Consistently Low Levels of Osteocalcin From Late Pregnancy to Postpartum Are Related to Postpartum Abnormal Glucose Metabolism in GDM Patients

Novel serum biomarkers for early diagnosis of gestational diabetes mellitus-a review

Gestational diabetes mellitus (GDM) affects 9-25% of pregnancies. Undiagnosed or poorly managed GDM is associated with both short- and long-term complications in the fetus and mother. The pathogenesis of GDM is complex and has not yet been fully elucidated. Several biomarkers found in maternal serum have the potential for the early diagnosis of GDM. The aim of this narrative review was to explore novel biomarkers that have not been comprehensively described in previous reviews. We believe these biomarkers may allow for the detection of GDM in the early stages of pregnancy, enabling timely proper treatment and potentially preventing complications for both the mother and the fetus.

Mediating effect of osteocalcin underlying the link between insulin-like growth factor-I and gestational diabetes mellitus

PURPOSE

To investigate the associations of serum insulin like growth factor I (IGF-I) and Osteocalcin (OC) concentrations with gestational diabetes mellitus (GDM) risk among Chinese women.

METHODS

A case-control study was conducted in China, involving 125 GDM and 153 healthy pregnant women at 24-28 gestational weeks from 2019 to 2022. The study was approved by the Clinical Trial Ethics Committee of the Third Afliated Hospital of Zhengzhou University in January 04, 2020, and the study had been registered with the Chinese Clinical Trial Registry (ChiCTR2000028811). Maternal serum IGF-I and OC levels were measured in the second trimester. Logistic regression models and restricted cubic spline (RCS) were employed to calculate the association of IGF-I and OC levels with the risk of GDM, and and receiver operating characteristic (ROC) curves were generated to evaluate the predictive capacity of IGF-I and OC for GDM. Mediation analyses were used to investigate the mediation effect of OC on the association between IGF-I and the risk of GDM.

RESULTS

Both serum IGF-I and undercarboxylated Osteocalcin (ucOC) concentration were positively associated with the risk of GDM. The relationship between serum IGF-I and the risk of GDM is not linear (P-value < 0.001, P-Nonlinear < 0.001). Mediation analyses suggested that 48.61% of the associations between IGF-I and GDM might be mediated by ucOC. The areas under the ROC curves for IGF-I and integrated model were 74.5% and 76.2%.

CONCLUSIONS

Serum IGF-I might provide a new dimension in the diagnosis of GDM for clinical application, and ucOC might serve as a mediator between IGF-I and GDM.

Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis

PURPOSE

This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum to inform the development of preventive strategies.

METHOD

We searched Pubmed, Embase, Web of Science, the Cochrane Library, Ovid, China Knowledge Resource Integrated Database (CNKI), Wanfang Database and China Biology Medicine Database for entries between January 1990 and September 2022. The search terms included gestational diabetes mellitus, postpartum, glucose intolerance and type 2 diabetes. The meta-analysis was conducted using Stata 14.0.

RESULT

We included 37 studies, with 21 and 16 having low and medium risk of bias, respectively. The incidence of glucose intolerance in women with GDM 6-12 weeks postpartum was 27% (95% CI: 0.22-0.33). The following risk factors for GDM 6-12 weeks postpartum were identified: insulin use during pregnancy (OR = 3.23; 95% CI: 2.35-4.44), family history of diabetes (OR = 2.94; 95% CI: 1.98-4.33), abnormal fasting glucose levels at 24-28 weeks of gestation (OR = 1.15; 95% CI: 1.07-1.25), high pre-pregnancy BMI (OR = 1.63; 95% CI: 1.23-2.15), abnormal triglyceride levels during 28-40 weeks of gestation (OR = 2.18; 95% CI: 1.18-4.03), abnormal HbA1c levels at 28-40 weeks of gestation (OR = 6.62; 95% CI: 4.71-9.30), history of previous GDM (OR = 2.11; 95% CI: 1.27-3.49), and high 1-h glucose levels at 24-28 weeks of gestation (OR = 1.16; 95% CI:1.06-1.28).

CONCLUSION

The incidence of glucose intolerance in GDM patients at 6-12 weeks postpartum was high. To prevent early postpartum glucose intolerance, healthcare providers should develop individualized interventions for GDM patients, depending on existing risk factors.

Correlation analysis of bone metabolism indices and glycosylated hemoglobin in middle-aged and older adult patients with type 2 diabetes mellitus

This study aimed to evaluate the association between bone metabolism indices and glycated hemoglobin (HbA1c) levels in middle-aged and older adult patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed 372 T2DM patients aged > 45 years who had attended the Endocrinology Department at our hospital (males, n = 192; postmenopausal females, n = 180). We collected data concerning patient characteristics, HbA1c levels, and bone metabolism indices (25-hydroxyvitamin D [25(OH)D], β-isomerized C-terminal telopeptides, N-terminal osteocalcin [N-MID], procollagen type 1 N-terminal propeptide [P1NP], bone-specific alkaline phosphatase [BAP], calcium [Ca], and phosphorus [P]). Study patients were divided into 3 groups according to their HbA1c levels: Group A, HbA1c < 7.5%; Group B, HbA1c 7.5 to 8.9%; and Group C, HbA1c ≥ 9.0%. Pearson correlation was used to determine the correlation between HbA1c levels and the bone metabolism indices. Multiple linear regression analysis was performed to identify factors influencing HbA1c in T2DM patients. Among the 3 groups, no differences were observed in 25(OH)D, β-CTx, Ca, or P indices among the 3 groups, whereas a statistically significant difference in N-MID was observed. Pearson correlation analysis showed an inverse correlation between HbA1c levels and N-MID and no correlation with other bone metabolism indices. Multiple linear regression analysis showed that N-MID was a factor influencing HbA1c levels after adjusting for age and body mass index (BMI). Serum N-MID levels negatively correlated with HbA1c levels in middle-aged and older adult men with T2DM. Therefore, high serum N-MID levels may contribute to blood glucose control in T2DM patients.

Does bone mobilization interfere with energy metabolism in transition cows?

The onset of lactation represents a challenge for both mineral homeostasis and energy metabolism in high-performing dairy cows. It has been shown that subclinical and clinical hypocalcemia increases the risk of ketosis and recent studies suggest that bone-derived endocrine factors could play a role in intermediary metabolism. Therefore, we analyzed serum samples from calculated d -7, calculated d -3, d +1, d +3, and d +7 relative to calving from 15 multiparous cows for total Ca, the bone resorption marker CrossLaps, the bone formation marker intact osteocalcin, undercarboxylated osteocalcin (ucOC), insulin, glucose, nonesterified fatty acids, β-hydroxybutyrate, and insulin-like growth factor 1. Serum concentrations of Ca on d -3 and d +1 were associated with parameters of energy metabolism on d +3 and d +7. As we found large variations for serum concentrations of ucOC already on d -7, we allocated the cows retrospectively to 3 groups: low ucOC, medium ucOC, and high ucOC. These groups differed not only in their ucOC dynamics, but also in insulin sensitivity estimated using the revised quantitative insulin sensitivity index (RQUICKI). High ucOC cows presented with the highest RQUICKI throughout the entire observation period. Our data further support the hypothesis that low serum Ca precedes disturbances of energy metabolism. Furthermore, from our preliminary results it can be assumed that the potential link between mineral homeostasis, bone turnover, and intermediary metabolism should be further investigated.