Gestational diabetes and progression to type two diabetes mellitus: missed opportunities of follow up and prevention?

BackgroundThe incidence of type 2 diabetes (T2DM) is increasing. Having a pregnancy complicated by gestational diabetes mellitus (GDM) is a potent risk factor for the later development of T2DM.AimsTo explore the characteristics of women diagnosed with GDM in a single centre and their follow up for progression to T2DM.MethodsA retrospective cohort study using anonymised data of one hundred and fifty four (154) women with GDM receiving maternity care at the Oxford University Hospitals NHS Foundation Trust (OUHFT) in 2010 and their follow up until 2018.ResultsThe prevalence of GDM in women delivering in Oxfordshire in 2010 was 3.4%. 70% of pregnant women were overweight or obese (with 51% being obese) at booking. Gestational weight gain (GWG) was excessive in 29% of women, when compared to Institute of Medicine (IOM) guidelines. Almost a quarter of women (23.4%) had no follow up after delivery. Over a median follow up of 3.5 years (range 0-8 years) nearly one in six (16.9%) of the total cohort (22% of those tested) went on to develop T2DM. 74% of women with GDM were multiparous, and 65% of nulliparous women were tested compared to 81% of multiparous women. There was a significant difference between multiparous women (53.8%) compared to nulliparous women (46.2%) developing T2DM (p = 0.01). There was no significant difference in BMI (p = 0.866) or GWG (p = 0.83) in women who progressed to T2DM versus those who did not.ConclusionThe risk of T2DM after GDM is substantial however, follow up rates of this population is poor. Subsequent screening of women with GDM and their management crosses secondary and primary care with scope for improvement in counselling of women of the importance of annual reviews, in data collection and follow up in both obstetrics and general practice. The implementation of a recall system, an education programme for general practitioners and/or a registry of women diagnosed with GDM could be useful to identify those at high risk of developing T2DM as well as providing a platform for the potential development of interventions to prevent progression to T2DM after GDM.     

Coeliac autoimmunity in type I diabetes mellitus

Background and study aimsCoeliac autoimmunity (CA) has a known association with type 1 diabetes mellitus (T1DM) for which screening is routinely recommended but less frequently followed. The impact of CA in T1DM has been variably reported. The aims of this study are as follows: (1) to study the prevalence of CA in patients with T1DM and (2) to study the impact of CA not only on nutritional parameters but also on glycaemic control, endocrine axes and bone health.Patients and methodsEighty-six consecutive patients with T1DM were screened for CA using immunoglobulin A (IgA) tissue transglutaminase as a marker (TTG; IgG anti-gliadin in IgA-deficient case). CA positive (CA+) cases were compared with age-matched and sex-matched CA negative (CA−) T1DM cases for anthropometry, glycaemic control (assessed by glycated haemoglobin (HbA1c) and hypoglycaemic/hyperglycaemic episodes), endocrine (thyroid function, cortisol, growth hormone (GH) axis, gonadal axes), haematological (haemoglobin, iron profile and vitamin B₁₂ status) and calcium metabolism parameters and bone densitometry (by dual-energy X-ray absorptiometry (DXA)). Consenting patients with CA also underwent upper gastrointestinal (GI) endoscopy with duodenal biopsy.ResultsOut of 86 patients, 11 (12.75%) screened positive for CA (seven patients underwent duodenal biopsies which were suggestive of Marsh grade III(2), II(3) and I(2) disease). The CA+ T1DM patients were comparable with CA− T1DM in terms of anthropometry. CA+ patients had higher HbA1c (10.7 ± 1.8 vs. 8.4 ± 1.0 (93 ± 19 vs. 68 ± 11 mmol/mol); p < 0.01), more hypoglycaemic episodes (five vs. two; p < 0.05), higher prevalence of iron and vitamin B₁₂ deficiency, lower insulin-like growth factor-1 (IGF-1) levels and lower bone mineral density (BMD) z-score at total body (−1.91 ± 1.05 vs. −0.63 ± 0.73; p < 0.05) and lumbar spine (−1.69 ± 0.92 vs. −0.36 ± 0.93; p < 0.05). The incidence of fractures in the past 3 years was also more in CA+ patients than in CA− patients (four vs. one; p < 0.05).ConclusionCA has an important autoimmune association with T1DM. The concomitant presence of CA adversely affects stature, bone health, glycaemic control and iron and B₁₂ levels in T1DM. IgA sufficiency should be ensured before using an IgA-based screening test for CA.     

Modification of Total Magnesium level in pregnant Saudi Women developing gestational diabetes mellitus

BackgroundThe aim of our study is to measure total Magnesium in pregnant women screened for GDM and to compare total magnesium between whom were diagnosed having GDM and those having normal pregnancy.MethodsOur study is a prospective study involved 99 pregnant women referred to Maternity and Child Hospital Al Ahsa (Kingdom of Saudi Arabia) for 100 g Oral Glucose Tolerance test. All included pregnant women were in their 24–28 weeks of gestation with free past medical history and were free for any medicine. A 100-g Oral Glucose Tolerance (OGTT) with total plasma magnesium measurement were done to all included women. All patient were followed tell delivery.ResultsAmong 99 patients enrolled in our study, GDM was diagnosed in 19 patients (19.2%). Fifteen patients have normal fasting glycaemia and were diagnosed having GDM on 100-g OGTT. Four patients have fasting glycaemia more than 126 mg/dl (7 mmol/l) confirming the diagnosis of GDM. Hypomagnesemia was confirmed in eight patients (8.08%). no one of them had GDM. The serum magnesium concentration in GDM women was lower that of normal pregnant women but the difference was not significant. (0.89 ± 0.1 vs 0.92 ± 0.2 mmol/l, p = 0.51). BMI, systolic and diastolic blood pressure were not significantly different between the pregnant women who developed or not gestational diabetes.ConclusionIn our study, the development of GDM cannot be explained by low total serum magnesium. The low total serum magnesium in patient diagnosed having GDM compared to whom free of GDM and the importance of magnesium in the genesis of insulin resistance should encourage more large trial to explain the exact role of magnesium in the pathophysiology of GDM.     

Factors associated with screening for glucose abnormalities after gestational diabetes mellitus: Baseline cohort of the interventional IMPACT study

IntroductionAlthough it is important to screen women who have had gestational diabetes mellitus (GDM) for abnormal post-partum glucose levels, such testing is rarely performed. The aim of this study was to use data from the first observational phase of the IMPACT study to determine rates of screening within 6 months of delivery in a multiethnic cohort, focusing in particular on the effects of social deprivation and the risk of future diabetes.Patients and methodsTo investigate the frequency of post-partum screening, charts were analyzed, and all women attending four centres located in a deprived area who had had GDM between January 2009 and December 2010 were contacted by phone. The Evaluation of Precarity and Inequalities in Health Examination Centres (EPICES) deprivation index and Finnish Diabetes Risk Score (FINDRISK) questionnaire were also evaluated.ResultsData were evaluable for 589 of the 719 women contacted (mean age: 33.4 ± 5.2 years; mean body mass index: 27.6 ± 5.4 kg/m²), and 196 (33.3%) reported having been screened. On multivariate analysis, factors associated with a lack of screening were smoking [odds ratio (OR): 0.42 (0.20–0.90), P < 0.05], low consumption of fruit and vegetables [OR: 0.58 (0.39–0.82), P < 0.01] and heavier offspring birth weight (P < 0.05), although there were no differences in FINDRISK and EPICES scores between screened and unscreened women.ConclusionOne-third of women who had had GDM reported having been screened for dysglycaemia at 6 months post-partum. However, it is expected that the interventional phase of the IMPACT study will increase screening rates, especially in women with the risk factors associated with lower screening rates during this observational phase.     

Plasma cystatin-C and risk of developing gestational diabetes mellitus

AimsCystatin-C, a low molecular weight protein, is effectively applied to evaluate the risk of developing renal insufficiency, cardiovascular disorders, neural defects, and inflammatory states. However, the role of this biomarker to monitor different pregnancy-related complications remains controversial.Materials and methodsIn the present study, we compared serum cystatin-C concentration between pregnant women with gestational diabetes mellitus (GDM) and healthy pregnant women to assess value of this biomarker to predict presence of GDM in these women. The study consisted of 60 consecutive pregnant women (30 women suffered GDM and 30 healthy pregnant women) enrolled in Afzalipour hospital in Kerman, Iran in 2012. Fasting blood sample was collected to perform measurements on plasma glucose, lipids, serum creatinine, and C-cystatin. Serum cystatin-C level was quantified using ELISA techniques.ResultsUnadjusted comparison of cystatin-C level between the two study group showed no significant discrepancy between them so that the level of this biomarker in GDM group was 593.00 ± 204.81 mg/L and in healthy group was 531.67 ± 87.52 mg/L (P = 0.137); while in multivariable linear model with the presence of associated variables, GDM was a main determinant for increased level of cystatin-C (standardized beta of 0.355, P-value of 0.014).ConclusionGestational age was also identified to be another indicator of elevated cystatin-C. In final, our study showed that cystatin-C can be a reliable, useful and promising marker of GDM appearance in pregnant women.     

Gender and ethnic differences in the prevalence of type 2 diabetes among Asian subgroups in California

AimsTo investigate gender and ethnic type 2 diabetes (DM) prevalences among California Asian subgroups versus other ethnic groups and if risk factors explain these differences.MethodsWe identified the prevalence of DM and associated risk factors, stratified by gender, among Chinese, Filipino, South Asian, Japanese, Korean, Vietnamese, Mexican, Other Hispanic, African-American, Caucasian, and Native American adults in a large survey conducted in 2009 (n = 46,091, projected n = 26.6 million).ResultsThe highest age-adjusted DM prevalence was seen in Native Americans (32.4%), Filipinos (15.8%), and Japanese (11.8%) among men and in Native Americans (16.0%) and African-Americans (13.3%) among women. Caucasian and Mexican men had higher DM prevalences than women. Age and risk factor-adjusted logistic regression showed DM more likely (relative to Caucasians) among women in Koreans (OR = 4.6, p < 0.01), Native Americans (OR = 3.0, p < 0.01), and Other Hispanics (OR 2.9, p < 0.01) and among men in Filipinos (OR = 7.0, p < 0.01), South Asians (OR = 4.7, p < 0.01), and Native Americans (OR = 4.7, p < 0.01). No specific risk factors accounted for the gender differences.ConclusionsEthnic and gender differences in DM prevalence persist, even after adjusting for lifestyle and other risk factors; prevalence is high among certain Asian American subgroups. Different diabetes prevention approaches may be needed across ethnic/gender groups.     

Women with atrial fibrillation and type 2 diabetes have a higher incidence of hospitalization and undergo ablation or pacemaker implantation less frequently than men

BackgroundWe reviewed trends from 2004 to 2013 in the incidence and outcomes for atrial fibrillation (AF) in Spanish patients with type 2 diabetes mellitus (T2DM) comparing women and men.MethodsWe used national hospital discharge data including all T2DM patients discharged from the hospital after AF. Patients with AF in the primary diagnosis field were selected. Discharges were grouped by sex. Incidence was calculated overall and stratified by sex. We analyzed diagnostic and therapeutic procedures, patient comorbidities, CHA2DS2-VASc score, length of hospital stay, readmission rates and in-hospital mortality (IHM).ResultsWe identified a total of 214,457 admissions for AF. Patients with T2DM accounted for 21.1% (19,505 men and 25,954 women). Women with T2DM had a significantly higher incidence of AF compared to men over the study period (IRR 1.33;95%CI 1.31–1.35). Women were significantly older (77.24 ± 8.69 years) than men (72.62 ± 10.28 years), had higher prevalences of obesity and hypertension, and higher CHA2DS2-VASc score. Women less frequently underwent ablation (3.21% vs. 1.54%; p < 0.001) and received an implanted pacemaker (14.3% vs. 8.16%; p < 0.001) than men. Crude IHM was 2.81% for women and 2.48% for men (p = 0.030). Sex was not associated with a higher IHM after multivariable adjustment.ConclusionsOur study demonstrates an increase in hospitalization for AF in diabetic women. Women were older, had a higher comorbidity index and had CHAD2DS2-VASc score than men. Women with AF and T2DM undergo ablation or pacemaker implantation less frequently than their male counterparts. After multivariable adjustment sex did not predict mortality during admissions for AF.     

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

IntroductionObstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR).MethodsA total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5 h^?1.ResultsPatients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2 ± 6.0 vs. 1.9 ± 2.7 h^?1, p = .069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73–3.77; p = .232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation< 90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index.ConclusionOSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.     

Utilization of Frontal Assessment Battery and Executive Interview 25 in assessing for dysexecutive syndrome and its association with diabetes self-care in elderly patients with type 2 diabetes mellitus

AimsExecutive function (EF) comprises a set of cognitive skills that controls the execution of complex activities. In the context of diabetes, this may include patients’ self-monitoring and daily management of their condition. We compared two different measures of EF in a population of elderly patients with type 2 diabetes mellitus (T2DM) and studied its relationship with diabetes self-care.MethodsFifty patients (34 males) had EF assessed using Frontal Assessment Battery (FAB) and Executive Interview 25 (EXIT25). Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Haemoglobin A1c (HbA1c), lipid levels, blood pressure and diabetes duration were recorded.ResultsThe mean age of the patients was 67.0 ± 7.5 years and mean duration of diabetes was 8.1 ± 6.4 years. Mean HbA1c was 7.0 ± 1.2%, and mean fasting plasma glucose, cholesterol and LDL-C were 7.0 ± 1.7 mM, 4.0 ± 0.9 mM and 2.1 ± 0.7 mM respectively. Mean EXIT25 score was 9.5 ± 4.6 in the range of normal EF (14% had EXIT25 score > 15, indicating impaired EF). Mean FAB score was 13.7 ± 3.3 (48% having scores < 15, indicating impaired EF), suggesting a degree of dysexecutive syndrome involving frontal lobe functions. EXIT25 score was inversely correlated with SDSCA (r = −0.3, p < 0.05) but no significant correlation between FAB and SDSCA or HbA1c, diabetes duration, lipid levels and blood pressure with EXIT25, FAB or SDCSA was found.ConclusionA substantial proportion of elderly patients with T2DM may have dysexecutive syndrome and impairment in EF may impact on self-care in this group.     

Hypoglycemia symptoms are reduced in hospitalized patients with diabetes

AimsHospitalized patients with diabetes are have an impaired ability to detect hypoglycemia events. The purpose of this study was to compare hypoglycemia symptom scores (HSS) in hospitalized patients with diabetes after a documented blood glucose (BG) <70 mg/dl with recalled HSS with outpatient hypoglycemia events.MethodsNon-critically ill hospitalized patients with diabetes grouped as symptomatic (n = 23) or asymptomatic (n = 32) at time of index hypoglycemia completed a standardized HSS-Questionnaires (HSS-Q) related to the inpatient event and to recall of symptoms with outpatient hypoglycemia.ResultsAfter controlling for BG at time of index hypoglycemia (49.8 ± 11.4 vs. 57.4 ± 6.8 mg/dl, p = 0.02), symptomatic patients reported higher HSS than asymptomatic patients with the inpatient event (11.6 ± 7.3 vs. 1.5 ± 3.4, p < 0.001) and in the outpatient setting (13.9 ± 8.6 vs. 10.1 ± 10.6, p < 0.01). Recurrent hypoglycemia was more frequent in asymptomatic patients (13% vs. 44%, p = 0.015) during the hospitalization.ConclusionsCompared to symptomatic patients, asymptomatic patients had lower inpatient and outpatient HSS and more frequent recurrent hypoglycemia events. These results suggest modification of glycemic management strategies in high risk patients to reduce risk for hypoglycemia events.     

Maternal circulating adipokine profile and insulin resistance in women at high risk of developing gestational diabetes mellitus

BackgroundCytokines produced by adipose and placental tissues (adipokines) have been implicated in the development of gestational diabetes mellitus (GDM). There is, however, limited research regarding the relationship between advancing pregnancy, maternal adipokine profile, insulin resistance and the development of GDM. Furthermore, no studies have investigated these parameters in women with a history of GDM who are at the highest risk of recurrence. This study examined the circulating concentrations of a number of adipokines associated with insulin resistance at two points in pregnancy, and determined whether they were altered in women who developed GDM.MethodsNon-diabetic women with a history of GDM in a previous pregnancy (n = 123) had blood drawn at 14 and 28 weeks of pregnancy for GDM diagnosis, together with assessment of a range of adipokine concentrations by multiplex assay (fatty acid-binding protein 4 [FABP4], leptin, chemerin, adiponectin and resistin).ResultsWith advancing pregnancy, maternal adiponectin concentrations decreased, while leptin and resistin levels increased (p < 0.05). In women who developed GDM at 28 weeks of pregnancy (42%), fasting and postprandial glucose levels were already significantly elevated by 14 weeks (p < 0.05), while adiponectin concentrations were lower (p < 0.05). Adiponectin remained lower at the time of GDM diagnosis (p < 0.05), while the other adipokines were similar between groups at each timepoint.ConclusionMaternal glucose and adipokine profile is altered early in pregnancy in women with a history of GDM who subsequently develop recurrent disease.     

Sexual dimorphism in growth and insulin-like growth factor-I in children with type 1 diabetes mellitus

ObjectiveImpaired linear growth and reduced IGF-I levels in children with type 1 diabetes (T1DM) have been related to poor metabolic control. The aim of this study was to identify additional factors which may negatively affect growth and IGF system in patients with T1DM.DesignNinety-one T1DM children (54 males, age = : 11.73 ± 3 years, disease duration = 5.6 ± 2.1 years) were studied. All children were on intensive insulin therapy: 62 children were on multiple injection therapy (MI) and 29 children on continuous subcutaneous insulin infusion (CSII).ResultsHeight velocity (HV) SDS and IGF-I levels were higher in females and in pubertal children [HV SDS: females = 0.6 ± 2.4 vs males = − 0.45 ± 2.3 (p = 0.04); IGF-I SDS: females = − 1.09 ± 0.58 vs males = − 1.4 ± 0.6 (p = 0.02); IGF-I/IGFBP-3 molar ratio: females = 0.25 ± 0.1 vs males = 0.21 ± 0.08 (p = 0.04); IGF-I SDS: pre-pubertal = − 1.58 ± 0.46 vs pubertal = − 1.15 ± 0.65 (p < 0.001); IGF-I/IGFBP-3 molar ratio: pre-pubertal = 0.16 ± 0.08 vs pubertal = 0.26 ± 0.09 (p < 0.001)]. No differences between children on CSII or MI therapy were found. IGF-I SDS was positively related to C peptide level (p < 0.001), puberty (p < 0.001) and female gender (p = 0.02) and negatively related to HbA1c (p = 0.04). IGF-I/IGFBP-3 molar ratio was positively affected by C peptide level (p < 0.001), puberty (p < 0.001) and daily insulin dose (p < 0.001).ConclusionsOur results indicate that despite intensive insulin therapy, T1DM still negatively affects IGF-I secretion and linear growth. Growth impairment is more severe in males and primarily related to poor glycemic control and loss of the residual beta cell mass.     

Enhanced cholesterol efflux to HDL through the ABCA1 transporter in hypertriglyceridemia of type 2 diabetes

ObjectiveOur objective was to examine the role of hypertriglyceridemia on the capacity of HDL to facilitate ABCA-1 mediated cholesterol efflux in type 2 diabetes (T2DM).MethodsHDL mediated cholesterol efflux through the ABCA-1 transporter was measured using BHK cell lines in samples of 71 participants with T2DM in the presence or absence of high triglyceride levels (TG). Additionally, HDL mediated efflux was measured in 13 diabetic and non-diabetic participants fasting and four hours after a high-fat test challenge.ResultsHDL mediated cholesterol efflux function was increased in participants with T2DM with hypertriglyceridemia when compared to participants with T2DM without hypertriglyceridemia (efflux ratio mean ± standard deviation (SD), T2DM + TG: 1.17 ± 0.25 vs. T2DM − TG: 1.03 ± 0.19, p = 0.0098). In the fat challenge study, we observed a significant increase in ABCA-1 mediated cholesterol efflux capacity following an ingestion of high-fat test meal by participants in both groups of T2DM (n = 6, efflux ratio, mean ± SD, pre: 0.86 ± 0.4 vs. post: 1.34 ± 0.6, p = 0.01) and non-diabetic participants (n = 7, efflux ratio mean ± SD pre: 1.24 ± 0.31 vs. post: 1.39 ± 0.42, p = 0.04) that was partly explained by the difference in CETP activity (r = 0.6, p = 0.03).ConclusionOur study suggests that high triglyceride levels facilitate ABCA-1 mediated efflux function of HDL in part by activating CETP.     

Women with normal glucose tolerance and a history of gestational diabetes show significant impairment of β-cell function at normal insulin sensitivity

ObjectiveAlthough the nature of gestational diabetes mellitus (GDM) remains unclear, the condition is thought to be related primarily to insulin resistance, overweight and obesity. Most studies include women with a history of GDM and later carbohydrate metabolism abnormalities, while reports of women with previous GDM and subsequent normoglycaemia are scarce. The aim of this study was to assess insulin resistance and β-cell function in normoglycaemic women with a history of GDM.Materials and methodsThe study group included 199 women, aged 38.4 ± 6.6 years, diagnosed with GDM within the last 5–12 years [GDM(+)] and a control group of 50 comparable women in whom GDM was excluded [GDM(−)], according to WHO criteria. Blood glucose and insulin levels were measured at the beginning (fasting) and at 60 and 120 min of oral glucose tolerance tests. Indices of insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S%) and β-cell function (HOMA-B%) were calculated.ResultsNormoglycaemia was observed in 57% of GDM(+) and 88% of GDM(−) women (P = 0.0003). Diabetes was diagnosed in 13 (6.5%) GDM(+) women and in none of the GDM(−) women. Comparison of 113 normoglycaemic GDM(+) and 44 normoglycaemic GDM(−) women revealed significantly impaired β−cell function (HOMA-B%: 131.1 ± 51.1 vs 144.7 ± 47.1, respectively; P = 0.038) with similar normal body mass index (BMI) and no differences in HOMA-IR and HOMA-S%.ConclusionIn this study, more than half of the GDM(+) women were presented with normal glucose tolerance. However, despite normoglycaemia, women with a history of GDM were characterized by significantly impaired insulin secretion, but no signs of increased insulin resistance.     

Association of interferon-γ and its (+874 T/A) gene polymorphism with type 2 diabetes mellitus in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) patients are at an increased risk of developing type-2 diabetes mellitus (T2DM) compared to the general population. Interferon-γ (IFN-γ) was found to have a role in both RA and T2DM.Aim of the workTo investigate the role of IFN-γ and its +874T/A gene polymorphism in the development of T2DM in RA patients.Patients and methodsIFN-γ level and its +874T/A gene polymorphism were investigated in 70 RA patients with T2DM and in 80 without, in addition to 150 healthy controls.ResultsThe level of IFN-γ was significantly higher in RA patients with (465 ± 64.4 pg/ml) and without (219 ± 50.3 pg/ml) T2DM compared to controls (110 ± 18 pg/ml) (p < 0.0001). IFN-γ +874T/A genotyping showed a significant increase in the frequency of AA genotype (42.9%) and a significant decrease in TT genotype (14.2%) in RA patients with T2DM compared to those without; similarly, the frequency of the T-allele was significantly lower (p < 0.05) and the A-allele increased (p < 0.05); however no significant differences in the genotypes distribution were found between non-diabetic RA patients and healthy controls. The TT-genotyped RA patients with (539.6 ± 4 pg/ml) and without (260 ± 59.6 pg/ml) diabetes had higher serum IFN-γ levels compared to other genotypes (p < 0.001), while in controls, no significant difference in IFN-γ levels according to genotype was observed.ConclusionsSerum IFN-γ and its gene polymorphism may play a role in the susceptibility of RA patients to T2DM. The homozygous genotypes AA and TT seem to be more commonly associated with diabetes in RA patients with special contribution of the A-allele.     

Prospective study of the impact of diabetes mellitus newly diagnosed by glycated hemoglobin on outcomes in patients undergoing percutaneous coronary intervention

BackgroundWe sought to determine the prevalence of diabetes mellitus (DM) newly diagnosed by elevated glycated hemoglobin (HbA1c) in patients undergoing percutaneous coronary intervention (PCI) and its association with 1-year clinical outcomes.MethodsWe prospectively enrolled consecutive patients undergoing PCI (2011–2013). HbA1c levels were assessed during the index hospitalization and newly diagnosed DM was defined as HbA1c ≥ 6.5% in the absence of the previous diagnosis. The primary outcome was MACCE (Major Adverse Cerebro- and Cardiovascular Events) defined as death, stroke, PCI or acute myocardial infarction at 1 year.ResultsDiabetes was previously diagnosed in 391 (34%) patients (DM group), 221 (19%) had newly diagnosed DM based on the HbA1c level and 539 (47%) did not have diabetes (Non-DM). In DM group HbA1c was 7.80 ± 1.36% as compared with 7.62 ± 1.30% in patients with newly diagnosed DM (p < 0.001). These patients were younger (62.0 ± 11.3 years) compared to DM (67.9 ± 10.4 years) and non-DM (63.7 ± 13.0) patients, p < 0.001. 1-year MACCE rates were 14.8%, 19.5% and 27.96% in the non-DM, newly diagnosed DM and DM groups, respectively (p < 0.001). Multivariate analysis showed that compared to non-DM, the adjusted one-year hazard ratios for MACCE were 1.75 and 1.40 in patients with known DM and newly diagnosed DM, respectively (p < 0.05 for both).ConclusionNewly diagnosed DM based on peri-procedural HbA1c is common and associated with increased short and long term risk for adverse outcomes. Our results may warrant routine screening for DM in all patients undergoing PCI.     

Protein oxidation markers in women with and without gestational diabetes mellitus: A possible relation with paraoxonase activity

AimsTo clarify the levels of protein oxidation markers such as protein carbonyl (PCO), protein hydroperoxides (P-OOH), advanced oxidation protein products (AOPP) and nitrotyrosine (NT), as well as antioxidative enzymes such as paraoxonase (PON-1) in women with and without gestational diabetes mellitus (GDM).MethodsThe study was conducted on 23 women with GDM and 22 women without GDM. The levels of the P-OOH, AOPP, and PON-1 were determined by colorimetric methods; whereas NT and PCO levels were measured by ELISA.ResultsThe concentrations of protein oxidation markers were significantly increased and PON1 activity was significantly decreased in GDM group compared to those of normal pregnant women. The control group showed a significant negative correlation between PON-1 and PCO (r = −0.451, p = 0.027); whereas in GDM group, there was a significant positive correlation between P-OOH and HbA1c (r = 0.89, p = 0.001). There was no significant correlation between AOPP, PON-1, P-OOH, PCO, and HbA1c in either group.ConclusionsThere is evidence of a possible association between protein oxidation and decreased PON1 activity in GDM. The increase in protein oxidation parameters in the GDM group leading to decreased PON1 activity might, we think, create a predisposition for clinical complications in GDM group.     

PONI and its association with oxidative stress in type I and type II diabetes mellitus

ObjectiveParaoxonase (PON) is an antioxidant enzyme linked with cardiovascular disease (CVD), diabetes as it prevents LDL oxidation. The relation of PON with the other established risk factor of diabetic complications has not been looked into.Research design and methods370 subjects were included in the study. Dividing into four group, i.e. group I included type II DM (n = 220), group II was age matched control (n = 100), group III were type I DM (n = 25) and group IV (n = 25) were age matched control group. The protocol of the study was approved by the ethical committee of the institute. SOD, GSH, PON (paraoxonase and arylesterase activity), GHb, and MDA were estimated.ResultsA highly significant decrease in paraoxonase and arylesterase activity was seen in the type II DM (p < 0.0001) while in type I DM both the activity was not significant (p > 0.05). Paraoxonase and arylesterase activity of PONI showed a negative significant correlated with MDA (r = ?0.51, p < 0.0001 and r = ?0.23, p < 0.001) in type II DM but was not correlated in type I DM. The GHb and MDA levels were significantly increased (p < 0.0001) while the levels of SOD and GSH have been decreased in type I and type II DM.ConclusionPONI is definitely associated with development of the complications of diabetes. This may be due to the role of it as an antioxidant. As it also show a negative correlation with MDA like the other antioxidants studied.     

Early age at menarche and gestational diabetes mellitus risk: Results from the Healthy Baby Cohort study

AimEarly age at menarche has been reported to increase type 2 diabetes risk, but little is known of its impact on gestational diabetes mellitus (GDM) risk. The aim of this study was to examine the association between age at menarche and plasma glucose levels as well as GDM risk.MethodsA total of 6900 pregnant women from the Healthy Baby Cohort Study were included in our analysis. Age at menarche was self-reported and categorized into five groups (9–11, 12, 13, 14 and 15–18 years of age). GDM was diagnosed using the International Association of Diabetes and Pregnancy Study Groups criteria. Comparisons of plasma glucose levels according to age at menarche categories were performed using analysis of covariance. Logistic regression models were used to estimate the association between age at menarche and GDM risk.ResultsOf our 6900 participants, 1015 (14.7%) were diagnosed with GDM. Mean age at menarche was 13.1 ± 1.2 years. Early age at menarche (9–11 years) was associated with higher fasting, 1-h and 2-h plasma glucose levels (all P < 0.05) compared with menarche at age 13 years. Furthermore, early age at menarche was linked to increased GDM risk after adjusting for potential confounders (OR: 1.41, 95% CI: 1.06–1.87).ConclusionEarly age at menarche is an independent risk factor for GDM and, as such, may help to identify women at higher GDM risk who would benefit from early preventative strategies.     

Screening and follow-up of pregestational diabetes and gestational diabetes mellitus: A survey of primary care physicians in Belgium

AimsConsensus regarding the best screening and follow-up strategy for gestational diabetes mellitus (GDM) is lacking, resulting in heterogeneity in clinical practice. We aimed to evaluate screening and follow-up practices for pregestational type 2 diabetes (T2DM) and GDM in primary care in Belgium.MethodsWe performed an online survey among primary care physicians (PCPs) in the northern part of Belgium, Flanders.ResultsResponses were obtained from 379 PCPs. Approximately two thirds of participants estimated the prevalence of pregestational T2DM and GDM in Flanders at 5% and <10%, respectively. The risk of developing T2DM within 10 years after a history of GDM was estimated at <30% by nearly half of all participants. The majority of interviewed PCPs screen for pre-existing T2DM and GDM. For T2DM, fasting glycaemia was used by 92.2% whereas for GDM, 75.2% used the 50 g glucose challenge test (GCT). Fasting glycaemia was the preferred test for postpartum follow-up.ConclusionsWhile overall guideline adherence appears favourable, the prevalence of GDM is underestimated. Increased awareness on the long-term risk for women with a history of GDM is needed. The overall preference for the two-step strategy with GCT indicates that the 2019 Flemish guidelines on GDM screening are attainable in primary care.