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Benham JL, Gingras V, McLennan NM, Most J, Yamamoto JM, Aiken CE, Ozanne SE, Reynolds RM. Precision gestational diabetes treatment: a systematic review and meta-analyses. Commun Med (Lond) 2023; 3:135. [PMID: 37794196 PMCID: PMC10550921 DOI: 10.1038/s43856-023-00371-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) affects approximately 1 in 7 pregnancies globally. It is associated with short- and long-term risks for both mother and baby. Therefore, optimizing treatment to effectively treat the condition has wide-ranging beneficial effects. However, despite the known heterogeneity in GDM, treatment guidelines and approaches are generally standardized. We hypothesized that a precision medicine approach could be a tool for risk-stratification of women to streamline successful GDM management. With the relatively short timeframe available to treat GDM, commencing effective therapy earlier, with more rapid normalization of hyperglycaemia, could have benefits for both mother and fetus. METHODS We conducted two systematic reviews, to identify precision markers that may predict effective lifestyle and pharmacological interventions. RESULTS There was a paucity of studies examining precision lifestyle-based interventions for GDM highlighting the pressing need for further research in this area. We found a number of precision markers identified from routine clinical measures that may enable earlier identification of those requiring escalation of pharmacological therapy (to metformin, sulphonylureas or insulin). This included previous history of GDM, Body Mass Index and blood glucose concentrations at diagnosis. CONCLUSIONS Clinical measurements at diagnosis could potentially be used as precision markers in the treatment of GDM. Whether there are other sensitive markers that could be identified using more complex individual-level data, such as omics, and if these can feasibly be implemented in clinical practice remains unknown. These will be important to consider in future studies.
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Affiliation(s)
- Jamie L Benham
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Véronique Gingras
- Department of Nutrition, Université de Montréal, Montreal, QC, Canada
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Niamh-Maire McLennan
- MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jasper Most
- Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, the Rosie Hospital, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
- Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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Galdikaitė G, Simanauskaitė A, Ramonienė G, Savukynė E, Malakauskienė L, Tarasevičienė V. The Effect of Timing and Methods for the Diagnosis of Gestational Diabetes Mellitus on Obstetric Complications. Medicina (Kaunas) 2023; 59:medicina59050854. [PMID: 37241086 DOI: 10.3390/medicina59050854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Aim. To compare the impact of the time and method of diagnosis on gestational diabetes mellitus (GDM) in women who gave birth at the Hospital of the Lithuanian University of Health Sciences (LUHS) Kauno klinikos. Methods. A retrospective study was performed using data from the Department of Obstetrics and Gynecology of the LUHS Birth Registry to analyze the data of women who gave birth and had GDM in 2020-2021. The subjects were divided based on the type of diagnosis: GDM was diagnosed either at the first antenatal visit when fasting plasma glycemia (FPG) was ≥5.1 mmol/L (early diagnosis group) or after OGTT at 24 + 0 - 28 + 6 weeks of gestation when at least one pathological glycemic index was observed: fasting glycemia 5.1-6.9 mmol/L or 1-h glycemia ≥10.0 mmol/L or 2 h glycemia 8.5-11.0 mmol/L (late diagnosis group). The results were processed using IBM SPSS. Results. The early diagnosis group had 1254 (65.7%) women, the late diagnosis group had 654 (34.3%). More primigravida women were in the late diagnosis group (p = 0.017) while more multigravida were in the early diagnosis group (p = 0.033). The early diagnosis group had more obese women (p = 0.001), including those with a BMI > 40 (p = 0.001). In the early diagnosis group, GDM was more frequently diagnosed in women who gained <11 kg (p = 0.005), while in the late diagnosis group->16 kg (p = 0.001). FPG was higher in the early diagnosis group (p = 0.001). Glycemia was more commonly corrected with lifestyle changes in the late diagnosis group (p = 0.001), and with additional insulin therapy in the early diagnosis group (p = 0.001). Polyhydramnios and preeclampsia were more common in the late diagnosis group (p = 0.027 and p = 0.009). There were more large-for-gestational-age neonates in the late diagnosis group (p = 0.005). Macrosomia was more common in the late diagnosis group (p = 0.008). Conclusions. GDM is more commonly diagnosed with OGTT in primigravida women. Higher pregestational weight and BMI has an impact on the early diagnosis of GDM and need for insulin therapy with lifestyle changes. Late diagnosis of GDM is connected with obstetric complications.
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Affiliation(s)
- Gintarė Galdikaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Atėnė Simanauskaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Gitana Ramonienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Eglė Savukynė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Laura Malakauskienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
| | - Viktorija Tarasevičienė
- The Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences Hospital Kauno Klinikos, 50009 Kaunas, Lithuania
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Bai W, Wang H, Fang R, Lin M, Qin Y, Han H, Cui J, Zhang R, Ma Y, Chen D, Zhang W, Wang L, Yu H. Evaluating the effect of gestational diabetes mellitus on macrosomia based on the characteristics of oral glucose tolerance test. Clin Chim Acta 2023; 544:117362. [PMID: 37088117 DOI: 10.1016/j.cca.2023.117362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND GDM is always treated as a homogenous disease ignoring the different metabolic characteristics in oral glucose tolerance test (OGTT). We assessed the effect of GDM on macrosomia based on the different characteristics of OGTT. METHODS We retrospectively divided 998 GDM pregnant women into 7 groups, Group A1: abnormal OGTT0h; Group A2: abnormal OGTT1 h; Group A3: abnormal OGTT2 h; Group B1: abnormal OGTT0h+1 h; Group B2: abnormal OGTT0h+2 h; Group B3: abnormal OGTT1 h+2 h; Group C: abnormal OGTT0h+1 h+2 h; RESULTS: The incidence of macrosomia in group C (21.92%) was higher than other groups. The OR of OGTT0h+1 h+2 h was significant (OGTT1 h: OR=1.577, 95% CI: 0.791, 3.145; OGTT2 h: OR=1.151, 95% CI: 0.572, 2.313; OGTT0h+1 h: OR=1.346, 95% CI: 0.584, 3.101; OGTT0h+2 h: OR=1.327, 95% CI: 0.517, 3.409; OGTT1 h+2 h: OR=0.771, 95% CI: 0.256, 2.322; OGTT0h+1 h+2 h: OR=4.164, 95% CI: 2.095, 8.278) when comparing with OGTT0h. Subgroup analysis showed abnormal OGTT0h+1 h+2 h might contribute more to macrosomia in pre-pregnancy BMI ≥ 24 kg/m2 than those with BMI < 24 kg/m2. CONCLUSION The effect of abnormal OGTT0h+1 h+2 h on macrosomia was significantly greater than other OGTT characteristics, especially for those with pre-pregnancy BMI ≥ 24 kg/m2. Individualized management of GDM based on OGTT characteristics and pre-pregnancy BMI might be needed.
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Affiliation(s)
- Wenlin Bai
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hui Wang
- Obstetrics Clinic, Changzhi Maternal and Child Health Care Hospital, Changzhi, 046000, China
| | - Ruiling Fang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Mengwen Lin
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Yao Qin
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hongjuan Han
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Jing Cui
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Rong Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Yifei Ma
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Durong Chen
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Wenping Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Li Wang
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China
| | - Hongmei Yu
- School of Public Health, Shanxi Medical University, Taiyuan, 030001, China.
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Luo P, Fan Y, Xiong Y, Zhang C, Yang Z, Sun F, Mei B. Metabolic Characteristics of Gestational Diabetes Mellitus and the Effects on Pregnancy Outcomes. Diabetes Metab Syndr Obes 2023; 16:15-29. [PMID: 36760593 PMCID: PMC9843504 DOI: 10.2147/dmso.s390999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/30/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To describe the metabolic characteristics of gestational diabetes mellitus (GDM) and assess their effects on perinatal outcomes. METHODS A two-center nested case‒control study was designed, including 192 pregnant women with GDM and 191 pregnant women with normal glucose tolerance (NGT). Serum glucose and insulin concentrations based upon the 75 g oral glucose tolerance test (OGTT) were measured. Several indices were calculated to describe the metabolic characteristics of the subjects. The relationship between glucose metabolism parameters and pregnancy outcomes was evaluated using stepwise linear regression and binary logistic regression. RESULTS Compared with the NGT group, the GDM group showed significantly higher fasting and postprandial glucose parameters but significantly lower fasting and postprandial insulin responses. Meanwhile, the GDM group had significantly lower HOMA-β, DI and ISIMatsuda but comparable HOMA-IR. The IFG subgroup showed significantly lower FINS/FPG only, while the IGT and IFSG subgroups showed deficiency in both fasting and postprandial insulin response. The IFSG subgroup had the highest glucose parameters and the lowest insulin parameters, as well as significantly lower ISIMatsuda and HOMA-β than the NGT group. FPG had a significant effect on infants' birth weight, and 1hPG and FINS/FPG had a significant effect on delivery gestational age. AUC-INS, IGI60 and DI were related to premature delivery risk after adjusting for confounders. The IFG subgroup of GDM was 2.319 times more likely to be subject to cesarean section than the NGT group. FPG, FINS/FPG, AUC-GLU, AUC-INS/AUC-GLU and HOMA-β were related to macrosomia risk. CONCLUSION Beta cell dysfunction rather than insulin resistance determines the occurrence of GDM in the central Chinese population. Women with predominant insulin secretion defects had a similar risk of adverse perinatal outcomes to women with NGT. Our study provided a basis for the selection of glucose metabolism monitoring indicators useful for the prevention of adverse perinatal outcomes.
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Affiliation(s)
- Ping Luo
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, People’s Republic of China
| | - Ying Fan
- Gongan County Maternal and Child Health Care Hospital, Jingzhou, People’s Republic of China
| | - Yusha Xiong
- Gongan County Maternal and Child Health Care Hospital, Jingzhou, People’s Republic of China
| | - Chunlin Zhang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, People’s Republic of China
| | - Zhiping Yang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, People’s Republic of China
| | - Fenglan Sun
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, People’s Republic of China
| | - Bing Mei
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, People’s Republic of China
- Correspondence: Bing Mei, Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, People’s Republic of China, Email
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Mecacci F, Lisi F, Vannuccini S, Ottanelli S, Rambaldi MP, Serena C, Simeone S, Petraglia F. Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better? Front Endocrinol (Lausanne) 2021; 12:630903. [PMID: 33767671 PMCID: PMC7985539 DOI: 10.3389/fendo.2021.630903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Maternal characteristics and OGTT values of pregnancies complicated by gestational diabetes mellitus (GDM) were evaluated according to treatment strategies. The goal was to identify different maternal phenotypes in order to predict the appropriate treatment strategy. METHODS We conducted a retrospective study among 1,974 pregnant women followed up for GDM in a tertiary referral hospital for high-risk pregnancies (Careggi University Hospital, Florence, Italy) from 2013 to 2018. We compared nutritional therapy (NT) alone (n = 962) versus NT and insulin analogues (n = 1,012) group. Then, we focused on different insulin analogues groups: long acting (D), rapid acting (R), both D and R. We compared maternal characteristics of the three groups, detecting which factors may predict the use of rapid or long-acting insulin analogue alone versus combined therapy. RESULTS Among women included in the analysis, 51.3% of them needed insulin therapy for glycemic control: 61.8% D, 28.3% combined D and R, and 9.9% R alone. Age >35 years, pre-pregnancy BMI >30, family history of diabetes, previous GDM, altered fasting plasma glucose (FPG), hypothyroidism, and assisted reproductive technologies (ART) were identified as maternal variables significantly associated with the need of insulin therapy. Altered 1-h and 2-h glucose plasma glucose level at OGTT, age >35 years, and previous GDM were found as independent predicting factors for the use of combined therapy with rapid and long acting analogues for glycemic control. On the contrary, pre-pregnancy BMI <25 and normal fasting plasma glucose values at OGTT were found to be significantly associated to the use of rapid insulin analogue only. CONCLUSION A number of maternal and metabolic variables may be identified at the diagnosis of GDM, in order to identify different GDM phenotypes requiring a personalized treatment for glycemic control.
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Affiliation(s)
- Federico Mecacci
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | - Federica Lisi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Silvia Vannuccini
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- *Correspondence: Silvia Vannuccini,
| | - Serena Ottanelli
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | | | - Caterina Serena
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | - Serena Simeone
- High Risk Pregnancy Unit, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
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