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Knudsen LL, Knorr S, Prange SK, Wolff C, Nørgaard H, Torp AM, Madsen LR, Mortensen L, Thomsen HH, Sørensen LP, Ovesen PG, Fuglsang J, Kampmann U. Clinical and Metabolic Characterization of Women With Gestational Diabetes Mellitus Within the First Year Postpartum. J Endocr Soc 2024; 8:bvae044. [PMID: 38601785 PMCID: PMC11004785 DOI: 10.1210/jendso/bvae044] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Indexed: 04/12/2024] Open
Abstract
Context Women with gestational diabetes mellitus (GDM) have an increased risk of long-term complications, including impaired glucose metabolism, type 2 diabetes (T2DM), cardiovascular disease, and obesity. In current clinical practice, a 1 size fits all approach to GDM is applied, although heterogeneity among women with GDM has been recognized. Objective To give the most adequate preventive care and postpartum (PP) guidance, we aimed to make a metabolic characterization and identify subgroups of women with previous GDM within the first year PP. Methods In this prospective cohort study, we collected data in gestational week 34-38, at 3 months, and 1 year PP on women with GDM who participated in a PP follow-up program in Central Region Denmark from April 2019 to December 2022. Results In total, 1270 women were included in the program in late pregnancy. Of the 768 women participating in either the oral glucose tolerance test 3 months PP (n = 545) or the 1-year follow-up (n = 493) or both (n = 261), 608 (79.2%) were normoglycemic, 137 (17.8%) had prediabetes, 20 (2.6%) had T2DM, and 3 (.4%) had developed T1DM. More than 40% of the women gained weight in the first year PP compared with their pregestational weight. Conclusion Our study shows that 20.8% of women with GDM who volunteered to participate in a clinical follow-up program developed prediabetes or diabetes (T1DM and T2DM) within the first year PP. The GDM diagnosis encompasses a heterogenetic group of women and a deeper characterization may provide an opportunity for a more personalized risk assessment to prevent the progression to T2DM.
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Affiliation(s)
| | - Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Charlotte Wolff
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Nørgaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Mette Torp
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Ring Madsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Gødstrup Hospital, Herning, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Lene Mortensen
- Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Henrik Holm Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | - Lars Peter Sørensen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Per Glud Ovesen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Nielsen D, Nørgaard H, Vestermark L, Pfeiffer P, Jensen B, Nelausen K, Bergenfeldt M, Hermann K, Jensen B. Intrahepatic and systemic therapy with oxaliplatin combined with capecitabine in patients with hepatic metastases from breast cancer. Breast 2012; 21:556-61. [DOI: 10.1016/j.breast.2012.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/09/2012] [Accepted: 05/14/2012] [Indexed: 12/28/2022] Open
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Abstract
OBJECTIVE This review summarises the effects of lactic acid bacteria on lactose malabsorption, bacterial/viral or antibiotic associated diarrhoea, and describes the impact of lactic acid bacteria on cancer and the fermentative products in the colon. RESULTS Eight studies (including 78 patients) demonstrated that lactase deficient subjects absorbed lactose in yogurt better than lactose in milk, while two studies (25 patients) did not support this. Two studies (22 patients) showed that unfermented acidophilus milk was absorbed better than milk, while six studies (68 patients) found no significant differences. Addition of lactose hydrolysing enzyme, lactase, to milk improved lactose malabsorption in seven studies (131 lactose malabsorbers), while one study (10 malabsorbers) demonstrated no improvement. Lactic acid bacteria alleviated travellers' diarrhoea in one study (94 individuals) while a study including 756 individuals was borderline statistically significant. One study (50 individuals) did not find an effect of lactic acid bacteria on travellers' diarrhoea. Six studies (404 infants) demonstrated a significant effect of lactic acid bacteria on infant diarrhoea, while one study (40 infants) did not. Lactic acid bacteria moderated antibiotic associated diarrhoea in three studies (66 individuals), while two studies (117 individuals) were insignificant. CONCLUSIONS Lactase deficient subjects benefit from a better lactose absorption after ingestion of yoghurt compared with milk and from milk added lactase, whereas ingestion of unfermented acidophilus milk does not seem to improve lactose absorption. The majority of studies support that lactic acid bacteria alleviate bacterial/viral induced diarrhoea, especially in infants, while the effect on antibiotic associated diarrhoea is less clear. Experimental studies indicate an effect of lactic bacteria on human cell cancer lines, but clinical evidence is lacking. A 'stabilising' effect of lactic acid bacteria on the colonic flora has not been documented.
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Affiliation(s)
- H Hove
- Medical Department CA, Rigshospitalet, Denmark
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Wachtell K, Ibsen H, Olsen MH, Laybourn C, Christoffersen JK, Nørgaard H, Mantoni M, Lund JO. Prevalence of renal artery stenosis in patients with peripheral vascular disease and hypertension. J Hum Hypertens 1996; 10:83-5. [PMID: 8867560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of peripheral vascular disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe peripheral ischemia, underwent aortography to determine the degree of peripheral vascular disease and possible renal artery stenosis. History of claudication, and measurement of systolic distal blood pressure (BP) and calculation of the Ankle Brachial Index was used to define the severity of peripheral vascular disease. A total of 31% had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and peripheral vascular disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% have hypertension. Patients with renal artery stenosis and lumen reduction of more than 50%, 93% have hypertension (P < or = 0.001). In conclusion this study shows that the combination of peripheral vascular disease and hypertension is an important clinical clue for renovascular disease. Examination for reno-vascular disease in this population should be considered, since the prevalence of the condition is high. Furthermore examination for renal vascular disease in this population is mandatory, before treatment with angiotensin converting enzyme (ACE) inhibitors is initiated, since treatment might lead to serious renal function impairment.
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Affiliation(s)
- K Wachtell
- Department of Internal Medicine C, Glostrup University Hospital, Denmark
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Nørgaard H, Gjørup T, Brems-Dalgaard E, Hartelius H, Brun B. Interobserver variation in the detection of pulmonary venous hypertension in chest radiographs. Eur J Radiol 1990; 11:203-6. [PMID: 2265630 DOI: 10.1016/0720-048x(90)90057-i] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A total of 171 sets of chest radiographs chosen randomly were reviewed independently by two residents in their second year of training, and two experienced radiologists. The degree of interobserver agreement in an overall assessment of pulmonary venous hypertension and in the assessment of five signs, indicative of pulmonary venous hypertension was determined by kappa statistics. The average level of agreement was moderate (0.51-0.56) for the overall assessment and the signs of perivascular clouding, perihilar haze and pleural effusion, and poorer (0.31-0.38) for flow shift and Kerley lines. In the overall assessment agreement between experienced radiologists was slightly better (0.63) than average. Multiple reader interpretation is recommended for the assessment of low-grade pulmonary venous hypertension.
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Affiliation(s)
- H Nørgaard
- Department of Radiology, Frederiksberg Hospital, Denmark
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Gotfredsen A, Pødenphant J, Nørgaard H, Nilas L, Nielsen VA, Christiansen C. Accuracy of lumbar spine bone mineral content by dual photon absorptiometry. J Nucl Med 1988; 29:248-54. [PMID: 3346735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The accuracy of measurement of the bone mineral content (BMC, g) and bone mineral density (BMD, g/cm2) of the lumbar spine by dual photon absorptiometry (DPA) was estimated by means of two different spine scanners (a Nuclear Data 2100 and a Lunar Radiation DP3). The lumbar spines of 13 cadavers were used. BMC and BMD were measured in situ and on the excised vertebrae in a solution of water/ethanol; and covered with ox muscle/porcine muscle/lard. The actual mineral weight and areal density were determined after chemical maceration, fat extraction, drying to a constant weight, ashing for 24 hr at 600 degrees C, and correction for the transverse processes. The true are was measured by parallax free X rays and planimetry. All measurements of BMC or BMD were highly interrelated (r = 0.94-0.99). The standard error of estimate (s.e.e.) of BMC in situ versus BMC in water/ethanol was 5.2%. The agreement between the BMD values of the two scanners was very good (s.e.e. = 2.9%). BMC in situ predicted the actual vertebral mineral mass with an s.e.e. of 8.1%. BMD in situ and BMD in water/ethanol predicted the actual area density with s.e.e.s of 10.3% and 5.0%, respectively. This study discloses the correlation and accuracy error of spinal DPA measurements in situ in whole cadavers versus the actual BMC and BMD. The error, which is underestimated in in vitro studies, amounts to 10%.
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Affiliation(s)
- A Gotfredsen
- Department of Clinical Chemistry, Glostrup Hospital, University of Copenhagen, Denmark
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Nilas L, Nørgaard H, Pødenphant J, Gotfredsen A, Christiansen C. Bone composition in the distal forearm. Scand J Clin Lab Invest 1987; 47:41-6. [PMID: 3576108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Recent data have indicated that measurements of bone mass in the very distal part of the forearm is superior to more proximal measurements in identifying osteoporosis. Bone slices from the distal part of the forearm were obtained from 16 necropsies and the trabecular fraction of the total dry bone weight was measured in adjacent bone slices, 8 mm thick. Prior to autopsy bone mass at the corresponding sites was measured using a multipath single photon absorptiometric method by which scans are obtained proximal (proximal BMC) and distal (distal BMC) to the site, where the ulna and radius are 8 mm apart. The accuracy of bone measurements at the two sites was virtually similar (r = 0.98 and r = 0.94, respectively). In both areas the amount of trabecular bone increased towards the metaphysis with a trabecular/cortical ratio ranging from 10 to 60% (wt/wt). If bone composition is known it is possible to estimate rates of bone loss from the two compartments.
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Abstract
The aim of the study was to evaluate the representativity of iliac crest biopsy for the amount of mineralized trabecular and cortical bone in the skeleton. The following data were obtained on bone from 14 necropsies: right sided iliac crest biopsy, lumbar spine biopsy, dry fat free weight of lumbar spine, bone mineral density (BMD) in the lumbar spine and dry fat free weight of cortical and trabecular bone from the left distal forearm. The amount of mineralized cortical and trabecular bone from various sites was compared by linear regression analysis. The results confirm iliac crest biopsy as a good predictor of the amount of trabecular bone, but not of cortical bone. Furthermore, iliac crest biopsy is a better estimate of the amount of trabecular bone in the lumbar spine than spinal BMD.
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