia was lower than scenario A and closer to the other scenarios. There was a reduction in perinatal deaths among those with GDM, lower than that predicted by all scenarios, indicating an improvement for all with GDM, not only women newly diagnosed. Incidence of maternal and neonatal morbidity indicators was within the confidence bounds for all three predicted scenarios. CONCLUSIONS Our study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower rates of macrosomic babies, but with no clear impacts on maternal or neonatal morbidity.
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Affiliation(s)
- Deborah A Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia
| | - Jonathan M Morris
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia
| | - Patrick Kelly
- The University of Sydney, School of Public Health, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Northern Sydney Local Health District, Kolling Institute, St Leonards, New South Wales, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- The University of Sydney, Northern Clinical School, St Leonards, New South Wales, Australia
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13
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Rodrigo N, Learoyd D, Glastras SJ. Complexities surrounding the diagnosis and management of hypercalcaemia in pregnancy. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200163. [PMID: 33982664 PMCID: PMC8185537 DOI: 10.1530/edm-20-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Hypercalcaemia in pregnancy is uncommon, with associated adverse obstetric and perinatal outcomes for both the mother and the fetus. Determination of causality is central to its management. Diagnostic imaging techniques are limited during pregnancy and the diagnosis is made more complex by physiological changes in calcium and vitamin D homeostasis in pregnancy. Further, therapeutic options are limited due to safety considerations for the pregnant woman and the developing foetus. Three cases of hypercalcaemia in pregnancy will be presented, highlighting the distinct aetiologies and management strategies for hypercalcaemia in pregnancy and the importance of early measurement of serum calcium in pregnancy screening. LEARNING POINTS There are complex physiological changes in calcium balance in pregnancy, including increased calcium intestinal absorption and renal excretion. Hypercalcaemia in pregnancy is uncommon but has important potential maternal and foetal complications, making a compelling argument for routine antenatal, calcium screening. Identifying the cause of hypercalcaemia in pregnancy can be challenging due to the complex placental interplay in biochemical test interpretation and due to safety constraints restricting imaging and surgery. Acute medical management of hypercalcaemia must be considered in the context of both maternal and foetal well-being, along with gestational age and specific consideration for the safety of the developing fetus in late gestation.
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Affiliation(s)
- Natassia Rodrigo
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, Department of Medicine, University of Sydney, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
| | - Diana Learoyd
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, Department of Medicine, University of Sydney, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
| | - Sarah J Glastras
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, Department of Medicine, University of Sydney, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
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14
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Larkin BP, Saad S, Glastras SJ, Nguyen LT, Hou M, Chen H, Wang R, Pollock CA. Low-dose hydralazine during gestation reduces renal fibrosis in rodent offspring exposed to maternal high fat diet. PLoS One 2021; 16:e0248854. [PMID: 33735324 PMCID: PMC7971884 DOI: 10.1371/journal.pone.0248854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal high fat diet (HFD) promotes chronic kidney disease (CKD) in offspring. This is in accordance with the theory of fetal programming, which suggests adverse conditions occurring in utero predispose offspring to chronic conditions later in life. DNA methylation has been proposed as a key mechanism by which fetal programming occurs and is implicated in CKD progression. DNA demethylating drugs may interrupt the fetal programming of CKD by maternal obesity. Hydralazine, an antihypertensive agent, demethylates DNA at low doses which do not reduce blood pressure. We used a mouse model of maternal obesity to determine whether gestational administration of low-dose hydralazine to mothers can prevent CKD in offspring. METHODS C57BL/6 dams received HFD or chow from 6 weeks prior to mating and were administered subcutaneous hydralazine (5mg/kg) or saline thrice weekly during gestation. Male offspring were weaned to chow and were sacrificed at either postnatal week 9 or week 32. Biometric and metabolic parameters, renal global DNA methylation, renal structural and functional changes and markers of fibrosis, oxidative stress and inflammation were measured in offspring at weeks 9 and 32. RESULTS In week 9 offspring, maternal HFD consumption did not significantly alter anthropometric or metabolic parameters, or renal global DNA methylation. Week 32 offspring had increased renal global DNA methylation, together with albuminuria, glomerulosclerosis, renal fibrosis and oxidative stress. Administration of low-dose hydralazine to obese mothers during gestation reduced renal global DNA methylation and renal fibrotic markers in week 32 offspring. CONCLUSION Gestational hydralazine reduced renal global DNA methylation in offspring of obese mothers and attenuated maternal obesity-induced renal fibrosis. These data support the use of low-dose hydralazine as a demethylating agent to prevent CKD arising in offspring due to maternal HFD consumption.
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Affiliation(s)
- Benjamin P. Larkin
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Sarah J. Glastras
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, Australia
| | - Long T. Nguyen
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Miao Hou
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Rosy Wang
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Carol A. Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
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15
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Affiliation(s)
- Sarah J. Glastras
- Department of Diabetes, Metabolism and Endocrinology, and Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Damaskini Valvi, ; Amita Bansal,
| | - Amita Bansal
- Australian National University (ANU) Medical School, and John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
- *Correspondence: Damaskini Valvi, ; Amita Bansal,
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16
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Glastras SJ, Cohen N, Dover T, Kilov G, MacIsaac RJ, McGill M, Fulcher GR. The Clinical Role of Insulin Degludec/Insulin Aspart in Type 2 Diabetes: An Empirical Perspective from Experience in Australia. J Clin Med 2020; 9:jcm9041091. [PMID: 32290465 PMCID: PMC7230791 DOI: 10.3390/jcm9041091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Treatment intensification in people with type 2 diabetes following failure of basal insulin commonly involves the addition of a rapid-acting insulin analogue (basal plus one or more prandial doses; multiple daily injections) or by a switch to premixed insulin. Insulin degludec/insulin aspart (IDegAsp), comprising rapid-acting insulin aspart and ultra-long-acting insulin degludec in solution, enables both fasting and post-prandial glucose control, with some advantages over other treatment intensification options. These include straightforward dose titration, flexibility in dose timing, low injection burden, simplicity of switching and a lower risk of hypoglycaemia. In Australia, where insulin degludec on its own is not available, IDegAsp enables patients to still benefit from its ultra-long-acting properties. This review aims to provide guidance on where and how to use IDegAsp. Specifically, guidance is included on the initiation of IDegAsp in insulin-naïve patients, treatment intensification from basal insulin, switching from premixed or basal-bolus insulin to IDegAsp, up-titration from once- to twice-daily IDegAsp and the use of IDegAsp in special populations or situations.
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Affiliation(s)
- Sarah J. Glastras
- Department of Diabetes, Endocrinology and Metabolism, The Royal North Shore Hospital, University of Sydney, Reserve Road, St Leonards NSW 2065, Australia;
- Correspondence: ; Tel.: +61-2-9463-1680
| | - Neale Cohen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia;
| | - Thomas Dover
- Ipswich Hospital, University of Queensland, Chelmsford Avenue, Ipswich QLD 4305, Australia;
- Mater Hospital Brisbane, Raymond Terrace, South Brisbane QLD 4101, Australia
| | - Gary Kilov
- Launceston Diabetes Clinic, 247 Wellington Street, Launceston TAS 7250, Australia;
- Department of General Practice and Primary Health Care, University of Melbourne, 230 Gratton Street, Parkville VIC 3010, Australia
| | - Richard J. MacIsaac
- Department of Endocrinology & Diabetes, St Vincent’s Hospital Melbourne, University of Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia;
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia;
| | - Greg R. Fulcher
- Department of Diabetes, Endocrinology and Metabolism, The Royal North Shore Hospital, University of Sydney, Reserve Road, St Leonards NSW 2065, Australia;
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17
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McGrath RT, Glastras SJ, Hocking SL, Fulcher GR. Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia. Diabetes Care 2018; 41:1821-1828. [PMID: 30030258 DOI: 10.2337/dc18-0551] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023]
Abstract
Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia. We review potential contributors to excess fetal growth in pregnancies complicated by type 1 diabetes. In addition to hyperglycemia, we explore the role of glycemic variability, prepregnancy overweight and obesity, gestational weight gain, and maternal lipid levels. Greater understanding of the stimuli that drive excess fetal growth could lead to targeted management strategies in pregnant women with type 1 diabetes, potentially reducing the incidence of LGA neonates and the inherent risk of acute and long-term complications.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia .,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,Kolling Institute, St Leonards, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- Central Clinical School and The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology & Metabolism and the Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
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18
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Rodrigo N, Glastras SJ. The Emerging Role of Biomarkers in the Diagnosis of Gestational Diabetes Mellitus. J Clin Med 2018; 7:E120. [PMID: 29882903 PMCID: PMC6024961 DOI: 10.3390/jcm7060120] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy; its rising incidence is a result of increased maternal obesity and older maternal age together with altered diagnostic criteria identifying a greater proportion of pregnant women with GDM. Its consequences are far-reaching, associated with poorer maternal and neonatal outcomes compared to non-GDM pregnancies, and GDM has implications for metabolic health in both mother and offspring. Objective markers to identify women at high risk for the development of GDM are useful to target therapy and potentially prevent its development. Established clinical risk factors for GDM include overweight/obesity, age, ethnicity, and family history of diabetes, though they lack specificity for its development. The addition of biomarkers to predictive models of GDM may improve the ability to identify women at risk of GDM prior to its development. These biomarkers reflect the pathophysiologic mechanisms of GDM involving insulin resistance, chronic inflammation, and altered placental function. In addition, the role of epigenetic changes in GDM pathogenesis highlights the complex interplay between genetic and environmental factors, potentially offering further refinement of the prediction of GDM risk. In this review, we will discuss the clinical challenges associated with the diagnosis of GDM and its current pathophysiologic basis, giving rise to potential biomarkers that may aid in its identification. While not yet validated for clinical use, we explore the possible clinical role of biomarkers in the future. We also explore novel diagnostic tools, including high throughput methodologies, that may have potential future application in the identification of women with GDM.
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Affiliation(s)
- Natassia Rodrigo
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia.
- The Kolling Institute of Medical Research, St Leonards, Sydney 2065, Australia.
- Faculty of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia.
- The Kolling Institute of Medical Research, St Leonards, Sydney 2065, Australia.
- Faculty of Medicine, The University of Sydney, Sydney 2006, Australia.
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19
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Mcgrath RT, Gunton JE, Hocking SL, Glastras SJ, Fulcher GR. Women with type 2 diabetes in pregnancy remain a high-risk group. MINERVA ENDOCRINOL 2018; 43:224-225. [PMID: 29761685 DOI: 10.23736/s0391-1977.17.02653-0] [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: 11/08/2022]
Affiliation(s)
- Rachel T Mcgrath
- Department of Diabetes, Endocrinology and Metabolism, the Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, Australia - .,Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, Australia -
| | - Jenny E Gunton
- Department of Diabetes and Endocrinology, Westmead Hospital, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology and Metabolism, the Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, the Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, Australia.,Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, the Northern Clinical School, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, Australia
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20
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Glastras SJ, Chen H, Pollock CA, Saad S. Maternal obesity increases the risk of metabolic disease and impacts renal health in offspring. Biosci Rep 2018; 38:BSR20180050. [PMID: 29483369 PMCID: PMC5874265 DOI: 10.1042/bsr20180050] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022] Open
Abstract
Obesity, together with insulin resistance, promotes multiple metabolic abnormalities and is strongly associated with an increased risk of chronic disease including type 2 diabetes (T2D), hypertension, cardiovascular disease, non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). The incidence of obesity continues to rise in astronomical proportions throughout the world and affects all the different stages of the lifespan. Importantly, the proportion of women of reproductive age who are overweight or obese is increasing at an alarming rate and has potential ramifications for offspring health and disease risk. Evidence suggests a strong link between the intrauterine environment and disease programming. The current review will describe the importance of the intrauterine environment in the development of metabolic disease, including kidney disease. It will detail the known mechanisms of fetal programming, including the role of epigenetic modulation. The evidence for the role of maternal obesity in the developmental programming of CKD is derived mostly from our rodent models which will be described. The clinical implication of such findings will also be discussed.
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Affiliation(s)
- Sarah J Glastras
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Australia
| | - Carol A Pollock
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Sonia Saad
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
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21
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Larkin BP, Glastras SJ, Chen H, Pollock CA, Saad S. DNA methylation and the potential role of demethylating agents in prevention of progressive chronic kidney disease. FASEB J 2018; 32:5215-5226. [PMID: 29688808 DOI: 10.1096/fj.201800205r] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 01/19/2023]
Abstract
Chronic kidney disease (CKD) is a global epidemic, and its major risk factors include obesity and type 2 diabetes. Obesity not only promotes metabolic dysregulation and the development of diabetic kidney disease but also may independently lead to CKD by a variety of mechanisms, including endocrine and metabolic dysfunction, inflammation, oxidative stress, altered renal hemodynamics, and lipotoxicity. Deleterious renal effects of obesity can also be transmitted from one generation to the next, and it is increasingly recognized that offspring of obese mothers are predisposed to CKD. Epigenetic modifications are changes that regulate gene expression without altering the DNA sequence. Of these, DNA methylation is the most studied. Epigenetic imprints, particularly DNA methylation, are laid down during critical periods of fetal development, and they may provide a mechanism by which maternal-fetal transmission of chronic disease occurs. Our current review explores the evidence for the role of DNA methylation in the development of CKD, diabetic kidney disease, diabetes, and obesity. DNA methylation has been implicated in renal fibrosis-the final pathophysiologic pathway in the development of end-stage kidney disease-which supports the notion that demethylating agents may play a potential therapeutic role in preventing development and progression of CKD.-Larkin, B. P., Glastras, S. J., Chen, H., Pollock, C. A., Saad, S. DNA methylation and the potential role of demethylating agents in prevention of progressive chronic kidney disease.
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Affiliation(s)
- Benjamin P Larkin
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Diabetes, Endocrinology, and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia; and
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Carol A Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
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22
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McGrath RT, Fulcher GR, Glastras SJ. Comment on Ooi and Wong. Twin Pregnancy With Gestational Diabetes Mellitus: A Double Whammy? Diabetes Care 2018;41:e15-e16. Diabetes Care 2018; 41:e67. [PMID: 29559464 DOI: 10.2337/dc17-2594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia .,Northern Clinical School, University of Sydney, St Leonards, Sydney, New South Wales, Australia.,Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, St Leonards, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, St Leonards, Sydney, New South Wales, Australia.,Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
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McGrath RT, Dryden JC, Newlyn N, Pamplona E, O'Dea J, Hocking SL, Glastras SJ, Fulcher GR. Utility of the Hospital Admission Risk Programme diabetes risk calculator in identifying patients with type 2 diabetes at risk of unplanned hospital presentations. Intern Med J 2018; 48:1198-1205. [PMID: 29604162 DOI: 10.1111/imj.13824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/07/2017] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prevention of hospitalisation is an important aspect of type 2 diabetes (T2D) management. AIMS We retrospectively determined the utility of the Hospital Admission Risk Programme (HARP) diabetes risk calculator (HARP tool) in identifying patients with T2D more likely to have unplanned hospital presentations. METHODS The HARP tool includes a clinical assessment score (Part A) and a psychosocial and self-management impact score (Part B), and categorises patients into low, medium, high or urgent risk of acute hospitalisation. It was completed for T2D patients attending Royal North Shore Hospital, Sydney, in 2013. RESULTS Within the cohort of 278 patients (age 65.3 ± 10.5 years; 62.9% male; diabetes duration 10.7 ± 6.6 years), 67.3% were classified as low risk, 32.7% as medium risk and none as high or urgent risk. Following adjustment for confounders, a medium HARP score was associated with a 3.1-fold increased risk of unplanned hospital presentations in the subsequent 12 months (95% confidence interval: 1.35-7.31; P = 0.008). Part A scores were significantly higher for patients that presented to hospital compared to those that did not (14.2 ± 6.8 vs 11.4 ± 5.5; P = 0.034), whereas there was no difference in Part B scores (P = 0.860). CONCLUSIONS In patients with low and medium HARP scores, clinical features were more predictive of hospital presentations than certain psychosocial or self-management factors in the present cohort. Further studies are required to characterise unplanned hospitalisation in patients with higher HARP scores, or whether additional psychosocial assessments could improve the tool's predictability.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Justin C Dryden
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Neroli Newlyn
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Elline Pamplona
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Judy O'Dea
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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McGrath RT, Glastras SJ, Scott ES, Hocking SL, Fulcher GR. Outcomes for Women with Gestational Diabetes Treated with Metformin: A Retrospective, Case-Control Study. J Clin Med 2018. [PMID: 29522471 PMCID: PMC5867576 DOI: 10.3390/jcm7030050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Metformin is increasingly being used a therapeutic option for the management of gestational diabetes mellitus (GDM). The aim of this study was to compare the maternal characteristics and perinatal outcomes of women with GDM treated with metformin (with or without supplemental insulin) with those receiving other management approaches. A retrospective, case-control study was carried out and 83 women taking metformin were matched 1:1 with women receiving insulin or diet and lifestyle modification alone. Women managed with diet and lifestyle modification had a significantly lower fasting plasma glucose (p < 0.001) and HbA1c (p < 0.01) at diagnosis of GDM. Furthermore, women managed with metformin had a higher early pregnancy body mass index (BMI) compared to those receiving insulin or diet and lifestyle modification (p < 0.001). There was no difference in mode of delivery, birth weight or incidence of large- or small-for-gestational-age neonates between groups. Women receiving glucose lowering therapies had a higher rate of neonatal hypoglycaemia (p < 0.05). The incidence of other adverse perinatal outcomes was similar between groups. Despite their greater BMI, women with metformin-treated GDM did not have an increased risk of adverse perinatal outcomes. Metformin is a useful alternative to insulin in the management of GDM.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Northern Clinical School, University of Sydney, Sydney NSW 2065, Australia.
- Kolling Institute of Medical Research, St Leonards, Sydney NSW 2065, Australia.
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Northern Clinical School, University of Sydney, Sydney NSW 2065, Australia.
- Kolling Institute of Medical Research, St Leonards, Sydney NSW 2065, Australia.
| | - Emma S Scott
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney NSW 2050, Australia.
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Boden Institute, Charles Perkins Centre, University of Sydney, Camperdown, Sydney NSW 2006, Australia.
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Level 3, Acute Services Building, Royal North Shore Hospital, St Leonards, Sydney NSW 2065, Australia.
- Northern Clinical School, University of Sydney, Sydney NSW 2065, Australia.
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Ring S, Glastras SJ, Hocking SL, Seeho SK, Scott ES, Fulcher GR, McGrath RT. Excess foetal growth and glycaemic control in type 1 diabetes and pregnancy. Diabetes Metab 2018; 45:497-499. [PMID: 29398256 DOI: 10.1016/j.diabet.2018.01.002] [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] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 11/18/2022]
Affiliation(s)
- S Ring
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
| | - S J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia; Kolling Institute, St-Leonards, NSW, Australia
| | - S L Hocking
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
| | - S K Seeho
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St-Leonards, NSW, Australia
| | - E S Scott
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia
| | - G R Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia
| | - R T McGrath
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore hospital, St-Leonards, NSW, Australia; Northern Clinical School, University of Sydney, NSW, Australia; Kolling Institute, St-Leonards, NSW, Australia.
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McGrath RT, Glastras SJ, Seeho SK, Scott ES, Fulcher GR, Hocking SL. Association Between Glycemic Variability, HbA 1c, and Large-for-Gestational-Age Neonates in Women With Type 1 Diabetes. Diabetes Care 2017; 40:e98-e100. [PMID: 28615243 DOI: 10.2337/dc17-0626] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/11/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Australia.,Northern Clinical School, University of Sydney, St Leonards, Australia.,Kolling Institute, University of Sydney, Royal North Shore Hospital, St Leonards, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Australia.,Kolling Institute, University of Sydney, Royal North Shore Hospital, St Leonards, Australia
| | - Sean K Seeho
- Northern Clinical School, University of Sydney, St Leonards, Australia.,Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia
| | - Emma S Scott
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Australia.,Northern Clinical School, University of Sydney, St Leonards, Australia
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, Australia .,Northern Clinical School, University of Sydney, St Leonards, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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Wijewardene AA, Glastras SJ, Learoyd DL, Robinson BG, Tsang VHM. ACTH-secreting medullary thyroid cancer: a case series. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160110. [PMID: 28567290 PMCID: PMC5445425 DOI: 10.1530/edm-16-0110] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2022] Open
Abstract
Medullary thyroid cancer (MTC) is a rare neuroendocrine tumour that originates from the parafollicular cells of the thyroid gland. The most common presentation of MTC is with a single nodule; however, by the time of diagnosis, most have spread to the surrounding cervical lymph nodes. Cushing’s syndrome is a rare complication of MTC and is due to ectopic adrenocorticotrophic hormone (ACTH) secretion by tumour cells. Cushing’s syndrome presents a challenging diagnostic and management issue in patients with MTC. Tyrosine kinase inhibitors (TKI) previously used for the management of metastatic MTC have become an important therapeutic option for the management of ectopic ACTH in metastatic MTC. The article describes three cases of ectopic ACTH secretion in MTC and addresses the significant diagnostic and management challenges related to Cushing’s syndrome in metastatic MTC.
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Affiliation(s)
| | - Sarah J Glastras
- Departments of Endocrinology, Diabetes & Metabolism, Royal North Shore Hospital, SydneyAustralia.,Kolling Institute of Medical Research.,Sydney Medical School, University of Sydney, SydneyAustralia
| | - Diana L Learoyd
- Departments of Endocrinology, Diabetes & Metabolism, Royal North Shore Hospital, SydneyAustralia.,Sydney Medical School, University of Sydney, SydneyAustralia
| | - Bruce G Robinson
- Departments of Endocrinology, Diabetes & Metabolism, Royal North Shore Hospital, SydneyAustralia.,Sydney Medical School, University of Sydney, SydneyAustralia
| | - Venessa H M Tsang
- Departments of Endocrinology, Diabetes & Metabolism, Royal North Shore Hospital, SydneyAustralia.,Sydney Medical School, University of Sydney, SydneyAustralia
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Delaney G, Newlyn N, Pamplona E, Hocking SL, Glastras SJ, McGrath RT, Fulcher GR. Identification of Patients With Diabetes Who Benefit Most From a Health Coaching Program in Chronic Disease Management, Sydney, Australia, 2013. Prev Chronic Dis 2017; 14:E21. [PMID: 28253473 PMCID: PMC5338599 DOI: 10.5888/pcd14.160504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction Chronic disease management programs (CDMPs) that include health coaching can facilitate and coordinate diabetes management. The aim of this study was to assess changes in patients’ general knowledge of diabetes, self-reported health status, diabetes distress, body mass index (BMI), and glycemic control after enrollment in a face-to-face CDMP group health coaching session (with telephone follow-up) compared with participation in telephone-only health coaching, during a 12-month period. Methods Patients with diabetes were enrolled in a health coaching program at Royal North Shore Hospital, Sydney, Australia, in 2013. Questionnaires were administered at baseline and at 3, 6, and 12 months, and the results were compared with baseline. Glycemic control, measured with glycated hemoglobin A1c (HbA1c) and BMI, were measured at baseline and 12 months. Results Overall, 238 patients attended a face-to-face CDMP session with telephone follow-up (n = 178) or participated in telephone-only health coaching (n = 60). We found no change in BMI in either group; however, HbA1c levels in patients with baseline above the current recommended target (>7%) decreased significantly from 8.5% (standard deviation [SD], 1.0%) to 7.9% (SD, 1.0%) (P = .03). Patients with the lowest self-reported health status at baseline improved from 4.4 (SD, 0.5) to 3.7 (SD, 0.9) (P = .001). Diabetes knowledge improved in all patients (24.4 [SD, 2.4] to 25.2 [SD, 2.4]; P < .001), and diabetes distress decreased among those with the highest levels of distress at baseline (3.0 [SD, 0.4] vs 3.8 [SD, 0.6]; P = .003). Conclusion Diabetes health coaching programs can improve glycemic control and reduce diabetes distress in patients with high levels of these at baseline.
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Affiliation(s)
- Grace Delaney
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Neroli Newlyn
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Elline Pamplona
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Samantha L Hocking
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.,University of Sydney, Northern Clinical School, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.,Charles Perkins Centre, University of Sydney, Australia
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.,Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Rachel T McGrath
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.,University of Sydney, Northern Clinical School, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.,Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.,University of Sydney, Northern Clinical School, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Glastras SJ, Chen H, Tsang M, Teh R, McGrath RT, Zaky A, Chen J, Wong MG, Pollock CA, Saad S. The renal consequences of maternal obesity in offspring are overwhelmed by postnatal high fat diet. PLoS One 2017; 12:e0172644. [PMID: 28225809 PMCID: PMC5321436 DOI: 10.1371/journal.pone.0172644] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/07/2017] [Indexed: 12/26/2022] Open
Abstract
AIMS/HYPOTHESIS Developmental programming induced by maternal obesity influences the development of chronic disease in offspring. In the present study, we aimed to determine whether maternal obesity exaggerates obesity-related kidney disease. METHODS Female C57BL/6 mice were fed high-fat diet (HFD) for six weeks prior to mating, during gestation and lactation. Male offspring were weaned to normal chow or HFD. At postnatal Week 8, HFD-fed offspring were administered one dose streptozotocin (STZ, 100 mg/kg i.p.) or vehicle control. Metabolic parameters and renal functional and structural changes were observed at postnatal Week 32. RESULTS HFD-fed offspring had increased adiposity, glucose intolerance and hyperlipidaemia, associated with increased albuminuria and serum creatinine levels. Their kidneys displayed structural changes with increased levels of fibrotic, inflammatory and oxidative stress markers. STZ administration did not potentiate the renal effects of HFD. Though maternal obesity had a sustained effect on serum creatinine and oxidative stress markers in lean offspring, the renal consequences of maternal obesity were overwhelmed by the powerful effect of diet-induced obesity. CONCLUSION Maternal obesity portends significant risks for metabolic and renal health in adult offspring. However, diet-induced obesity is an overwhelming and potent stimulus for the development of CKD that is not potentiated by maternal obesity.
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Affiliation(s)
- Sarah J. Glastras
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Michael Tsang
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Rachel Teh
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Rachel T. McGrath
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Amgad Zaky
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Jason Chen
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Muh Geot Wong
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Carol A. Pollock
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Sonia Saad
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
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McGrath RT, Glastras SJ, Hocking S, Fulcher GR. Use of metformin earlier in pregnancy predicts supplemental insulin therapy in women with gestational diabetes. Diabetes Res Clin Pract 2016; 116:96-9. [PMID: 27321322 DOI: 10.1016/j.diabres.2016.04.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Received: 04/05/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
Abstract
The use of metformin in gestational diabetes is safe and effective, yet some women require additional insulin therapy to achieve glycaemic targets. We found a significant association between earlier gestational age at initiation of metformin therapy and the necessity for supplemental insulin in women treated with metformin during pregnancy.
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Affiliation(s)
- Rachel T McGrath
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Samantha Hocking
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Gregory R Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
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McGrath RT, Donnelly VC, Glastras SJ, Preda VA, Sheriff N, Ward P, Hocking SL, Fulcher GR. Evaluation of Blood Glucose Meter Efficacy in an Antenatal Diabetes Clinic. Diabetes Technol Ther 2016; 18:68-74. [PMID: 26440810 DOI: 10.1089/dia.2015.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/12/2022]
Abstract
BACKGROUND The optimal treatment of diabetes in pregnancy requires accurate measurement of blood glucose levels, in order to minimize adverse outcomes for both mother and neonate. Self-monitoring of blood glucose is routinely used to measure glycemic control and to assess whether treatment targets are being met; however, the accuracy of blood glucose meters in pregnancy is unclear. MATERIALS AND METHODS Pregnant women with gestational, type 1, or type 2 diabetes mellitus were eligible to participate. Nonfasting capillary blood glucose levels were measured in duplicate using the BGStar(®) (Sanofi, Sydney, Australia) and FreeStyle Lite(®) (Abbott, Sydney) blood glucose meters. Venous blood samples were collected and analyzed for plasma glucose, hematocrit, and glycated hemoglobin. Capillary blood glucose was compared with plasma glucose and further assessed according to International Organization for Standardization (ISO) 15197:2013 standards. RESULTS One hundred ten women were recruited, providing 96 samples suitable for analysis. The mean ± SD laboratory plasma glucose level was 4.6 ± 1.4 mmol/L; the BGStar and FreeStyle Lite capillary blood glucose values were 5.3 ± 1.4 mmol/L and 5.0 ± 1.3 mmol/L, respectively. Both meters showed a positive bias (0.42 mmol/L for the FreeStyle Lite and 0.65 mmol/L for the BGStar). Furthermore, neither meter fulfilled the ISO 15197:2013 standards, and there was a nonsignificant improvement in meter performance at blood glucose levels of ≤4.2 mmol/L. Hematocrit did not affect the results of either blood glucose meter. Clarke Error Grid analysis demonstrated that approximately 70% of the results of both meters would lead to appropriate clinical action. CONCLUSIONS The BGStar and FreeStyle Lite blood glucose meters did not meet ISO 15197:2013 recommendations for blood glucose monitoring systems when assessed in a population of women with diabetes in pregnancy. Clinicians should consider this difference in blood glucose readings when making diabetes-related treatment decisions.
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Affiliation(s)
- Rachel T McGrath
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
- 2 Northern Clinical School, University of Sydney , Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Vanessa C Donnelly
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
- 2 Northern Clinical School, University of Sydney , Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Veronica A Preda
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
- 2 Northern Clinical School, University of Sydney , Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nisa Sheriff
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
| | - Peter Ward
- 3 Pathology North (Northern Sydney), Chemical Pathology, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
| | - Samantha L Hocking
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
- 2 Northern Clinical School, University of Sydney , Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gregory R Fulcher
- 1 Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital , St Leonards, Sydney, New South Wales, Australia
- 2 Northern Clinical School, University of Sydney , Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Glastras SJ, Wong MG, Chen H, Zhang J, Zaky A, Pollock CA, Saad S. FXR expression is associated with dysregulated glucose and lipid levels in the offspring kidney induced by maternal obesity. Nutr Metab (Lond) 2015; 12:40. [PMID: 26583035 PMCID: PMC4650952 DOI: 10.1186/s12986-015-0032-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/14/2015] [Indexed: 01/07/2023] Open
Abstract
Background Maternal obesity is associated with dysregulation of glucose and lipid metabolism with consequent exposure of the fetus to an abnormal metabolic milieu. It is recognized that maternal obesity predisposes offspring to chronic kidney disease (CKD). We aimed to determine whether the nuclear Farnesoid X receptor (FXR), known to play a role in maintaining homeostasis of glucose and lipid metabolism, is involved in renal injury in offspring of obese mothers. Methods Maternal obesity was established in a rat model by feeding dams with high-fat diet prior to and during pregnancy and lactation. The offspring’s kidneys were examined at postnatal Day 1and Day 20. Human kidney 2 (HK2) cells were exposed to high glucose with or without the FXR agonist GW4064 or when FXR mRNA was silenced. Results Glucose intolerance in the offspring of obese mothers was evident at weaning, with associated downregulation of renal FXR expression and upregulation of monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β1 (TGF-β1). HK2 cells exposed to high glucose had reduced FXR expression and increased MCP-1, TGF-β1, fibronectin and collagen IV expression, which was reversed in the presence of GW4064. FXR-silenced HK2 cells had amplified pro-inflammatory and pro-fibrotic markers under high glucose conditions. Conclusions Maternal obesity influences renal expression of pro-inflammatory and fibrotic factors that predispose the offspring to CKD. This was associated with the downregulation of the renal FXR expression suggesting a potential protective role for FXR. Electronic supplementary material The online version of this article (doi:10.1186/s12986-015-0032-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah J Glastras
- Kolling Institute, Department of Medicine, University of Sydney, Sydney, Australia ; Department of Endocrinology, Diabetes and Metabolism, Royal North Shore Hospital, St Leonards, Australia
| | - Muh Geot Wong
- Kolling Institute, Department of Medicine, University of Sydney, Sydney, Australia
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Jie Zhang
- Kolling Institute, Department of Medicine, University of Sydney, Sydney, Australia
| | - Amgad Zaky
- Kolling Institute, Department of Medicine, University of Sydney, Sydney, Australia
| | - Carol A Pollock
- Kolling Institute, Department of Medicine, University of Sydney, Sydney, Australia
| | - Sonia Saad
- Kolling Institute, Department of Medicine, University of Sydney, Sydney, Australia
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Abstract
Complications of diabetes include retinopathy, nephropathy, neuropathy, macrovascular disease, and associated autoimmune diseases. Clinical manifestations of complications uncommonly present in childhood and adolescence. Screening during the early years can identify subclinical disease and it offers an opportunity for early intervention. The Diabetes and Complications Control Trial has provided evidence for the long-term benefits of good glycemic control in preventing and delaying the onset of microvascular complications. Complications begin to manifest during adolescence, during which time all efforts should be made to educate and support young persons in achieving optimal diabetes control.
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Affiliation(s)
- Sarah J Glastras
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Sydney, Australia
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Glastras SJ, Craig ME, Verge CF, Chan AK, Cusumano JM, Donaghue KC. The role of autoimmunity at diagnosis of type 1 diabetes in the development of thyroid and celiac disease and microvascular complications. Diabetes Care 2005; 28:2170-5. [PMID: 16123485 DOI: 10.2337/diacare.28.9.2170] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [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: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to explore whether the presence of thyroid and endomysial autoantibodies at diagnosis of type 1 diabetes in children predicts development of thyroid and celiac disease, respectively, and whether diabetes-associated autoantibodies at diagnosis predict development of microvascular complications up to 13 years later. RESEARCH DESIGN AND METHODS Autoantibodies were measured at diagnosis of type 1 diabetes in 173 children aged 0-15 years and included thyroperoxidase antibody (TPOA), endomysial antibody (EMA), islet cell autoantibody, GAD antibody (GADA), and insulin autoantibody. Thyroid disease was defined as thyroid stimulating hormone level > or = 5 microU/ml. Celiac disease was confirmed by small-bowel biopsy. Assessment of microvascular complications included stereoscopic fundal photography, pupillometry, thermal threshold, and albumin excretion rate (AER). RESULTS The incidence rates for thyroid and celiac disease were 0.9 and 0.7 per 100 patient-years, respectively. Within 13 years, 6 of 13 children with positive TPOA tests at diagnosis developed thyroid disease compared with 5 of 139 children with negative TPOA tests (P < 0.001). All four patients with positive EMA titers at diagnosis had biopsy-proven celiac disease. Five of 11 patients who developed thyroid disease and 4 of 8 who developed celiac disease had negative TPOA and EMA tests at diagnosis, respectively. Retinopathy was detected in 39% and elevated AER in 36%. The presence of diabetes-associated autoantibodies at diagnosis did not predict microvascular complications though GADA titer levels predicted pupillary abnormality. CONCLUSIONS Elevated TPOA and EMA levels at diagnosis of type 1 diabetes predict the development of thyroid and celiac disease, respectively. In children with negative antibody titers at diagnosis, screening at 2-year intervals is recommended.
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Affiliation(s)
- Sarah J Glastras
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia.
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