Acta Diabetologica最新文献

Proper nutrition is essential during pregnancy to ensure an adequate supply of nutrients to the foetus and adequate maternal weight gain. In pregnancy complicated by diabetes (both gestational and pre-gestational), diet in terms of both the intake and quality of carbohydrates is an essential factor in glycaemic control. Maternal BMI at conception defines the correct weight increase during gestation in order to reduce maternal-foetal complications related to hypo- or hyper-nutrition. The recommendations presented here, which are based on national and international guidelines and the most recently published data on nutrition in physiological pregnancy and pregnancy complicated by hyperglycaemia and/or obesity, are designed to help healthcare professionals prescribe suitable eating patterns to safeguard the health of the mother and the foetus.

Introduction: Women with first trimester fasting glycaemia (FTFG) 92-125 mg/dL may present with normal 24-28th week OGTT (2T-OGTT). Predictors of persistent hyperglycaemia were scarcely investigated. We studied the prevalence and predictors of gestational diabetes mellitus (GDM) in the 2T-OGTT in women with untreated elevated FTFG.

Methods: Retrospective study of women from the national GDM registry with FTFG between 92 and 125 mg/dL that had passed unnoticed and untreated until the 2T-OGTT.

Primary endpoint: GDM in the 2T-OGTT. Women with and without GDM were compared. A multivariate logistic regression analysis was used to study GDM predictors. Included variables: FTFG, newborn sex, and known GDM risk factors.

Results: We studied 407 women. 82% (82.1%) of women had a positive 2T-OGTT. Women with abnormal 2T-OGTT were older, had higher BMI, and more often carried female newborns. There were no differences concerning other known GDM risk factors, FTFG, and obstetric or neonatal complications. Age, BMI and newborn sex were associated with higher risk of GDM independently of other GDM risk factors or FTFG. Per 1 year of age and 1 kg/m2 of BMI, the OR (95%CI) for this association were 1.10 (1.05-1.16) and 1.07 (1.02-1.12), respectively. Alternatively, women older than 35 years or with a BMI ≥ 30Kg/m2 had an OR of 2.53 (1.30-4.90) and 2.20 (1.22-3.98), respectively. Women with male newborns had approximately half the risk of abnormal 2T-OGTT [OR 0.51 (0.30-0.87)].

Conclusions: Nearly 18% of women with FTFG between 92 and 125 mg/dL had a normal 2T-OGTT. Older age, higher BMI, and female newborns were associated with increased risk of abnormal 2T-OGTT.

Aim: The outcomes of automated insulin delivery (AID) systems in pregnant women with type 1 diabetes (T1D) have not been systematically evaluated. This study aims to evaluate the efficacy and safety of AID in pregnancy.

Material and methods: Literature searches were conducted until July 5, 2024, on Embase, PubMed, Cochrane Library, and ClinicalTrials.gov website. We included clinical trials and observational studies evaluating AID systems in T1D pregnant individuals. Time in the target range (TIR, 3.5-7.8 mmol/L) was the primary outcome. Secondary outcomes included time below range (TBR, < 3.5 mmol/L), time above range (TAR, > 7.8 mmol/L), and maternal and neonatal outcomes.

Results: Eighteen studies (550 participants) were included. Compared with standard care, AID did not improve 24-h TIR (mean differences [MD] 3.56%, 95% CI - 0.60 to 7.72). However, the overnight TIR increased by 10.05% (95% CI 6.57 to 13.53). The association between AID and decreased TBR (MD - 0.90%, 95% CI - 1.60 to - 0.20) was found, but not with deceased TAR. Only 7 of the 17 studies achieved the goal of a 24-h TIR above 70%. Additionally, the maternal and neonatal outcomes were comparable between AID and standard care, and AID might reduce maternal weight gain (MD - 2.54 kg, 95% CI - 3.96 to - 1.11).

Conclusions: AID did not exhibit favourable TIR when compared to standard care. However, AID could increase overnight TIR and decrease TBR. Available evidence indicates that employing AID to meet the target of a 24-h TIR above 70% remains challenging.

Background: Gestational diabetes mellitus (GDM) is defined as a glucose intolerance resulting in hyperglycaemia of variable severity with onset during pregnancy, and is prevalent worldwide. The study of diagnostic markers of GDM in early pregnancy is important for early diagnosis and early intervention of GDM. The aim of this study was to search for biomarkers of GDM in early and mid-pregnancy using a targeted proteomics approach.

Methods: Through multiple response monitoring (MRM) technology and bioinformatics analysis including machine learning, 44 proteins associated with complement and coagulation cascades, and one protein, adiponectin, which is frequently reported to be associated with GDM, were targeted for quantitative analysis, and potential biomarkers were screened.

Results: The results showed that 7 and 6 proteins were identified as differentially expressed proteins (DEPs) between pregnant women subsequently diagnosed with GDM and controls during the first trimester, as well as between GDM cases and controls during the second trimester, respectively. Among them, C1QC and CFHR1 may serve as early predictive markers, and C1QC and adiponectin may serve as mid-term diagnostic markers.

Discussion: Complement and coagulation-related proteins and adiponectin, have been implicated in the pathogenesis of GDM, and some of these proteins have the potential to serve as markers for the prediction or diagnosis of GDM.

Aims: To assess the utility of reanalysing GCK variants of uncertain significance (VUS) as an intervention to improve the detection of monogenic diabetes.

Methods: We examined GCK VUS in a local cohort of individuals with suspected monogenic diabetes and re-curated each variant against the recent ClinGen GCK-specific variant classification guidelines.

Results: Variant reanalysis achieved a new 'likely pathogenic' classification (i.e., positive results) in 4/8 identified VUS. The single most common newly applied criterion indicating variant pathogenicity was a confirmed phenotype of GCK-hyperglycaemia. RNA sequencing and segregation studies were performed in two cases but not additive to reclassification.

Conclusions: This is the first VUS reclassification study in monogenic diabetes using gene-specific guidelines. Within the limits of this small study, we observed a high rate (50%) of VUS upgrades to a positive result, thereby confirming the utility of VUS reanalysis- particularly with biochemical phenotyping- in increasing the detection of monogenic diabetes. We recommend HbA1c, fasting blood glucose and either pancreatic autoantibody negativity or a small oral glucose tolerance test increment as a feasible minimum dataset to inform variant classification at the individual patient level, noting the ongoing work of the ClinGen Monogenic Diabetes Expert Panel in systematically reviewing GCK variants at the international level.

Purpose: Glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) and basal insulin are currently used in the treatment of type 2 diabetes mellitus (T2DM) as long-acting injectables. In this study, we aimed to compare the cardiovascular (CV) and renal outcomes of GLP-1 RAs and basal insulin treatment in patients with T2DM.

Method: We conducted a propensity score-matched cohort study of patients from Chang Gung Memorial Hospital institutions between 2013 and 2021. A diverse patient base from multiple centers was enrolled to enhance the applicability of the findings, including patients with T2DM who were prescribed either GLP-1 RAs or basal insulin.

Results: Over a mean follow-up period of 2.2 years, 10,839 patients were collected (mean age = 54.3 years; 54.2% men). Among the propensity score-matched patients, 45 (2.23%) in the GLP-1 RA group (2,854 patients) and 72 (3.56%) in the basal insulin group (7,985 patients) experienced 3-point major adverse cardiovascular events (3P-MACEs; hazard ratio [HR] 0.68, 95% CI 0.47-0.99, P =.44). Additionally, composite renal outcomes were observed in 237 (11.7%) patients in the GLP-1 RA group and 360 (17.8%) in the basal insulin group (HR 0.69, 95% CI 0.59-0.81, P <.001).

Conclusions: In patients with T2DM, GLP-1 RAs were associated with more favorable cardiovascular and renal outcomes than basal insulin, suggesting that GLP-1 RA treatment may be a preferable option for managing T2DM with a lower risk of CV and renal complications.

Objective: The objective is to investigate the differences in urinary organic acid (OA) profiles and metabolism between healthy control (HC) pregnant women and those with gestational diabetes mellitus (GDM) during the second trimester and third trimester of pregnancy.

Methods: A total of 66 HC pregnant women and 32 pregnant women with GDM were assessed for 107 hydrophilic metabolites in urine samples collected during the second and third trimester of pregnancy using tandem mass spectrometry. The urine OA profiles for each group were obtained, and metabolomic analysis and discussion were conducted.

Results: This study identified a total of 50 metabolic biomarkers. In the third trimester of pregnancy, short-chain dicarboxylic acids (DCAs) and tryptophan (Trp)-related metabolites were significantly upregulated in the urine of both the HC group and the GDM group. Comparatively, the glycine (Gly) levels and related synthetic precursor metabolites were lower in the GDM2 group. The overall dietary polyphenol metabolic intermediates level in the GDM group was lower than in the HC group. Among the pathways enriched for differentially expressed metabolites, the predominant metabolic pathway in the GDM group was the citric acid cycle. In contrast, in the HC group, it was the metabolism of alanine, aspartate, and glutamate.

Conclusions: The study reveals the differences in metabolomics between pregnant women with HC and those with GDM, identifying several metabolites associated with the occurrence and development of GDM. Demonstrating the presence of abnormal mitochondrial and peroxisomal functions at the metabolite level in GDM will contribute to future exploration of the condition.

Background: Evidence suggests a bidirectional relationship between oral health status and type 2 diabetes (T2D) in adults. Studies on associations between childhood oral health and T2D in adulthood are lacking.

Methods: This is a nationwide Danish registry-based cohort study of individuals born between 1963 and 1972, having at least one registration in the National Child Odontology Registry between 1972 and 1987 (n = 627,758). Follow-up lasted from 1995 to 2018. Main exposure variables were the highest achieved levels of dental caries and gingivitis between 1972 and 1987. The outcome was T2D diagnosis during follow-up. Data was analyzed using Cox-regression, stratified on sex, with age as the underlying timescale and highest achieved level of education between age 25-30 years as Cox-strata. Main analyses were conducted with and without age-restrictions (T2D diagnosis before/after age 40).

Results: Compared to lowest-level references, high levels of gingivitis associated with increased hazard ratios (HRs) of T2D in both males (HR [95% confidence interval]: 1.59 [1.47; 1.72]) and females (1.87 [1.68; 2.08]), as did severe dental caries (males: (1.15 [1.04; 1.27], in females: 1.19 [1.06; 1.35]). Below age 40, gingivitis associated with increased HRs in males (1.84 ([1.58; 2.15]) and females (1.94 [1.63; 2.30]). Above age 40, both exposures displayed higher HRs in males (high gingivitis: 1.52 [1.39; 1.66] vs. severe caries: 1.23 [1.09; 1.38]) and females (1.83 [1.59; 2.10] vs. 1.37 [1.17; 1.59]).

Conclusions: Data suggest an association between childhood dental caries and gingivitis with risk of receiving a T2D diagnosis in adulthood. However, results are affected by residual confounding warranting further studies.