1
|
Bandala-Sanchez E, Roth-Schulze AJ, Oakey H, Penno MAS, Bediaga NG, Naselli G, Ngui KM, Smith AD, Huang D, Zozaya-Valdes E, Thomson RL, Brown JD, Vuillermin PJ, Barry SC, Craig ME, Rawlinson WD, Davis EA, Harris M, Soldatos G, Colman PG, Wentworth JM, Haynes A, Morahan G, Sinnott RO, Papenfuss AT, Couper JJ, Harrison LC. Women with type 1 diabetes exhibit a progressive increase in gut Saccharomyces cerevisiae in pregnancy associated with evidence of gut inflammation. Diabetes Res Clin Pract 2022; 184:109189. [PMID: 35051423 DOI: 10.1016/j.diabres.2022.109189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/26/2022]
Abstract
AIMS Studies of the gut microbiome have focused on its bacterial composition. We aimed to characterize the gut fungal microbiome (mycobiome) across pregnancy in women with and without type 1 diabetes. METHODS Faecal samples (n = 162) were collected from 70 pregnant women (45 with and 25 without type 1 diabetes) across all trimesters. Fungi were analysed by internal transcribed spacer 1 amplicon sequencing. Markers of intestinal inflammation (faecal calprotectin) and intestinal epithelial integrity (serum intestinal fatty acid binding protein; I-FABP), and serum antibodies to Saccharomyces cerevisiae (ASCA) were measured. RESULTS Women with type 1 diabetes had decreased fungal alpha diversity by the third trimester, associated with an increased abundance of Saccharomyces cerevisiae that was inversely related to the abundance of the anti-inflammatory butyrate-producing bacterium Faecalibacterium prausnitzii. Women with type 1 diabetes had higher concentrations of calprotectin, I-FABP and ASCA. CONCLUSIONS Women with type 1 diabetes exhibit a shift in the gut mycobiome across pregnancy associated with evidence of gut inflammation and impaired intestinal barrier function. The relevance of these findings to the higher rate of pregnancy complications in type 1 diabetes warrants further study.
Collapse
Affiliation(s)
- Esther Bandala-Sanchez
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra J Roth-Schulze
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Helena Oakey
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Megan A S Penno
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Naiara G Bediaga
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Gaetano Naselli
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Katrina M Ngui
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Alannah D Smith
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Dexing Huang
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Enrique Zozaya-Valdes
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia
| | - Rebecca L Thomson
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - James D Brown
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Peter J Vuillermin
- Faculty of School of Medicine, Deakin University and Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
| | - Simon C Barry
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Maria E Craig
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division, South Eastern Area Laboratory Services Microbiology, NSW Health Pathology, Sydney, NSW, Australia; School of Medical Sciences, Biotechnology and Biomolecular Sciences, Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth A Davis
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Mark Harris
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Translational Research Institute, Woolloongabba, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne and Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - John M Wentworth
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Aveni Haynes
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Grant Morahan
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA, Australia
| | - Richard O Sinnott
- Melbourne eResearch Group, School of Computing and Information Services, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony T Papenfuss
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Department of Medical Biology and School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia; Bioinformatics and Cancer Genomics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer J Couper
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Women's and Children's Hospital, Adelaide, SA, Australia
| | - Leonard C Harrison
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|
2
|
Roth-Schulze AJ, Penno MAS, Ngui KM, Oakey H, Bandala-Sanchez E, Smith AD, Allnutt TR, Thomson RL, Vuillermin PJ, Craig ME, Rawlinson WD, Davis EA, Harris M, Soldatos G, Colman PG, Wentworth JM, Haynes A, Barry SC, Sinnott RO, Morahan G, Bediaga NG, Smyth GK, Papenfuss AT, Couper JJ, Harrison LC. Type 1 diabetes in pregnancy is associated with distinct changes in the composition and function of the gut microbiome. MICROBIOME 2021; 9:167. [PMID: 34362459 PMCID: PMC8349100 DOI: 10.1186/s40168-021-01104-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/28/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND The gut microbiome changes in response to a range of environmental conditions, life events and disease states. Pregnancy is a natural life event that involves major physiological adaptation yet studies of the microbiome in pregnancy are limited and their findings inconsistent. Pregnancy with type 1 diabetes (T1D) is associated with increased maternal and fetal risks but the gut microbiome in this context has not been characterized. By whole metagenome sequencing (WMS), we defined the taxonomic composition and function of the gut bacterial microbiome across 70 pregnancies, 36 in women with T1D. RESULTS Women with and without T1D exhibited compositional and functional changes in the gut microbiome across pregnancy. Profiles in women with T1D were distinct, with an increase in bacteria that produce lipopolysaccharides and a decrease in those that produce short-chain fatty acids, especially in the third trimester. In addition, women with T1D had elevated concentrations of fecal calprotectin, a marker of intestinal inflammation, and serum intestinal fatty acid-binding protein (I-FABP), a marker of intestinal epithelial damage. CONCLUSIONS Women with T1D exhibit a shift towards a more pro-inflammatory gut microbiome during pregnancy, associated with evidence of intestinal inflammation. These changes could contribute to the increased risk of pregnancy complications in women with T1D and are potentially modifiable by dietary means. Video abstract.
Collapse
Affiliation(s)
- Alexandra J Roth-Schulze
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Megan A S Penno
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Katrina M Ngui
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Helena Oakey
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Esther Bandala-Sanchez
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Alannah D Smith
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Theo R Allnutt
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Rebecca L Thomson
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Peter J Vuillermin
- Faculty of School of Medicine, Deakin University and Child Health Research Unit, Barwon Health, Geelong, VIC, 3220, Australia
| | - Maria E Craig
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, 2145, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division, South Eastern Area Laboratory Services Microbiology, Prince of Wales Hospital, Sydney, NSW, 2031, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Elizabeth A Davis
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, 6009, Australia
| | - Mark Harris
- The University of Queensland Diamantina Institute, Faculty of Medicine, University of Queensland, Translational Research Institute, Woolloongabba, QLD, 4102, Australia
- Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Georgia Soldatos
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne and Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC, 3168, Australia
| | - Peter G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia
| | - John M Wentworth
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia
| | - Aveni Haynes
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, 6009, Australia
| | - Simon C Barry
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Richard O Sinnott
- Melbourne eResearch Group, School of Computing and Information Services, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Grant Morahan
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA, 6009, Australia
| | - Naiara G Bediaga
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Gordon K Smyth
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology and School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Anthony T Papenfuss
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia
- Department of Medical Biology and School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, 3010, Australia
- Bioinformatics and Cancer Genomics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jennifer J Couper
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia
- Women's and Children's Hospital, Adelaide, SA, 5006, Australia
| | - Leonard C Harrison
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia.
- Department of Medical Biology, University of Melbourne, Melbourne, VIC, 3010, Australia.
| |
Collapse
|
3
|
Meek CL. Monitoring motherhood: Monitoring and optimizing glycaemia in women with pre-existing diabetes in pregnancy. Ann Clin Biochem 2021; 59:37-45. [PMID: 34260324 DOI: 10.1177/00045632211035815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite recent advances in care, women with diabetes in pregnancy are still at increased risk of multiple pregnancy complications. Offspring exposed to hyperglycaemia in utero also experience long-term health sequelae, affecting neurocognitive and cardiometabolic status. Many of these adverse consequences can be prevented or ameliorated with good medical care, specifically to optimize glycaemic control. The accurate assessment of glycaemia in pregnancy is therefore vital to safeguard the health of mother and child. However, there is no consensus about the best method of monitoring glycaemic control in pregnancy. Short-term changes in insulin dosage and lifestyle, with altered appetite, insulin sensitivity and red cell turnover create difficulties in interpretation of standard laboratory measures such as HbA1c. The ideal marker would provide short-term feedback on daily or weekly glycaemic control, with additional capability to predict pregnancies at high risk of suboptimal outcomes. Several novel biochemical markers are available which allow assessment of dynamic changes in glycaemia over weeks rather than months. Continuous glucose monitoring devices have advanced in accuracy and provide new opportunities for robust assessment of glycaemia in pregnancy. Recent work from the continuous glucose monitoring in pregnant women with type 1 diabetes trial (CONCEPTT) has provided information about the ability of different markers of glycaemia to predict pregnancy outcomes.The aim of this review is to summarize the care for women with pre-existing diabetes in pregnancy and to highlight the important role of glycaemic monitoring in pregnancy.
Collapse
Affiliation(s)
- Claire L Meek
- Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,Wolfson Diabetes and Endocrinology Clinic, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK.,Department of Clinical Biochemistry, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
4
|
Meek CL, Tundidor D, Feig DS, Yamamoto JM, Scott EM, Ma DD, Halperin JA, Murphy HR, Corcoy R. Novel Biochemical Markers of Glycemia to Predict Pregnancy Outcomes in Women With Type 1 Diabetes. Diabetes Care 2021; 44:681-689. [PMID: 33495292 PMCID: PMC8051277 DOI: 10.2337/dc20-2360] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The optimal method of monitoring glycemia in pregnant women with type 1 diabetes remains controversial. This study aimed to assess the predictive performance of HbA1c, continuous glucose monitoring (CGM) metrics, and alternative biochemical markers of glycemia to predict obstetric and neonatal outcomes. RESEARCH DESIGN AND METHODS One hundred fifty-seven women from the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT) were included in this prespecified secondary analysis. HbA1c, CGM data, and alternative biochemical markers (glycated CD59, 1,5-anhydroglucitol, fructosamine, glycated albumin) were compared at ∼12, 24, and 34 weeks' gestation using logistic regression and receiver operating characteristic (ROC) curves to predict pregnancy complications (preeclampsia, preterm delivery, large for gestational age, neonatal hypoglycemia, admission to neonatal intensive care unit). RESULTS HbA1c, CGM metrics, and alternative laboratory markers were all significantly associated with obstetric and neonatal outcomes at 24 weeks' gestation. More outcomes were associated with CGM metrics during the first trimester and with laboratory markers (area under the ROC curve generally <0.7) during the third trimester. Time in range (TIR) (63-140 mg/dL [3.5-7.8 mmol/L]) and time above range (TAR) (>140 mg/dL [>7.8 mmol/L]) were the most consistently predictive CGM metrics. HbA1c was also a consistent predictor of suboptimal pregnancy outcomes. Some alternative laboratory markers showed promise, but overall, they had lower predictive ability than HbA1c. CONCLUSIONS HbA1c is still an important biomarker for obstetric and neonatal outcomes in type 1 diabetes pregnancy. Alternative biochemical markers of glycemia and other CGM metrics did not substantially increase the prediction of pregnancy outcomes compared with widely available HbA1c and increasingly available CGM metrics (TIR and TAR).
Collapse
Affiliation(s)
- Claire L Meek
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K. .,Cambridge Universities NHS Foundation Trust, Cambridge, U.K
| | - Diana Tundidor
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Denice S Feig
- Mount Sinai Hospital, Sinai Health System, Department of Medicine, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Jennifer M Yamamoto
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eleanor M Scott
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds Centre for Diabetes and Endocrinology, University of Leeds, Leeds, U.K
| | - Diane D Ma
- Laboratory for Translational Research, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Jose A Halperin
- Laboratory for Translational Research, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, U.K.,School of Life Course Sciences, King's College London, London, U.K
| | | | | |
Collapse
|
5
|
Jang H, Oh J, Ki H, Kim MG. Paper-based 1,5-anhydroglucitol quantification using enzyme-based glucose elimination. Analyst 2020; 145:5740-5743. [PMID: 32686804 DOI: 10.1039/d0an00905a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The monosaccharide 1,5-anhydroglucitol (1,5-AG) is a known indicator of glucose levels. Conventional 1,5-AG quantification methods with enzyme-based sensors using pyranose oxidase (PROD) require elimination of interference from the sample (a laborious and time-consuming process), as PROD cannot distinguish 1,5-AG from other sugars. We developed a one-step paper-based sensor for detecting 1,5-AG using glucose oxidase, catalase, and mutarotase that eliminates excess glucose, which interferes with 1,5-AG detection. This sensor consists of two compartments for the quantification of glucose and 1,5-AG and reflects the concentration of these targets after reaction with water or spiked human urine. The limit of detection of the sensor was 0.9 mg dL-1 for glucose and 3.2 μg mL-1 for 1,5-AG.
Collapse
Affiliation(s)
- Hyungjun Jang
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), 261 Cheomdan-gwagiro, Gwangju 500-712, Republic of Korea.
| | | | | | | |
Collapse
|
6
|
Yefet E, Twafra S, Shwartz N, Hissin N, Hasanein J, Colodner R, Mirsky N, Nachum Z. Inverse association between 1,5-anhydroglucitol and neonatal diabetic complications. Endocrine 2019; 66:210-219. [PMID: 31435861 DOI: 10.1007/s12020-019-02058-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/08/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE A glycemic control marker to predict neonatal diabetic complications is unavailable. We aimed to examine if 1,5-anhydroglucitol (1,5-AG) can predict neonatal complications in women with diabetes in pregnancy. METHODS Prospective observational study from December 2011 to August 2013. We recruited 105 women, 70 diabetic (gestational and pregestational) and 35 nondiabetic. 1,5-AG at birth was compared between the two groups. In the diabetic group 1,5-AG, HbA1c, and fructosamine were measured before glycemic control initiation (first visit), after 4-6 weeks (second visit), and at delivery. Women were divided to poor (1,5-AG values below median at birth) and good (1,5-AG values at median and above) glycemic control groups. Mean daily glucose charts were collected. The primary outcome was a composite of neonatal diabetic complications: respiratory distress, hypoglycemia, polycythemia, hyperbilirubinemia, and large for gestational age. RESULTS Mean 1,5-AG in the nondiabetic group was similar to that of the diabetic group without the composite outcome and was significantly higher than in the diabetic group with the composite outcome. The rate of the composite outcome was higher in the poor glycemic control group compared with the good glycemic control group (adjusted odds ratio (OR) 3.8 95% CI [1.2-12.3]). Only 1,5-AG was inversely associated with the composite outcome at all time points; the second visit was the only independent risk factor in multivariable logistic regression (OR 0.7 95% CI 0.54-0.91). The rest of the glycemic markers were not associated with neonatal composite outcome. CONCLUSIONS 1,5-AG is inversely associated with neonatal diabetic complications and is superior to other glycemic markers in predicting those complications.
Collapse
Affiliation(s)
- Enav Yefet
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel.
| | - Shams Twafra
- Department of Human Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
- Clinical Chemistry Laboratory, Emek Medical Center, Afula, Israel
| | - Neta Shwartz
- Clinical Chemistry Laboratory, Emek Medical Center, Afula, Israel
| | - Noura Hissin
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
| | - Jamal Hasanein
- Neonatology Department, Emek Medical Center, Afula, Israel
| | - Raul Colodner
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Molecular Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Neetsa Mirsky
- Department of Human Biology, Faculty of Natural Sciences, University of Haifa, Mount Carmel, Haifa, Israel
| | - Zohar Nachum
- Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
7
|
Kadakia R, Talbot O, Kuang A, Bain JR, Muehlbauer MJ, Stevens RD, Ilkayeva OR, Lowe LP, Metzger BE, Newgard CB, Scholtens DM, Lowe WL. Cord Blood Metabolomics: Association With Newborn Anthropometrics and C-Peptide Across Ancestries. J Clin Endocrinol Metab 2019; 104:4459-4472. [PMID: 31498869 PMCID: PMC6735762 DOI: 10.1210/jc.2019-00238] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/28/2019] [Indexed: 12/18/2022]
Abstract
CONTEXT Newborn adiposity is associated with childhood obesity. Cord blood metabolomics is one approach that can be used to understand early-life contributors to adiposity and insulin resistance. OBJECTIVE To determine the association of cord blood metabolites with newborn adiposity and hyperinsulinemia in a multiethnic cohort of newborns. DESIGN Cross-sectional, observational study. SETTING Hyperglycemia and Adverse Pregnancy Outcome study. PARTICIPANTS One thousand six hundred multiethnic mother-newborn pairs. MAIN OUTCOME MEASURE Cord blood C-peptide, birthweight, and newborn sum of skinfolds. RESULTS Meta-analyses across four ancestry groups (Afro-Caribbean, Northern European, Thai, and Mexican American) demonstrated significant associations of cord blood metabolites with cord blood C-peptide, birthweight, and newborn sum of skinfolds. Several metabolites, including branched-chain amino acids (BCAAs), medium- and long-chain acylcarnitines, nonesterified fatty acids, and triglycerides were negatively associated with cord C-peptide but positively associated with birthweight and/or sum of skinfolds. 1,5-Anhydroglucitol, an inverse marker of recent maternal glycemia, was significantly inversely associated with birthweight and sum of skinfolds. Network analyses revealed groups of interrelated amino acid, acylcarnitine, and fatty acid metabolites associated with all three newborn outcomes. CONCLUSIONS Cord blood metabolites are associated with newborn size and cord blood C-peptide levels after adjustment for maternal body mass index and glucose during pregnancy. Negative associations of metabolites with C-peptide at birth were observed. 1,5-Anhydroglucitol appears to be a marker of adiposity in newborns. BCAAs were individually associated with birthweight and demonstrated possible associations with newborn adiposity in network analyses.
Collapse
Affiliation(s)
- Rachel Kadakia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Correspondence and Reprint Requests: William L. Lowe, Jr., MD, Feinberg School of Medicine, Northwestern University, Rubloff Building, 12th Floor, 420 East Superior Street, Chicago, Ilinois 60611.
| | - Octavious Talbot
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alan Kuang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James R Bain
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
- Duke Molecular Physiology Institute, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
| | - Michael J Muehlbauer
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
- Duke Molecular Physiology Institute, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
| | - Robert D Stevens
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
- Duke Molecular Physiology Institute, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
| | - Olga R Ilkayeva
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
- Duke Molecular Physiology Institute, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
| | - Lynn P Lowe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Boyd E Metzger
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christopher B Newgard
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
- Duke Molecular Physiology Institute, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
| | | | - William L Lowe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | |
Collapse
|
8
|
Wexler DJ, Powe CE, Barbour LA, Buchanan T, Coustan DR, Corcoy R, Damm P, Dunne F, Feig DS, Ferrara A, Harper LM, Landon MB, Meltzer SJ, Metzger BE, Roeder H, Rowan JA, Sacks DA, Simmons D, Umans JG, Catalano PM. Research Gaps in Gestational Diabetes Mellitus: Executive Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Obstet Gynecol 2019; 132:496-505. [PMID: 29995731 DOI: 10.1097/aog.0000000000002726] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop on research gaps in gestational diabetes mellitus (GDM) with a focus on 1) early pregnancy diagnosis and treatment and 2) pharmacologic treatment strategies. This article summarizes the proceedings of the workshop. In early pregnancy, the appropriate diagnostic criteria for the diagnosis of GDM remain poorly defined, and an effect of early diagnosis and treatment on the risk of adverse outcomes has not been demonstrated. Despite many small randomized controlled trials of glucose-lowering medication treatment in GDM, our understanding of medication management of GDM is incomplete as evidenced by discrepancies among professional society treatment guidelines. The comparative effectiveness of insulin, metformin, and glyburide remains uncertain, particularly with respect to long-term outcomes. Additional topics in need of further research identified by workshop participants included phenotypic heterogeneity in GDM and novel and individualized treatment approaches. Further research on these topics is likely to improve our understanding of the pathophysiology and treatment of GDM to improve both short- and long-term outcomes for mothers and their children.
Collapse
Affiliation(s)
- Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Divisions of Endocrinology, Metabolism, and Diabetes and Maternal-Fetal Medicine, University of Colorado School of Medicine and Anschutz Medical Campus, Aurora, Colorado; the Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; Women & Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Diabetes Unit, Hospital de la Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Bellaterra, Barcelona, CIBER-BBN, Spain; the Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; College Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland; the Diabetes & Endocrine in Pregnancy Program, Mount Sinai Hospital and University of Toronto, Toronto, Canada; the Division of Research, Kaiser Permanente Northern California, Oakland, California; the Department of Maternal-Fetal Medicine, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; the Departments of Medicine and Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Kaiser Permanente Southern California, San Diego, California; National Women's Health, Auckland, New Zealand; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California; Campbelltown Hospital and Western Sydney University, Sydney, Australia; MedStar Health Research Institute, Hyattsville, Maryland; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC; and the Center for Reproductive Health, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Sakasai-Sakai A, Takata T, Suzuki H, Maruyama I, Motomiya Y, Takeuchi M. Immunological evidence for in vivo production of novel advanced glycation end-products from 1,5-anhydro-D-fructose, a glycogen metabolite. Sci Rep 2019; 9:10194. [PMID: 31308400 PMCID: PMC6629992 DOI: 10.1038/s41598-019-46333-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/14/2019] [Indexed: 11/09/2022] Open
Abstract
The anhydrofructose pathway is an alternate pathway for glycogen degradation by α-1,4-glucan lyase. The sugar 1,5-anhydro-D-fructose (1,5-AF) acts as the central intermediate of this pathway, but its physiological role of in mammals is unclear. Glycation reactions forming advanced glycation end-products (AGEs) are important in the development of complications of diabetes mellitus. We hypothesized that 1,5-AF may contribute to cellular damage by forming 1,5-AF-derived AGEs (AF-AGEs) with intracellular proteins. To clarify the role of 1,5-AF in protein modification, we created a novel antibody targeting AF-AGEs. Serum albumin modified by AF-AGEs was prepared by incubating rabbit serum albumin (RSA) or bovine serum albumin (BSA) with 1,5-AF. After immunizing rabbits with AF-AGEs-RSA, affinity chromatography of anti-AF-AGE antiserum was performed on a Sepharose 4B column coupled with AF-AGEs-BSA or N-(carboxymethyl)/N-(carboxyethyl)lysine-BSA. A novel immunopurified anti-AF-AGE antibody was obtained and was characterized using a competitive enzyme-linked immunosorbent assay. Then an AF-AGEs assay was established using this immunopurified antibody. This assay was able to detect AF-AGEs in human and animal serum samples. Finally, intracellular accumulation of AF-AGEs was shown to be associated with damage to cultured hepatocytes (HepG2 cells). This is the first report about in vivo detection of AF-AGEs with a novel structural epitope.
Collapse
Affiliation(s)
- Akiko Sakasai-Sakai
- Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Takanobu Takata
- Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Uchinada-machi, Ishikawa, 920-0293, Japan
| | - Hirokazu Suzuki
- Department of Organic and Medicinal Chemistry, Faculty of Pharmaceutical Sciences, Hokuriku University, Kanazawa, Ishikawa, 920-1181, Japan
| | - Ikuro Maruyama
- Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8520, Japan
| | | | - Masayoshi Takeuchi
- Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Uchinada-machi, Ishikawa, 920-0293, Japan.
| |
Collapse
|
10
|
Pramodkumar TA, Jayashri R, Gokulakrishnan K, Velmurugan K, Pradeepa R, Venkatesan U, Saravanan P, Uma R, Anjana RM, Mohan V. 1,5 Anhydroglucitol in gestational diabetes mellitus. J Diabetes Complications 2019; 33:231-235. [PMID: 30594413 DOI: 10.1016/j.jdiacomp.2018.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/17/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE 1,5 Anhydroglucitol (1,5 AG) is reported to be a more sensitive marker of glucose variability and short-term glycemic control (1-2 weeks) in patients with type1 and type 2 diabetes. However, the role of 1,5 AG in gestational diabetes mellitus (GDM) is not clear. We estimated the serum levels of 1,5 AG in pregnant women with and without GDM. METHODS We recruited 220 pregnant women, 145 without and 75 with GDM visiting antenatal clinics in Tamil Nadu in South India. Oral glucose tolerance tests (OGTTs) were carried out using 82.5 g oral glucose (equivalent to 75 g of anhydrous glucose) and GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Group criteria. Serum 1,5 AG levels were measured using an enzymatic, colorimetric assay kit (Glycomark®, New York, NY). Receiver operating characteristic (ROC) curves were used to identify 1,5 AG cut-off points to identify GDM. RESULTS The mean levels of the 1,5 AG were significantly lower in women with GDM (11.8 ± 5.7 μg/mL, p < 0.001) compared to women without GDM (16.2 ± 6.2 μg/mL). In multiple logistic regression analysis, 1.5 AG showed a significant association with GDM (odds ratio [OR]: 0.876, 95% confidence interval [CI]: 0.812-0.944, p < 0.001) after adjusting for potential confounders. 1,5 AG had a C statistic of 0.693 compared to Fructosamine (0.671) and HbA1c (0.581) for identifying GDM. A 1,5 AG cut-off of 13.21 μg/mL had a C statistic of 0.6936 (95% CI: 0.6107-0.7583, p < 0.001), sensitivity of 67.6%, and specificity of 65.3% to identify GDM. CONCLUSION 1,5AG levels are lower in pregnant women with GDM compared to individuals without GDM.
Collapse
Affiliation(s)
- Thyparambil Aravindakshan Pramodkumar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ramamoorthy Jayashri
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Kuppan Gokulakrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Kaliyaperumal Velmurugan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Ponnusamy Saravanan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ram Uma
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, ICMR Centre for Advanced Research on Diabetes, Gopalapuram, Chennai, India.
| |
Collapse
|
11
|
Xue X, Qiu Y, Cao S, Yue Y, Sun X, Yan W. Detection and significance of TNF-α and hs-CRP in the pleural effusion of patients with diabetes and pulmonary tuberculosis. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219828628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It is postulated that high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor α (TNF-α) are diagnostic utilities for pleural effusion. This study was designed to explore the detection and significance of TNF-α and hs-CRP in the pleural effusion of patients with diabetes and pulmonary tuberculosis. A total of 60 patients with diabetes and pulmonary tuberculosis pleural effusion were selected as the study group, while 60 patients with pulmonary tuberculosis pleural effusion were considered as the control group. The expression of TNF-α and hs-CRP in the two groups was determined from pleural effusion by enzyme-linked immunosorbent assay (ELISA). The expression levels of TNF-α and hs-CRP in pleural effusion of the study group were significantly ( P < 0.05) higher than the control group, and the sensitivity and specificity of the combined detection were significantly ( P < 0.05) higher than those of the separate detection. The expression of TNF-α and hs-CRP in the pleural effusion of patients with diabetes and pulmonary tuberculosis increased remarkably, which plays an important role in the diagnosis and treatment helping with differential diagnosis and evaluation of severity and prognosis by related detection of changes of these indexes, especially the combined detections.
Collapse
Affiliation(s)
- Xin Xue
- Department of Women and Children’s Tuberculosis, Xi’an Chest Hospital, Xi’an, China
| | - Yi Qiu
- Four Department of Disease, Xi’an Chest Hospital, Xi’an, China
| | - Sizhe Cao
- Department of Women and Children’s Tuberculosis, Xi’an Chest Hospital, Xi’an, China
| | - Ying Yue
- Department of Women and Children’s Tuberculosis, Xi’an Chest Hospital, Xi’an, China
| | - Xiaofang Sun
- Department of Women and Children’s Tuberculosis, Xi’an Chest Hospital, Xi’an, China
| | - Wen Yan
- Department of Women and Children’s Tuberculosis, Xi’an Chest Hospital, Xi’an, China
| |
Collapse
|
12
|
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] [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.
Collapse
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
| |
Collapse
|
13
|
Nahavandi S, Seah JM, Shub A, Houlihan C, Ekinci EI. Biomarkers for Macrosomia Prediction in Pregnancies Affected by Diabetes. Front Endocrinol (Lausanne) 2018; 9:407. [PMID: 30108547 PMCID: PMC6079223 DOI: 10.3389/fendo.2018.00407] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/29/2018] [Indexed: 12/16/2022] Open
Abstract
Large birthweight, or macrosomia, is one of the commonest complications for pregnancies affected by diabetes. As macrosomia is associated with an increased risk of a number of adverse outcomes for both the mother and offspring, accurate antenatal prediction of fetal macrosomia could be beneficial in guiding appropriate models of care and interventions that may avoid or reduce these associated risks. However, current prediction strategies which include physical examination and ultrasound assessment, are imprecise. Biomarkers are proving useful in various specialties and may offer a new avenue for improved prediction of macrosomia. Prime biomarker candidates in pregnancies with diabetes include maternal glycaemic markers (glucose, 1,5-anhydroglucitol, glycosylated hemoglobin) and hormones proposed implicated in placental nutrient transfer (adiponectin and insulin-like growth factor-1). There is some support for an association of these biomarkers with birthweight and/or macrosomia, although current evidence in this emerging field is still limited. Thus, although biomarkers hold promise, further investigation is needed to elucidate the potential clinical utility of biomarkers for macrosomia prediction for pregnancies affected by diabetes.
Collapse
Affiliation(s)
- Sofia Nahavandi
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jas-mine Seah
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Alexis Shub
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Christine Houlihan
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Mercy Hospital for Women, Mercy Health, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Corcoran SM, Achamallah N, Loughlin JO, Stafford P, Dicker P, Malone FD, Breathnach F. First trimester serum biomarkers to predict gestational diabetes in a high-risk cohort: Striving for clinically useful thresholds. Eur J Obstet Gynecol Reprod Biol 2018; 222:7-12. [PMID: 29328940 DOI: 10.1016/j.ejogrb.2017.12.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/18/2017] [Accepted: 12/30/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Screening and diagnosis of gestational diabetes (GDM) has been a source of controversy. The prevalence has increased in line with an obesity epidemic and a trend towards delayed child-bearing. Treatment of even modest glycaemic impairment in pregnancy has been shown to be beneficial in preventing its clinical sequalae. However the cumbersome nature and timing of the oral glucose tolerance test coupled with debate around universal versus risk factor based screening have been problematic. This group aimed to investigate a panel of biomarkers which have shown promise in the literature to predict GDM from the first trimester in a group of high risk women. METHODS Serum samples were drawn on 248 women deemed at risk of GDM before 15 weeks' gestation to measure C-reactive protein, sex hormone binding globulin, adiponectin and 1,5 anhydroglucitol. Patients underwent an oral glucose tolerance test as per IADPSG criteria at 28 weeks' gestation. Multiple logistic regression was used to examine the link between incidence of GDM and early pregnancy serum biomarkers. RESULTS Adiponectin levels in the first trimester are independently linked to the risk of GDM. Serum adiponectin <8.9 μg/ml gives an odds ratio of 3.3 for GDM.Mean 1,5 AG levels are significantly lower in those that go on to develop GDM. SHBG levels measured in the first trimester were linked to the risk of GDM. However, this was no longer statistically significant once BMI, ethnicity and family history were taken into consideration. First trimester measurement of CRP is not a useful indicator of GDM risk. CONCLUSIONS First trimester measurement of Adiponectin and 1,5 Anhydroglucitol are potential early biomarkers for the later onset of GDM. Risk stratification using these biomarkers may facilitate early diagnosis and management of GDM to mitigate against its complications.
Collapse
Affiliation(s)
| | | | | | - Philip Stafford
- Department of Biochemistry, Dublin Institute of Technology, Ireland
| | - Pat Dicker
- RCSI Department of Public Health and Epidemiology, Ireland
| | | | | |
Collapse
|
15
|
Saglam B, Uysal S, Sozdinler S, Dogan OE, Onvural B. Diagnostic value of glycemic markers HbA1c, 1,5-anhydroglucitol and glycated albumin in evaluating gestational diabetes mellitus. Ther Adv Endocrinol Metab 2017; 8:161-167. [PMID: 29238514 PMCID: PMC5721970 DOI: 10.1177/2042018817742580] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/26/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The oral glucose tolerance test (OGTT) is the current established method performed worldwide to diagnose gestational diabetes mellitus (GDM). The purpose of this study was to assess the utility of the use of long- and short-term markers of glycemic status. METHODS The study group was composed of 80 pregnant women, 40 with GDM and 40 with normal glucose tolerance. GDM was diagnosed with the American Diabetes Association criteria. Glycemic markers were measured in the OGTT blood samples of women at 24-28 weeks of gestation. RESULTS HbA1c was significantly higher in the GDM group when compared with the controls, whereas 1,5-anhydroglucitol (1,5-AG) levels were significantly lower. There was not a significant difference between the groups for glycated albumin. Whereas HbA1c levels were correlated with fasting and 1 h glucose and negatively correlated with mean corpuscular volume, 1,5-AG was only negatively correlated with the first hour glucose. No difference was found for the diagnostic performances of HbA1c and 1,5-AG (receiver operating characteristic of the area under the concentration curve values were 0.756 and 0.722, respectively). CONCLUSION HbA1c and 1,5-AG alone does not have sufficient diagnostic accuracy to diagnose GDM. 1,5-AG values were correlated with post-load glucose values in pregnant women so will improve the GDM management and be useful to predict complications.
Collapse
Affiliation(s)
- Baris Saglam
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylul University, Izmir, Turkey
| | | | - Sadik Sozdinler
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dokuz Eylul University, Izmir, Turkey
| | - Omer Erbil Dogan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dokuz Eylul University, Izmir, Turkey
| | - Banu Onvural
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
16
|
Zekavat SM, Butkovich S, Young GJ, Nathan DM, Petrasek D. A computational model of 1,5-AG dynamics during pregnancy. Physiol Rep 2017; 5:5/16/e13375. [PMID: 28821595 PMCID: PMC5582262 DOI: 10.14814/phy2.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/01/2017] [Accepted: 07/03/2017] [Indexed: 11/24/2022] Open
Abstract
The importance of 1,5‐anhydroglucitol (1,5‐AG) as an intermediate biomarker for diabetic pregnancy is multi‐fold: (1) it serves as a reliable indicator of moderate‐level glycemic control, especially during early gestation; (2) it has been associated with increased risk of diabetes, independent of HbA1c and fasting glucose; and (3) it is an independent risk factor for the development of eclampsia during pregnancy. However, the clinical use of this biomarker during pregnancy has been underutilized due to physiological changes in glomerular filtration rate, plasma volume, and other hemodynamic parameters which have been hypothesized to bias gestational serum 1,5‐AG concentrations. Here, we develop an in‐silico model of gestational 1,5‐AG by combining pre‐existing physiological data in the literature with a two‐compartment mathematical model, building off of a previous kinetic model described by Stickle and Turk (1997) Am. J. Physiol., 273, E821. Our model quantitatively characterizes how renal and hemodynamic factors impact measured 1,5‐AG during normal pregnancy and during pregnancy with gestational diabetes and diabetes mellitus. During both normal and diabetic pregnancy, we find that a simple two‐compartment model of 1,5‐AG kinetics, with all parameters but reabsorption fraction adjusted for time in pregnancy, efficiently models 1,5‐AG kinetics throughout the first two trimesters. Allowing reabsorption fraction to decrease after 25 weeks permits parameters closer to expected physiological values during the last trimester. Our quantitative model of 1,5‐AG confirms the involvement of hypothesized renal and hemodynamic mechanisms during pregnancy, clarifying the expected trends in 1,5‐AG to aid clinical interpretation. Further research and data may elucidate biological changes during the third trimester that account for the drop in 1,5‐AG concentrations, and clarify physiological differences between diabetes subtypes during pregnancy.
Collapse
Affiliation(s)
- Seyedeh M Zekavat
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts .,Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | | | - David M Nathan
- Harvard Medical School, Boston, Massachusetts.,Massachussetts General Hospital, Boston, Massachusetts
| | - Danny Petrasek
- California Institute of Technology, Pasadena, California
| |
Collapse
|
17
|
Gutaj P, Wender-Ożegowska E, Brązert J. Maternal lipids associated with large-for-gestational-age birth weight in women with type 1 diabetes: results from a prospective single-center study. Arch Med Sci 2017; 13:753-759. [PMID: 28721142 PMCID: PMC5510499 DOI: 10.5114/aoms.2016.58619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite improvement in diabetes care over the years, the incidence of macrosomia in type 1 diabetic mothers is still very high and even shows an increasing tendency. It is suggested that other factors that maternal hyperglycemia might be associated with excessive fetal growth in diabetic mothers. The aim of this study was to determine whether maternal lipids might contribute to high rates of large-for-gestational-age (LGA) newborns in women with type 1 diabetes (T1DM). MATERIAL AND METHODS This prospective, single-center study was performed in a population of women with T1DM admitted to the perinatal center for women with diabetes. Data were collected in the first trimester (< 12th week), in mid-pregnancy (20th-24th weeks), and before delivery (34th-39th weeks). RESULTS Among 114 women included in the analysis, 30 (26.3%) delivered LGA newborns. The remaining 84 (73.7%) newborns were appropriate for gestational age (AGA). Lower high-density lipoprotein (HDL) HDL concentration in the first trimester was significantly associated with LGA (p = 0.01). Similar associations were observed for the HDL concentrations in mid-pregnancy (p = 0.04) and before delivery (p = 0.03). Higher triglyceride concentrations in the first trimester (p = 0.02) and before delivery (p = 0.008) were associated with LGA. Higher glycated haemoglobin (HbA1c) levels in mid-pregnancy and before delivery were associated with LGA. The associations between maternal lipids and LGA were independent of maternal body mass index at onset of the study, gestational weight gain and HbA1c concentrations. CONCLUSIONS Decreased HDL and increased triglycerides during pregnancy might contribute to the development of LGA in women with type 1 diabetes.
Collapse
Affiliation(s)
- Paweł Gutaj
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Wender-Ożegowska
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Brązert
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
18
|
Wright LAC, Hirsch IB. Metrics Beyond Hemoglobin A1C in Diabetes Management: Time in Range, Hypoglycemia, and Other Parameters. Diabetes Technol Ther 2017; 19:S16-S26. [PMID: 28541136 PMCID: PMC5444503 DOI: 10.1089/dia.2017.0029] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We review clinical instances in which A1C should not be used and reflect on the use of other glucose metrics that can be used, in substitution of or in combination with A1C and SMBG, to tailor an individualized approach that will result in better outcomes and patient empowerment.
Collapse
Affiliation(s)
- Lorena Alarcon-Casas Wright
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington Medical Center/Roosevelt , Seattle, Washington
| | - Irl B Hirsch
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington Medical Center/Roosevelt , Seattle, Washington
| |
Collapse
|
19
|
Su H, Ma X, Yin J, Wang Y, He X, Bao Y, Zhou J, Jia W. Serum 1,5-anhydroglucitol levels slightly increase rather than decrease after a glucose load in subjects with different glucose tolerance status. Acta Diabetol 2017; 54:463-470. [PMID: 28210869 DOI: 10.1007/s00592-017-0968-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/28/2017] [Indexed: 12/16/2022]
Abstract
AIMS Previous studies showed that serum 1,5-anhydroglucitol (1,5-AG) levels are significantly reduced in patients with diabetes mellitus (DM). However, it remains unclear how 1,5-AG levels acutely change in response to a glucose load. This study explored acute changes in 1,5-AG levels after a glucose load and the related influencing factors in individuals with differing degrees of glucose tolerance. METHODS A total of 681 participants (353 without DM and 328 with DM) without a prior history of DM were enrolled. All participants underwent an oral glucose tolerance test. Fasting and postload (30, 60, 120, and 180 min) levels of plasma glucose, serum 1,5-AG, and insulin were measured. RESULTS In all participant groups, serum 1,5-AG levels were slightly elevated after a glucose load and reached peak values at 120 min after loading (all P < 0.05). Regression analysis showed that body weight was negatively associated with the difference between peak and baseline 1,5-AG levels (Δ1,5-AG, standardized β = -0.119, P < 0.01). A strong and positive association between 1,5-AG0 and Δ1,5-AG was also found independent of other confounding factors (standardized β = 0.376, P < 0.01). The ratio of the Δ1,5-AG to the 1,5-AG0 was higher in DM patients (7.3% [3.4-11.5%]) than in those without DM (6.2% [3.6-9.2%]). CONCLUSIONS In contrast to the established decline in 1,5-AG levels with long-term hyperglycemia, the present study showed that serum 1,5-AG levels slightly increased by 6-7% after a glucose load. Further studies in different 1,5-AG transport models are needed to investigate the relevant metabolic pathways.
Collapse
Affiliation(s)
- Hang Su
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Jun Yin
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Xingxing He
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China.
- Department of Endocrinology and Metabolism, Kashgar Prefecture Second People's Hospital, Liberated South Road, Kashgar, 844000, Xinjiang Uygur Autonomous Region, China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China.
| |
Collapse
|
20
|
Cyganek K, Skupien J, Katra B, Hebda-Szydlo A, Janas I, Trznadel-Morawska I, Witek P, Kozek E, Malecki MT. Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control. Endocrine 2017; 55:447-455. [PMID: 27726091 PMCID: PMC5272887 DOI: 10.1007/s12020-016-1134-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
Abstract
Macrosomia risk remains high in type 1 diabetes (T1DM) complicated pregnancies. A linear relationship between macrosomia risk and glycated hemoglobin A1c (HbA1c) was described; however, low range of HbA1c has not been studied. We aimed to identify risk factors and examine the impact of HbA1c on the occurrence of macrosomia in newborns of T1DM women from a cohort with good glycemic control. In this observational retrospective one-center study we analyzed records of 510 consecutive T1DM pregnancies (1998-2012). The analyzed group consisted of 375 term singleton pregnancies. We used multiple regression models to examine the impact of HbA1c and self-monitored glucose in each trimester on the risk of macrosomia and birth weight. The median age of T1DM women was 28 years, median T1DM duration-11 years, median pregestational BMI-23.3 kg/m2. Median birth weight reached 3520 g (1st and 3rd quartiles 3150 and 3960, respectively) at median 39 weeks of gestation. There were 85 (22.7 %) macrosomic (>4000 g) newborns. Median HbA1c levels in the 1st, 2nd, and 3rd trimester were 6.4, 5.7, and 5.6 %. Third trimester HbA1c, mean fasting self-monitored glucose and maternal age were independent predictors of birth weight and macrosomia. There was a linear relationship between 3rd trimester HbA1c and macrosomia risk in HbA1c range from 4.5 to 7.0 %. Macrosomia in children of T1DM mothers was common despite excellent metabolic control. Glycemia during the 3rd trimester was predominantly responsible for this condition.
Collapse
Affiliation(s)
- Katarzyna Cyganek
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Jan Skupien
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Katra
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Hebda-Szydlo
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Izabela Janas
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Iwona Trznadel-Morawska
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Kozek
- Department of Metabolic Diseases, University Hospital, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, University Hospital, Krakow, Poland.
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
| |
Collapse
|
21
|
Delaney SS, Coley RY, Brown Z. 1,5-Anhydroglucitol: a new predictor of neonatal birth weight in diabetic pregnancies. Eur J Obstet Gynecol Reprod Biol 2015; 189:55-8. [PMID: 25864111 DOI: 10.1016/j.ejogrb.2015.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether 1,5-anhydroglucitol is predictive of neonatal birth weight. STUDY DESIGN A retrospective cohort study including 85 pregnancies complicated by diabetes (Type 1=37, Type 2=24, gestational=24). Women had simultaneous hemoglobin A1c and 1,5-anhydroglucitol measurements every 4-8 weeks throughout pregnancy until delivery. Neonatal birth weight was evaluated by standardized z-scores. Linear regression analysis was performed to determine an association of 1,5-anhydroglucitol with neonatal birth weight z-score. RESULTS Type 1 diabetic patients had the lowest mean 1,5-anhydroglucitol of 3.5mcg/mL (SD=1.6mcg/mL) and highest mean hemoglobin A1c of 6.5% (SD=0.74%) compared to gestational diabetic patients who had the highest mean 1,5-anhydroglucitol of 6.7mcg/mL (SD=3.8mcg/mL) and lowest mean hemoglobin A1c of 6.0% (SD=0.94%). Mean 1,5-anhydroglucitol values were significantly different between diabetes types (p<0.01). Mean neonatal birth weight was above population averages for all diabetes classifications, although mean birth weight z-scores did not differ significantly between diabetic types (p=0.38). Multivariate linear regression showed a negative association between log-transformed 1,5-anhydroglucitol and birth weight (coefficient -0.82, 95% CI -1.19, -0.46). CONCLUSION In pregnancies complicated by diabetes, low 1,5-anhydroglucitol was associated with increased neonatal birth weight. 1,5-Anhydroglucitol may be useful in the assessment of glycemic control in pregnancy in addition to A1c.
Collapse
Affiliation(s)
- Shani S Delaney
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA.
| | - R Yates Coley
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Zane Brown
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| |
Collapse
|
22
|
|
23
|
Mook-Kanamori DO, Selim MMED, Takiddin AH, Al-Homsi H, Al-Mahmoud KAS, Al-Obaidli A, Zirie MA, Rowe J, Yousri NA, Karoly ED, Kocher T, Sekkal Gherbi W, Chidiac OM, Mook-Kanamori MJ, Abdul Kader S, Al Muftah WA, McKeon C, Suhre K. 1,5-Anhydroglucitol in saliva is a noninvasive marker of short-term glycemic control. J Clin Endocrinol Metab 2014; 99:E479-83. [PMID: 24423354 DOI: 10.1210/jc.2013-3596] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In most ethnicities at least a quarter of all cases with diabetes is assumed to be undiagnosed. Screening for diabetes using saliva has been suggested as an effective approach to identify affected individuals. OBJECTIVE The objective of the study was to identify a noninvasive metabolic marker of type 2 diabetes in saliva. DESIGN AND SETTING In a case-control study of type 2 diabetes, we used a clinical metabolomics discovery study to screen for diabetes-relevant metabolic readouts in saliva, using blood and urine as a reference. With a combination of three metabolomics platforms based on nontargeted mass spectrometry, we examined 2178 metabolites in saliva, blood plasma, and urine samples from 188 subjects with type 2 diabetes and 181 controls of Arab and Asian ethnicities. RESULTS We found a strong association of type 2 diabetes with 1,5-anhydroglucitol (1,5-AG) in saliva (P = 3.6 × 10(-13)). Levels of 1,5-AG in saliva highly correlated with 1,5-AG levels in blood and inversely correlated with blood glucose and glycosylated hemoglobin levels. These findings were robust across three different non-Caucasian ethnicities (Arabs, South Asians, and Filipinos), irrespective of body mass index, age, and gender. CONCLUSIONS Clinical studies have already established 1,5-AG in blood as a reliable marker of short-term glycemic control. Our study suggests that 1,5-AG in saliva can be used in national screening programs for undiagnosed diabetes, which are of particular interest for Middle Eastern countries with young populations and exceptionally high diabetes rates.
Collapse
Affiliation(s)
- Dennis O Mook-Kanamori
- Department of Physiology and Biophysics (D.O.M.-K., J.R., N.A.Y., M.J.M.-K., W.A.A.M., K.S.) and Clinical Research Core (W.S.G., O.M.C., M.J.M.-K., S.A.K., C.M.), Weill Cornell Medical College, Qatar, Doha, Qatar; Department of Endocrinology (D.O.M.-K.), Leiden University Medical Centre, 2300 RC Leiden, The Netherlands; Departments of Dermatology (M.M.E.D.S., A.H.T., H.A.-H., K.A.S.A.-M., A.A.-O.) and Endocrinology (M.A.Z.), Hamad Medical Corporation, Doha, Qatar; Metabolon Inc (E.D.K.), Durham, North Carolina 27713; Unit of Periodontology (T.K.), Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, D-17487 Greifswald, Germany; and Institute of Bioinformatics and Systems Biology (K.S.), Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Scholtens DM, Muehlbauer MJ, Daya NR, Stevens RD, Dyer AR, Lowe LP, Metzger BE, Newgard CB, Bain JR, Lowe WL. Metabolomics reveals broad-scale metabolic perturbations in hyperglycemic mothers during pregnancy. Diabetes Care 2014; 37:158-66. [PMID: 23990511 PMCID: PMC3867997 DOI: 10.2337/dc13-0989] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize metabolites across the range of maternal glucose by comparing metabolomic profiles of mothers with high and low fasting plasma glucose (FPG). RESEARCH DESIGN AND METHODS We compared fasting serum from an oral glucose tolerance test at ∼28 weeks' gestation from 67 Northern European ancestry mothers from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study with high (>90th percentile) FPG with 50 mothers with low (<10th percentile) FPG but comparable BMI. Metabolic data from biochemical analyses of conventional clinical metabolites, targeted mass spectrometry (MS)-based measurement of amino acids, and nontargeted gas chromatography/MS were subjected to per-metabolite analyses and collective pathway analyses using Unipathway annotation. RESULTS High-FPG mothers had a metabolic profile consistent with insulin resistance including higher triglycerides, 3-hydroxybutyrate, and amino acids including alanine, proline, and branched-chain amino acids (false discovery rate [FDR]-adjusted P < 0.05). Lower 1,5-anhydroglucitol in high-FPG mothers suggested recent hyperglycemic excursions (FDR-adjusted P < 0.05). Pathway analyses indicated differences in amino acid degradation pathways for the two groups (FDR-adjusted P < 0.05), consistent with population-based findings in nonpregnant populations. Exploratory analyses with newborn outcomes indicated positive associations for maternal triglycerides with neonatal sum of skinfolds and cord C-peptide and a negative association between maternal glycine and cord C-peptide (P < 0.05). CONCLUSIONS Metabolomics reveals perturbations in metabolism of major macronutrients and amino acid degradation pathways in high- versus low-FPG mothers.
Collapse
|