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Ji Q, Liu H, Wang F, Gao L, Chen K, Quan H, Lu M. Progression of gestational diabetes mellitus to pregnancy-associated fulminant type 1 diabetes: a case report. AME Case Rep 2024; 8:83. [PMID: 39091556 PMCID: PMC11292075 DOI: 10.21037/acr-24-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/30/2024] [Indexed: 08/04/2024]
Abstract
Background Pregnancy-associated fulminant type 1 diabetes (PF) occurs during pregnancy or within 2 weeks of delivery. Although it occurs infrequently, it is associated with high fetal mortality rate. Few studies have examined whether PF is associated with gestational diabetes mellitus (GDM). Case Description A 29-year-old woman diagnosed with GDM at 24 weeks of gestation developed a fever, sore throat, nausea and vomiting at 29 weeks of gestation. Ketoacidosis was considered based on her blood ketone and glucose levels and the results of a blood gas analysis. Since the patient's islet function declined rapidly, fluid replacement, insulin therapy, and other treatments were administered. The patient was ultimately diagnosed with PF, and has required ongoing insulin therapy. She delivered a healthy baby girl by elective cesarean section at 37-week gestation. Her blood glucose has been satisfactorily controlled over the 12 months since her acute presentation. Conclusions PF is characterized by poor maternal and infant outcomes and a high stillbirth rate. Blood glucose should be regularly monitored in pregnant women with GDM. A sudden increase in blood glucose may indicate the possibility of PF, which needs to be managed in a timely manner to avoid adverse pregnancy outcomes.
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Affiliation(s)
- Qun Ji
- Department of Endocrinology, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
| | - Haiwei Liu
- Department of Endocrinology, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
| | - Fei Wang
- Department of Endocrinology, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
| | - Lan Gao
- Department of Endocrinology, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
| | - Kaining Chen
- Department of Endocrinology, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
| | - Huibiao Quan
- Department of Endocrinology, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
| | - Min Lu
- Department of Obstetrics, Hainan Hospital Affiliated Hospital of Hainan Medical University/Hainan General Hospital, Haikou, China
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Tang W, Wang X, Chen L, Lu Y, Kang X. Identification of potential gene markers in gestational diabetes mellitus. J Clin Lab Anal 2022; 36:e24515. [PMID: 35718998 PMCID: PMC9279970 DOI: 10.1002/jcla.24515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/31/2022] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
This study aims to investigate underlying mechanisms of gestational diabetes mellitus (GDM). In this work, the GSE70493 dataset from GDM and control samples was acquired from Gene Expression Omnibus (GEO) database. Afterward, differentially expressed genes (DEGs) were screened between GDM and control samples. Subsequently, functional enrichment analysis and protein–protein interaction (PPI) network analysis of these DEGs were carried out. Furthermore, significant sub‐modules were identified, and the functional analysis was also performed. Finally, we undertook a quantitative real‐time polymerase chain reaction (qRT‐PCR) with the purpose of confirming several key genes in GDM development. There were totally 528 up‐regulated and 684 down‐regulated DEGs between GDM and healthy samples. The functional analyses suggested that the above genes were dramatically enriched in type 1 diabetes mellitus (T1DM) process and immune‐related pathways. Moreover, PPI analysis revealed that several members of human leukocyte antigen (HLA) superfamily, including down‐regulated HLA‐DQA1, HLA‐DRB1, HLA‐DPA1, and HLA‐DQB1 served as hub genes. In addition, six significant sub‐clusters were extracted and functional analysis suggested that these four genes in sub‐module 1 were also associated with immune and T1DM‐related pathways. Finally, they were also confirmed by qRT‐PCR array. Besides, the four members of HLA superfamily might be implicated with molecular mechanisms of GDM, contributing to a deeper understanding of GDM development.
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Affiliation(s)
- Weichun Tang
- The Department of Obstetrics and Gynecology, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Xiaoyu Wang
- The Department of Obstetrics and Gynecology, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Liping Chen
- The Department of Obstetrics and Gynecology, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Yiling Lu
- The Department of Obstetrics and Gynecology, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Xinyi Kang
- The Department of Obstetrics and Gynecology, The Affiliated Hospital 2 of Nantong University, Nantong, China
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Maximiano C, Silva MR, Carvalho F, Almeida J, Gomes MM, Martins S, Marques O, Estrada A, Pereira A, Antunes A. Follow-up of infants born to mothers with Graves' disease. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:472-480. [PMID: 34863412 DOI: 10.1016/j.endien.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The prevalence of neonatal hyperthyroidism (HN) due to maternal Graves Disease (GD) ranges from 0.1 to 2.7%. It may occur in pregnant women with the following: active DG, after treatment with radioactive iodine, anti-thyroid or thyroidectomy or with a previous child with hyperthyroidism. The aim of our observational study was to evaluate the follow-up of infants born to mothers with GD at a Tertiary Hospital prior to the implementation of a follow-up protocol. METHODS This was a retrospective observational study using data from the medical records of mothers with a diagnosis of GD and their newborns from January 2013 until May 2018. Newborns were divided into two groups: high and low risk for NH according to maternal TRAb, third trimester treatment and signs of fetal hyperthyroidism. RESULTS We identified 31 newborns, 58% female; 87% high risk. In none of the newborns was umbilical cord blood collected. In the high risk group, 22% had thyroid function evaluation at day-1, one patient presented with hyperthyroidism and 82% were asymptomatic. Considering the cases with an insufficient blood sample for analysis, 9 consultations would have been spared. We found a significant delay in obtaining the high-risk group results which would have spared 10 appointments. A positive correlation was found between age at outpatient clinic discharge and the number of appointments and the maternal TRAb titer. CONCLUSION The correct surveillance of pregnancy and newborns with identification of those at high risk is essential to avoid unnecessary consultations and blood analyses that increase parental anxiety and hospital costs. Consequently, a multidisciplinary protocol was created to standardize the approach.
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Affiliation(s)
| | | | - Fábia Carvalho
- Department of Pediatrics, Hospital de Braga, Braga, Portugal
| | - Juliana Almeida
- Department of Clinical Pathology, Hospital de Braga, Braga, Portugal
| | - Maria Miguel Gomes
- Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal; School of Medicine, Universidade do Minho, Braga, Portugal
| | - Sofia Martins
- Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal
| | - Olinda Marques
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
| | - Alexandra Estrada
- Department of Clinical Pathology, Hospital de Braga, Braga, Portugal
| | - Almerinda Pereira
- Neonatal Intensive Care Department, Hospital de Braga, Braga, Portugal
| | - Ana Antunes
- Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal
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Maximiano C, Silva MR, Carvalho F, Almeida J, Gomes MM, Martins S, Marques O, Estrada A, Pereira A, Antunes A. Follow-up of infants born to mothers with Graves' disease. ACTA ACUST UNITED AC 2020. [PMID: 33386291 DOI: 10.1016/j.endinu.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The prevalence of neonatal hyperthyroidism (HN) due to maternal Graves Disease (GD) ranges from 0.1 to 2.7%. It may occur in pregnant women with the following: active DG, after treatment with radioactive iodine, anti-thyroid or thyroidectomy or with a previous child with hyperthyroidism. The aim of our observational study was to evaluate the follow-up of infants born to mothers with GD at a Tertiary Hospital prior to the implementation of a follow-up protocol. METHODS This was a retrospective observational study using data from the medical records of mothers with a diagnosis of GD and their newborns from January 2013 until May 2018. Newborns were divided into two groups: high and low risk for NH according to maternal TRAb, third trimester treatment and signs of fetal hyperthyroidism. RESULTS We identified 31 newborns, 58% female; 87% high risk. In none of the newborns was umbilical cord blood collected. In the high risk group, 22% had thyroid function evaluation at day-1, one patient presented with hyperthyroidism and 82% were asymptomatic. Considering the cases with an insufficient blood sample for analysis, 9 consultations would have been spared. We found a significant delay in obtaining the high-risk group results which would have spared 10 appointments. A positive correlation was found between age at outpatient clinic discharge and the number of appointments and the maternal TRAb titer. CONCLUSION The correct surveillance of pregnancy and newborns with identification of those at high risk is essential to avoid unnecessary consultations and blood analyses that increase parental anxiety and hospital costs. Consequently, a multidisciplinary protocol was created to standardize the approach.
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Affiliation(s)
| | | | - Fábia Carvalho
- Department of Pediatrics, Hospital de Braga, Braga, Portugal
| | - Juliana Almeida
- Department of Clinical Pathology, Hospital de Braga, Braga, Portugal
| | - Maria Miguel Gomes
- Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal; School of Medicine, Universidade do Minho, Braga, Portugal
| | - Sofia Martins
- Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal
| | - Olinda Marques
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
| | - Alexandra Estrada
- Department of Clinical Pathology, Hospital de Braga, Braga, Portugal
| | - Almerinda Pereira
- Neonatal Intensive Care Department, Hospital de Braga, Braga, Portugal
| | - Ana Antunes
- Pediatric Endrocrinology Unit of Pediatric Department, Hospital de Braga, Braga, Portugal
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Moll M, Regan EA, Hokanson JE, Lutz SM, Silverman EK, Crapo JD, Make BJ, DeMeo DL. The Association of Multiparity with Lung Function and Chronic Obstructive Pulmonary Disease-Related Phenotypes. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2020; 7:86-98. [PMID: 32324980 PMCID: PMC7454017 DOI: 10.15326/jcopdf.7.2.2019.0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Apparent increased female susceptibility to chronic obstructive pulmonary disease (COPD) suggests sex hormones modulate disease pathogenesis. Little is known about associations between multiparity and lung function in smokers. RESEARCH QUESTION We hypothesized that multiparity is associated with lung function and measures of emphysema and airway disease. STUDY DESIGN AND METHODS Utilizing female participants from the 5-year follow up of the COPD Genetic Epidemiology (COPDGene®) study we performed multivariable linear regressions to assess the effect of multiparity and number of pregnancies on forced expiratory volume in 1 second (FEV1) percentage of predicted (% predicted), FEV1/forced vital capacity (FVC), percent emphysema on computed tomography (CT) scans, and Pi10, a measure of airway thickening. We sampled never smokers and those with lower smoking exposure from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 dataset. RESULTS We included 1820 participants from COPDGene® and 418 participants from NHANES (321 never smokers, 97 ever smokers). In COPDGene®, multiparity (beta coefficient [β] = -3.8, 95% confidence interval [CI]: [-6.5, -1.1], p = 0.005) and higher number of pregnancies were associated with lower FEV1 % predicted. Multiparity was not associated with percent emphysema or Pi10. In individuals with no or mild obstruction, multiparity was associated with lower FEV1 % predicted. There was an interaction with multiparity and age on FEV1 % predicted (p = 0.025). In NHANES, there was no association between multiparity and FEV1 % predicted in never smokers or the lower smoking exposure group. INTERPRETATION Multiparity was associated with lower FEV1 % predicted in current and former smokers in COPDGene® study participants. These preliminary results emphasize the importance of smoking abstinence in women of child-bearing age.
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Affiliation(s)
- Matthew Moll
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Sharon M. Lutz
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Liu L, Zeng L, Sang D, Lu Z, Shen J. Recent findings on fulminant type 1 diabetes. Diabetes Metab Res Rev 2018; 34. [PMID: 28817230 DOI: 10.1002/dmrr.2928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 12/19/2022]
Abstract
Fulminant type 1 diabetes (fT1D) is a new subtype of type 1 diabetes proposed by Imagawa in 2000. It is a clinical syndrome characterized by a markedly rapid and almost complete destruction of pancreatic β cells. Metabolic derangement is more severe in this subtype than in autoimmune type 1 diabetes. The incidence of fT1D is associated with HLA DRB1*04:05DQB1*04:01; both innate and acquired immune disorders might contribute to the development of fT1D. The presence of specific innate immune responses to enterovirus infection connected with enhanced adaptive immune pathways responsible for aggressive β cell toxicity in fT1D. The process of β cell destruction is extremely rapid in fT1D, and the insulin secretary capacity rarely recovers after the onset. The serum glycated albumin to glycated haemoglobin ratio is significantly higher in fT1D; a cut-off value of 3.2 for serum glycated albumin to glycated haemoglobin ratio yielded 97% sensitivity and 98% specificity for differentiating fT1D from type 2 diabetes. Fulminant type 1 diabetes is associated with pregnancy. This article also updates the diagnostic criteria for fT1D by the Japanese Diabetes Association in 2012.
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Affiliation(s)
- Lan Liu
- Department of Endocrinology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Ling Zeng
- Department of Endocrinology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Dan Sang
- Department of Endocrinology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Zeyuan Lu
- Department of Endocrinology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jie Shen
- Department of Endocrinology, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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