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Cossu E, Incani M, Pani MG, Gattu G, Serafini C, Strazzera A, Bertoccini L, Cimini FA, Barchetta I, Cavallo MG, Baroni MG. Presence of diabetes-specific autoimmunity in women with gestational diabetes mellitus (GDM) predicts impaired glucose regulation at follow-up. J Endocrinol Invest 2018; 41:1061-1068. [PMID: 29340972 DOI: 10.1007/s40618-018-0830-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is the most frequent complication of pregnancy; around 10% of GDM cases may be determined by autoimmunity, and our aims were to establish the role of autoimmunity in a population of Sardinian women affected by GDM, to find predictive factors for autoimmune GDM, and to determine type 1 diabetes (T1D) auto-antibodies (Aabs) together with glucose tolerance after a mean 21.2 months of follow-up. METHODS We consecutively recruited 143 women affected by GDM and 60 without GDM; clinical data and pregnancy outcomes were obtained by outpatient visit or phone recall. T1D auto-antibodies GADA, IA2-A, IAA, ZnT8-A were measured in the whole population at baseline, and in the Aab-positive women at follow-up. RESULTS The overall prevalence of autoimmunity was 6.4% (13/203). No significant difference was found in the prevalence of auto-antibodies between GDM (5.6%) and control (8.3%) women, neither in antibody titres. Highest titres for GADA and ZnT8-A were observed in the control group; no phenotypic factors were predictive for autoimmune GDM. Diabetes-related autoantibodies were still present in all the GDM women at follow-up, and their presence was associated with a 2.65 (p < 0.0016) relative risk (RR) of glucose impairment. CONCLUSION We observed a low prevalence (5.6%) of diabetes-related autoimmunity in our GDM cohort, consistent with the prevalence reported in previous studies. It was not possible to uncover features predictive of autoimmune GDM. However, given the significant risk of a persistent impaired glycemic regulation at follow-up, it is advisable to control for glucose tolerance in GDM women with diabetes-related autoimmunity.
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Affiliation(s)
- E Cossu
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M Incani
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M G Pani
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - G Gattu
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - C Serafini
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Strazzera
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - F A Cimini
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - I Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - M G Cavallo
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy
| | - M G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy.
- Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Sentinelli F, Bertoccini L, Barchetta I, Capoccia D, Incani M, Pani MG, Loche S, Angelico F, Arca M, Morini S, Manconi E, Lenzi A, Cossu E, Leonetti F, Baroni MG, Cavallo MG. The vitamin D receptor (VDR) gene rs11568820 variant is associated with type 2 diabetes and impaired insulin secretion in Italian adult subjects, and associates with increased cardio-metabolic risk in children. Nutr Metab Cardiovasc Dis 2016; 26:407-413. [PMID: 27052925 DOI: 10.1016/j.numecd.2016.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/30/2015] [Accepted: 02/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS 1α,25-dihydroxyvitamin-D3, the biologically active vitamin D, plays a central role in several metabolic pathways through the binding to the vitamin D receptor (VDR). VDR has been shown to be involved in cardiovascular diseases, cancer, autoimmunity and type 2 diabetes mellitus (T2DM). Several polymorphisms in the VDR gene have been described. Among these, the rs11568820 G-to-A nucleotide substitution was found to be functional, modulating the transcription of the VDR gene. Objective of this study was to perform an association study between rs11568820 polymorphism and T2DM in a cohort of Italian adults with T2DM and in non-diabetic controls. To add further insight into the role of VDR gene we explored whether this association begins early in life in overweight/obese children, or becomes manifest only in adulthood. METHODS AND RESULTS As many as 1788 adults and 878 children were genotyped for the rs11568820 polymorphism. All participants underwent oral glucose tolerance tests (OGTT), with measurement of glucose and insulin levels. Indices of insulin-resistance and secretion were also calculated. The AA genotype was significantly more frequent in adults with T2DM compared to controls (7.5% vs. 4.6%, P = 0.037), and conferred a higher risk of T2DM (ORHom = 1.69C.I. = [1.13-2.53], P = 0.011). In the adult cohort, rs11568820 was also associated with reduced indices of β-cell insulin secretion. In children, the AA genotype was associated with 2 h high-normal glucose, a marker of cardio-metabolic risk. CONCLUSIONS Our study demonstrates for the first time that VDR gene AA carriers have higher risk of T2DM and impaired insulin secretion. In children, the association between AA homozygous and high-normal 2h glucose suggests that mild alterations associated with this genotype may appear early in life.
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Affiliation(s)
- F Sentinelli
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - I Barchetta
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - D Capoccia
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - M Incani
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - M G Pani
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Loche
- Pediatric Endocrine Unit, Regional Hospital for Microcitemia, Cagliari, Italy
| | - F Angelico
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - M Arca
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - S Morini
- Human Anatomy, (CIR), University Campus Bio-Medico, Rome, Italy
| | - E Manconi
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - E Cossu
- Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - F Leonetti
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - M G Baroni
- Department of Experimental Medicine, Sapienza University of Rome, Italy; Endocrinology and Diabetes, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
| | - M G Cavallo
- Internal Medicine Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
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