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Naessén S, Eliasson M, Berntorp K, Kitlinski M, Trimpou P, Amundson E, Thunström S, Ekman B, Wahlberg J, Karlsson A, Isaksson M, Bergström I, Levelind C, Bryman I, Landin-Wilhelmsen K. Autoimmune Disease in Turner Syndrome in Sweden: An up to 25 Years' Controlled Follow-up Study. J Clin Endocrinol Metab 2024; 109:e602-e612. [PMID: 37758506 PMCID: PMC10795927 DOI: 10.1210/clinem/dgad566] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
CONTEXT Turner syndrome (TS) is the most common chromosomal aberration in women; it is the result of structural or numeric abnormalities in the X chromosome. Autoimmune hypothyroidism has been recognized as one of the more prominent disorders associated with TS. OBJECTIVE This work aimed to study the prevalence of autoimmune diseases in TS. METHODS A cross-sectional, longitudinal, 25-year follow-up study was conducted of patients from adult Turner centers at the University Hospitals, Sweden. During 1994 to 2020, a total of 503 women aged 16 to 71 years with TS were evaluated consecutively every fifth year according to national guidelines. A random population sample of women, n = 401, aged 25 to 44 years, from the World Health Organization Monitoring of Trends and Determinants for Cardiovascular Disease (MONICA) project served as controls. Serum thyrotropin, free thyroxine, vitamin B12, antithyroid peroxidase (anti-TPO), and antitransglutaminase antibodies were measured. RESULTS Mean follow-up time (years) was 16 ± 7 for patients and 13 ± 1 for controls. From study start, the prevalence increased in TS for hypothyroidism 40% to 58%, vitamin B12 deficiency 5% to 12%, celiac disease 4% to 7%, positive anti-TPO 26% to 41%, and antitransglutaminase antibodies 6% to 8% (P < .0001 vs controls). Type 1 diabetes and Addison disease were rare. The only interrelationship was between hypothyroidism and vitamin B12 deficiency, both in TS and controls. No association between autoimmune disease and karyotype, antecedent growth hormone treatment, or ongoing estrogen hormone replacement, was seen in TS. CONCLUSION In women with TS up to older than 80 years, more than half developed hypothyroidism, mainly autoimmune, during follow-up. Awareness of vitamin B12 deficiency and celiac disease throughout life is also recommended in women with TS.
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Affiliation(s)
- Sabine Naessén
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Academic Primary Health Care Centre, 117 63 Stockholm, Sweden
| | | | - Kerstin Berntorp
- Genomics, Diabetes and Endocrinology Research Unit, Department of Clinical Sciences Malmö, Lund University, 222 42 Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, 214 28 Malmö, Sweden
| | - Margareta Kitlinski
- Department of Reproductive Medicine, Skåne University Hospital, 214 28 Malmö, Sweden
| | - Penelope Trimpou
- Section of Endocrinology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Emily Amundson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Department of Respiratory Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Sofia Thunström
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Bertil Ekman
- Department of Endocrinology, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Jeanette Wahlberg
- Department of Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 701 12 Örebro, Sweden
| | - Anders Karlsson
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Magnus Isaksson
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Ingrid Bergström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Solna, Sweden
| | - Carina Levelind
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Inger Bryman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Section of Endocrinology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
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Thunström S, Thunström E, Naessén S, Berntorp K, Kitlinski ML, Ekman B, Wahlberg J, Bergström I, Bech-Hanssen O, Krantz E, Laine CM, Bryman I, Landin-Wilhelmsen K. Reply to "Comment on aortic size predicts aortic dissection in Turner syndrome - A 25-year prospective cohort study" by Salman Khazaei. Int J Cardiol 2023; 380:56. [PMID: 36907450 DOI: 10.1016/j.ijcard.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Sofia Thunström
- Department of Clinical Genetics, Sahlgrenska University Hospital Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sabine Naessén
- Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | | | - Bertil Ekman
- Department of Endocrinology, Linköping University Hospital, Department of Internal Medicine, Norrköping Hospital, Sweden; Department of Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingrid Bergström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Metabolism & Diabetes, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emily Krantz
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christine M Laine
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Endocrine Out-patient Clinic, Carlanderska Hospital, Gothenburg, Sweden
| | - Inger Bryman
- Reproductive Medicine, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital Gothenburg, Sweden; Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal Medicine, and Section for Endocrinology, Sahlgrenska University Hospital Gothenburg, Sweden
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Thunström S, Thunström E, Naessén S, Berntorp K, Laczna Kitlinski M, Ekman B, Wahlberg J, Bergström I, Bech-Hanssen O, Krantz E, Laine CM, Bryman I, Landin-Wilhelmsen K. Aortic size predicts aortic dissection in Turner syndrome - A 25-year prospective cohort study. Int J Cardiol 2023; 373:47-54. [PMID: 36410543 DOI: 10.1016/j.ijcard.2022.11.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Women with Turner syndrome (TS) have an increased risk of aortic dissection. The current recommended cutoff to prevent aortic dissection in TS is an aortic size index (ASI) of ≥2.5 cm/m2. This study estimated which aortic size had the best predictive value for the risk of aortic dissection, and whether adjusting for body size improved risk prediction. METHODS A prospective, observational study in Sweden, of women with TS, n = 400, all evaluated with echocardiography of the aorta and data on medical history for up to 25 years. Receiver operating characteristic (ROC) curves, sensitivity and specificity were calculated for the absolute ascending aortic diameter (AAD), ascending ASI and TS specific z-score. RESULTS There were 12 patients (3%) with aortic dissection. ROC curves demonstrated that absolute AAD and TS specific z-score were superior to ascending ASI in predicting aortic dissection. The best cutoff for absolute AAD was 3.3 cm and 2.12 for the TS specific z-score, respectively, with a sensitivity of 92% for both. The ascending ASI cutoff of 2.5 cm/m2 had a sensitivity of 17% only. Subgroup analyses in women with an aortic diameter ≥ 3.3 cm could not demonstrate any association between karyotype, aortic coarctation, bicuspid aortic valve, BMI, antihypertensive medication, previous growth hormone therapy or ongoing estrogen replacement treatment and aortic dissection. All models failed to predict a dissection in a pregnant woman. CONCLUSIONS In Turner syndrome, absolute AAD and TS-specific z-score were more reliable predictors for aortic dissection than ASI. Care should be taken before and during pregnancy.
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Affiliation(s)
- Sofia Thunström
- Department of Clinical Genetics, Sahlgrenska University Hospital Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sabine Naessén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | | | - Bertil Ekman
- Department of Endocrinology, Linköping University Hospital, Department of Internal Medicine, Norrköping Hospital, Sweden; Department of Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden
| | - Jeanette Wahlberg
- Department of Endocrinology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingrid Bergström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Metabolism & Diabetes, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emily Krantz
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christine M Laine
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinic of Endocrinology, Hospital of Halland, Sweden
| | - Inger Bryman
- Reproductive Medicine, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital Gothenburg, Sweden; Department of Obstetrics and Gynecology, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal Medicine, Section for Endocrinology, Sahlgrenska University Hospital Gothenburg, Sweden
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Kjölhede K, Berntorp K, Kristensen K, Katsarou A, Shaat N, Wiberg N, Knop FK, Kristensen L, Dotevall A, Elfvin A, Sandgren U, Sengpiel V, Englund-Ögge L. Glycemic, maternal and neonatal outcomes in women with type 1 diabetes using continuous glucose monitoring during pregnancy - Pump vs multiple daily injections, a secondary analysis of an observational cohort study. Acta Obstet Gynecol Scand 2021; 100:927-933. [PMID: 33176006 DOI: 10.1111/aogs.14039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/11/2020] [Revised: 10/02/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuations over time. The method is increasingly being used in pregnant women with type 1 diabetes. However, only one previous study compared CGM results related to pregnancy outcomes in women using insulin pumps with those administering multiple daily injections (MDI). We performed a secondary analysis of CGM metrics from an observational cohort of pregnant women with type 1 diabetes and compared insulin pump and MDI therapies in relation to maternal and neonatal outcomes. MATERIAL AND METHODS The study included 185 pregnant Swedish women with type 1 diabetes undergoing CGM throughout pregnancy. Women were divided according to insulin administration mode, ie MDI (n = 131) or pump (n = 54). A total of 91 women used real-time CGM and 94 women used intermittently viewed CGM. Maternal demographics and maternal and neonatal outcome data were collected from medical records. CGM data were analyzed according to predefined glycemic indices: mean glucose; standard deviation; percentage of time within, below and above glucose target range; mean amplitude of glycemic excursion; high and low glucose indices; and coefficient variation in percent. Associations between insulin administration mode and CGM data, on the one hand, and maternal and neonatal outcomes, on the other, were analyzed with analysis of covariance and logistic regression, respectively, adjusted for confounders. RESULTS There were no differences in maternal characteristics or glycemic indices between the MDI and pump groups, except for a longer duration of type 1 diabetes and higher frequencies of microangiopathy and real-time CGM among pump users. Despite improvement with each trimester, glucose levels remained suboptimal throughout pregnancy in both groups. There were no differences between the MDI and pump groups concerning the respective associations with any of the outcomes. The frequency of large for gestational age was high in both groups (MDI 49% vs pump 63%) and did not differ significantly. CONCLUSIONS Pregnant women with type 1 diabetes did not differ in glycemic control or pregnancy outcome, related to MDI or pump administration of insulin. Glycemic control remained suboptimal throughout pregnancy, regardless of insulin administration mode.
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Affiliation(s)
- Karin Kjölhede
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.,The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nana Wiberg
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Ystad Hospital, Ystad, Sweden
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lars Kristensen
- The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika Dotevall
- Department of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ulrika Sandgren
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Linda Englund-Ögge
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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5
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Kristensen K, Wangel AM, Katsarou A, Shaat N, Simmons D, Fadl H, Berntorp K. Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference. J Diabetes Res 2020; 2020:7937403. [PMID: 32280717 PMCID: PMC7115054 DOI: 10.1155/2020/7937403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. METHODS A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n = 135), 1 h (n = 135), 1 h (n = 135), 1 h (. RESULTS Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P < 0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL. CONCLUSIONS A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.
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Affiliation(s)
- Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anne-Marie Wangel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, Australia
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Fadl H, Saeedi M, Montgomery S, Magnuson A, Schwarcz E, Berntorp K, Sengpiel V, Storck-Lindholm E, Strevens H, Wikström AK, Brismar-Wendel S, Persson M, Jansson S, Ahlsson F, Ursing C, Ryen L, Petersson K, Wennerholm UB, Hildén K, Simmons D. Changing diagnostic criteria for gestational diabetes in Sweden - a stepped wedge national cluster randomised controlled trial - the CDC4G study protocol. BMC Pregnancy Childbirth 2019; 19:398. [PMID: 31675922 PMCID: PMC6823965 DOI: 10.1186/s12884-019-2547-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden (www.cdc4g.se/en) is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches. Methods This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January–December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included. Discussion The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child. Trial registration CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017)
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Affiliation(s)
- Helena Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Maryam Saeedi
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, University Hospital Örebro, Örebro, Sweden
| | - Erik Schwarcz
- Department of Internal Medicine, School of medical health and sciences, Örebro University Hospital, Örebro, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Clinical Research Center Malmö, Lund University, Lund, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Helena Strevens
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Clinical Research Center Lund, Lund University, Lund, Sweden
| | | | - Sophia Brismar-Wendel
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Martina Persson
- Department of Paediatrics, Sachsska Children's and Youth hospital and Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Stefan Jansson
- School of Medical Sciences, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's health, Uppsala University, Uppsala, Sweden
| | - Carina Ursing
- Department of Endocrinology, Södersjukhuset, Stockholm, Sweden
| | - Linda Ryen
- Center for Health Care Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Petersson
- Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Hildén
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbell town, Australia.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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7
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Arora GP, Åkerlund M, Brøns C, Moen GH, Wasenius NS, Sommer C, Jenum AK, Almgren P, Thaman RG, Orho-Melander M, Eriksson J, Qvigstad E, Birkeland K, Berntorp K, Vaag AA, Groop L, Prasad RB. Phenotypic and genotypic differences between Indian and Scandinavian women with gestational diabetes mellitus. J Intern Med 2019; 286:192-206. [PMID: 30919529 DOI: 10.1111/joim.12903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is a transient form of diabetes characterized by impaired insulin secretion and action during pregnancy. Population-based differences in prevalence exist which could be explained by phenotypic and genetic differences. The aim of this study was to examine these differences in pregnant women from Punjab, India and Scandinavia. METHODS Eighty-five GDM/T2D loci in European and/or Indian populations from previous studies were assessed for association with GDM based on Swedish GDM criteria in 4018 Punjabi Indian and 507 Swedish pregnant women. Selected loci were replicated in Scandinavian cohorts, Radiel (N = 398, Finnish) and STORK/STORK-G (N = 780, Norwegian). RESULTS Punjabi Indian women had higher GDM prevalence, lower insulin secretion and better insulin sensitivity than Swedish women. There were significant frequency differences of GDM/T2D risk alleles between both populations. rs7178572 at HMG20A, previously associated with GDM in South Indian and European women, was replicated in North Indian women. The T2D risk SNP rs11605924 in the CRY2 gene was associated with increased GDM risk in Scandinavian but decreased GDM risk in Punjabi Indian women. No other overlap was seen between GDM loci in both populations. CONCLUSIONS Gestational diabetes mellitus is more common in Indian than Swedish women, which partially can be attributed to differences in insulin secretion and action. There was marked heterogeneity in the GDM phenotypes between the populations which could only partially be explained by genetic differences.
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Affiliation(s)
- G P Arora
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Deep Hospital, Ludhiana, Punjab, India
| | - M Åkerlund
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - C Brøns
- Department of Endocrinology (Diabetes and Metabolism), Rigshospitalet, Copenhagen, Denmark
| | - G-H Moen
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - N S Wasenius
- Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, Diabetes and Obesity Research Program Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - C Sommer
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - A K Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - P Almgren
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | | | - M Orho-Melander
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
| | - J Eriksson
- Department of General Practice and Primary Health Care, Diabetes and Obesity Research Program Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - E Qvigstad
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - K Birkeland
- Department of Endocrinology Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K Berntorp
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - A A Vaag
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Department of Endocrinology (Diabetes and Metabolism), Rigshospitalet, Copenhagen, Denmark.,Cardiovascular, Renal and Metabolism (CVRM) Translational Medicine Unit, Early Clinical development, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - L Groop
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden.,Finnish Institute of Molecular Medicine (FIMM), Helsinki University, Helsinki, Finland
| | - R B Prasad
- Department of Clinical Sciences, Clinical Research Centre, Lund University, Malmö, Sweden
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8
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Kristensen K, Ögge LE, Sengpiel V, Kjölhede K, Dotevall A, Elfvin A, Knop FK, Wiberg N, Katsarou A, Shaat N, Kristensen L, Berntorp K. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia 2019; 62:1143-1153. [PMID: 30904938 PMCID: PMC6560021 DOI: 10.1007/s00125-019-4850-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/25/2019] [Indexed: 01/12/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to analyse patterns of continuous glucose monitoring (CGM) data for associations with large for gestational age (LGA) infants and an adverse neonatal composite outcome (NCO) in pregnancies in women with type 1 diabetes. METHODS This was an observational cohort study of 186 pregnant women with type 1 diabetes in Sweden. The interstitial glucose readings from 92 real-time (rt) CGM and 94 intermittently viewed (i) CGM devices were used to calculate mean glucose, SD, CV%, time spent in target range (3.5-7.8 mmol/l), mean amplitude of glucose excursions and also high and low blood glucose indices (HBGI and LBGI, respectively). Electronic records provided information on maternal demographics and neonatal outcomes. Associations between CGM indices and neonatal outcomes were analysed by stepwise logistic regression analysis adjusted for confounders. RESULTS The number of infants born LGA was similar in rtCGM and iCGM users (52% vs 53%). In the combined group, elevated mean glucose levels in the second and the third trimester were significantly associated with LGA (OR 1.53, 95% CI 1.12, 2.08, and OR 1.57, 95% CI 1.12, 2.19, respectively). Furthermore, a high percentage of time in target in the second and the third trimester was associated with lower risk of LGA (OR 0.96, 95% CI 0.94, 0.99 and OR 0.97, 95% CI 0.95, 1.00, respectively). The same associations were found for mean glucose and for time in target and the risk of NCO in all trimesters. SD was significantly associated with LGA in the second trimester and with NCO in the third trimester. Glucose patterns did not differ between rtCGM and iCGM users except that rtCGM users had lower LBGI and spent less time below target. CONCLUSIONS/INTERPRETATION Higher mean glucose levels, higher SD and less time in target range were associated with increased risk of LGA and NCO. Despite the use of CGM throughout pregnancy, the day-to-day glucose control was not optimal and the incidence of LGA remained high.
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Affiliation(s)
- Karl Kristensen
- Department of Clinical Sciences Lund, Lund University, Sölvegatan 19, 221 84, Lund, Sweden.
- The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.
| | - Linda E Ögge
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Kjölhede
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Dotevall
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Östra/Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Elfvin
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Filip K Knop
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nana Wiberg
- Department of Clinical Sciences Lund, Lund University, Sölvegatan 19, 221 84, Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Lars Kristensen
- The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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9
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Ladfors L, Shaat N, Wiberg N, Katasarou A, Berntorp K, Kristensen K. Fetal overgrowth in women with type 1 and type 2 diabetes mellitus. PLoS One 2017; 12:e0187917. [PMID: 29121112 PMCID: PMC5679529 DOI: 10.1371/journal.pone.0187917] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives Despite improved glycemic control, the rate of large-for-gestational-age (LGA) infants remains high in pregnancies complicated by diabetes mellitus type 1 (T1DM) and type 2 (T2DM). Poor glycemic control, obesity, and excessive gestational weight gain are the main risk factors. The aim of this study was to determine the relative contribution of these risk factors for LGA in women with T1DM and T2DM, after controlling for important confounders such as age, smoking, and parity. Methods In this retrospective chart review study, we analyzed the medical files of pregnant women with T1DM and T2DM who attended the antenatal care program at Skåne University Hospital during the years 2006 to 2016. HbA1c was used as a measure of glycemic control. Maternal weight in early pregnancy and at term was registered. LGA was defined as birth weight > 2 standard deviations of the mean. Univariable and multivariable logistic regression analysis was used to calculate odds ratios (OR’s) and 95% confidence intervals (CIs) for LGA. Results Over the 11-year period, we identified 308 singleton pregnancies in 221 women with T1DM and in 87 women with T2DM. The rate of LGA was 50% in women with T1DM and 23% in women with T2DM. The multivariable regression model identified gestational weight gain and second-trimester HbA1c as risk factors for LGA in T1DM pregnancies (OR = 1.107, 95% CI: 1.044–1.17, and OR = 1.047, 95% CI: 1.015–1.080, respectively) and gestational weight gain as a risk factor in T2DM pregnancies (OR = 1.175, 95% CI: 1.048–1.318), independent of body mass index. Conclusions Gestational weight gain was associated with LGA in women with T1DM and T2DM, independent of maternal body mass index. The findings suggest that monitoring and regulation of gestational weight gain is important in the clinical care of these women, to minimize the risk of fetal overgrowth.
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Affiliation(s)
- Linnea Ladfors
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nana Wiberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anastasia Katasarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- * E-mail:
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10
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Abstract
CONTEXT Gestational diabetes is commonly linked to development of type 2 diabetes mellitus (T2DM). There is a need to characterize metabolic changes associated with gestational diabetes in order to find novel biomarkers for T2DM. OBJECTIVE To find potential pathophysiological mechanisms and markers for progression from gestational diabetes mellitus to T2DM by studying the metabolic transition from pregnancy to postpartum. DESIGN The metabolic transition profile from pregnancy to postpartum was characterized in 56 women by mass spectrometry-based metabolomics; 11 women had gestational diabetes mellitus, 24 had normal glucose tolerance, and 21 were normoglycaemic but at increased risk for gestational diabetes mellitus. Fasting serum samples collected during trimester 3 (gestational week 32±0.6) and postpartum (10.5±0.4months) were compared in diagnosis-specific multivariate models (orthogonal partial least squares analysis). Clinical measurements (e.g., insulin, glucose, lipid levels) were compared and models of insulin sensitivity and resistance were calculated for the same time period. RESULTS Women with gestational diabetes had significantly increased postpartum levels of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine, and their circulating lipids did not return to normal levels after pregnancy. The increase in BCAAs occurred postpartum since the BCAAs did not differ during pregnancy, as compared to normoglycemic women. CONCLUSIONS Postpartum levels of specific BCAAs, notably valine, are related to gestational diabetes during pregnancy.
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Affiliation(s)
- Elin Chorell
- Department of Public Health and Clinical Medicine, Umeå University.
| | | | | | - Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Jatta Puhkala
- UKK Institute for Health Promotion Research, Tampere, Finland,; National Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Luoto
- UKK Institute for Health Promotion Research, Tampere, Finland,; National Institute for Health and Welfare, Helsinki, Finland
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Umeå University
| | - Agneta Holmäng
- Institute of Neuroscience and Physiology, University of Gothenburg
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11
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Shaat N, Ignell C, Katsarou A, Berntorp K. Glucose homeostasis, beta cell function, and insulin resistance in relation to vitamin D status after gestational diabetes mellitus. Acta Obstet Gynecol Scand 2017; 96:821-827. [PMID: 28276579 DOI: 10.1111/aogs.13124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/18/2016] [Accepted: 03/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION We wanted to determine vitamin D status after gestational diabetes mellitus (GDM) and to evaluate whether levels of 25-hydroxyvitamin D3 (25OHD3 ) are associated with beta cell function, insulin resistance or a diagnosis of diabetes after GDM. MATERIAL AND METHODS Glucose homeostasis was assessed during a 75-g oral glucose tolerance test one to two years after delivery in 376 women with previous GDM (287 European and 78 non-European, including 33 Arab and 35 Asian women). Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR). The insulinogenic index (I/G30) and the disposition index [(I/G30)/HOMA-IR] were used to calculate insulin secretion. Concentrations of serum 25OHD3 were determined. RESULTS Mean (±SD) 25OHD3 concentration was 50.0 ± 22.3 nmol/L and differed significantly among subgroups of body mass index, ethnicity, and glucose tolerance status; 53% had 25OHD3 levels <50 nmol/L and 87% had 25OHD3 levels <75 nmol/L. There was a negative correlation between 25OHD3 concentration and HOMA-IR (p < 0.001) and a positive correlation between 25OHD3 and disposition index (p = 0.002) in univariable regression analysis. Correlations attenuated after adjustment for body mass index. In univariable regression analysis, 25OHD3 concentrations were significantly associated with diabetes after GDM (p = 0.004). However, in a multivariable model, non-European origin, HOMA-IR and insulinogenic index were significantly associated with postpartum diabetes, whereas 25OHD3 concentrations were not. CONCLUSION Vitamin D deficiency/insufficiency in previous GDM cases appears to be associated with beta cell dysfunction and insulin resistance, but not with postpartum diabetes when factors well known to influence type-2 diabetes were adjusted for.
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Affiliation(s)
- Nael Shaat
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Claes Ignell
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Obstetrics and Gynecology, Office for Healthcare "Sund", Helsingborg, Sweden
| | - Anastasia Katsarou
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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12
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Claesson R, Ignell C, Shaat N, Berntorp K. HbA1c as a predictor of diabetes after gestational diabetes mellitus. Prim Care Diabetes 2017; 11:46-51. [PMID: 27692850 DOI: 10.1016/j.pcd.2016.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 06/17/2016] [Revised: 08/28/2016] [Accepted: 09/03/2016] [Indexed: 12/16/2022]
Abstract
AIM We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). METHODS Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. RESULTS By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36mmol/mol) were associated with a 5.5-fold increased risk of diabetes. CONCLUSION Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM.
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Affiliation(s)
- Rickard Claesson
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Obstetrics and Gynaecology, Office for Healthcare "Kryh", SE-271 82 Ystad, Sweden.
| | - Claes Ignell
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Obstetrics and Gynaecology, Office for Healthcare "Sund", SE-251 87 Helsingborg, Sweden.
| | - Nael Shaat
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Endocrinology, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Endocrinology, Skåne University Hospital, SE-205 02 Malmö, Sweden.
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13
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Schmidt J, Dahlgren E, Bryman I, Berntorp K, Trimpou P, Wilhelmsen L, Landin-Wilhelmsen K. High androgen levels protect against hypothyroidism. Acta Obstet Gynecol Scand 2016; 96:39-46. [PMID: 27861716 PMCID: PMC6680242 DOI: 10.1111/aogs.13054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
Abstract
Introduction Hypothyroidism is a common disorder, appearing mainly in women although less frequently found in women with polycystic ovary syndrome (PCOS). The objective was to test the hypothesis that hyperandrogenism might protect against hypothyroidism. Material and methods The data from three prospective follow‐up studies (up to 21 years) and one register study were compared: women with PCOS (Rotterdam criteria), n = 25, women with Turner syndrome, n = 217, a random population sample of women, n = 315, and men, n = 95 (the WHO MONICA study). Findings were to be verified or rejected in all females, n = 553 716, from the same region. The proportion of hypothyroidism was calculated and thyroid peroxidase antibodies (TPO) in serum were measured. Results Hypothyroidism at >50 years of age was found in 8% of women with PCOS, 4% in men (PCOS vs. men; ns), 43% of women with Turner syndrome, irrespective of karyotype (p < 0.001 vs. PCOS), and in 17% of postmenopausal women in the population (p < 0.01 vs. PCOS). Elevated TPO were similar in PCOS and women and men in the population but higher in Turner syndrome. Hypothyroidism increased with age in all groups except PCOS women and men. In the register study, hypothyroidism was less common in women with PCOS >25 years (5.5%) than in women without PCOS (6.8%) from the same region (p < 0.01). Conclusions Hypothyroidism was less frequently seen in women with PCOS and in men compared with women in the general population and among women with Turner syndrome. This was not explained by altered autoimmunity or the Y‐chromosome. Androgens seem to protect against hypothyroidism.
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Affiliation(s)
- Johanna Schmidt
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Dahlgren
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Bryman
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skane University Hospital, Lund, Sweden
| | - Penelope Trimpou
- Section for Endocrinology, Department of Internal Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wilhelmsen
- Institution of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Section for Endocrinology, Department of Internal Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Brod M, Pfeiffer KM, Barnett AH, Berntorp K, Vilsbøll T, Weissenberger B. Perceptions of diabetes control among people with type 2 diabetes treated with basal insulin in Sweden, Switzerland, and the United Kingdom. Curr Med Res Opin 2016; 32:1653-1661. [PMID: 27263866 DOI: 10.1080/03007995.2016.1198311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate perceptions of control among people with uncontrolled and well controlled type 2 diabetes (T2D) treated with basal insulin, as well as differences in perceptions and diabetes management practices between the two groups. RESEARCH DESIGN AND METHODS Web surveys of 1012 people with uncontrolled T2D (HbA1c >8.0% or 64 mmol/mol) on basal insulin in Sweden, Switzerland, and the UK and 295 people with well controlled T2D (HbA1c <7.5% or 58 mmol/mol) on basal insulin in the UK were conducted. RESULTS People with uncontrolled T2D perceived a wide range of factors as very/extremely important for deciding whether they are well controlled, including diet (80.7%), HbA1c value (78.9%), times per day insulin taken (78.8%), insulin units taken per day (77.6%), and energy levels (74.5%). Fifty-one percent of uncontrolled respondents considered the past week or more recently when thinking about control. Perceived major obstacles to control included stress (75.4%), other health issues (70.8%), medicine side effects (69.9%), food cravings (69.8%), doctor not understanding individual situation (67.6%), and life crises (66.9%). Many uncontrolled respondents reported that diabetes was very/extremely interfering with their lives, including energy level (71.0%), performance at work (70.0%), general health (69.9%), and doing what one wants (69.3%). Analyses showed significant differences between well controlled and uncontrolled UK respondents. Compared to the uncontrolled, people with well controlled T2D were significantly more likely to consider the last 24 hours/current time when thinking about control (50% vs. 21%, p < 0.001) and reported greater healthcare contact related to diabetes and more frequent glucose measurement. Study limits include potential selection bias of web surveys and possible recall bias in patient-reported data. CONCLUSIONS The results illuminate how people with T2D treated with basal insulin perceive control and show important differences between the well controlled and uncontrolled. Findings may have implications for improving patient and physician education and diabetes management.
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Affiliation(s)
- Meryl Brod
- a The Brod Group , Mill Valley , CA , USA
| | | | - Anthony H Barnett
- b Heart of England NHS Foundation Trust, University of Birmingham , Birmingham , UK
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15
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Brod M, Pfeiffer KM, Barnett AH, Berntorp K, Vilsbøll T, Weissenberger B. Perceptions of diabetes control among physicians and people with type 2 diabetes uncontrolled on basal insulin in Sweden, Switzerland, and the United Kingdom. Curr Med Res Opin 2016; 32:981-9. [PMID: 26849483 DOI: 10.1185/03007995.2016.1150821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 11/23/2022]
Abstract
Objective A large proportion of people with type 2 diabetes (T2D) remain uncontrolled on basal insulin. Yet, there is limited understanding of how people with uncontrolled type 2 diabetes (PWUD) perceive control and insulin intensification and whether their perceptions differ from those of physicians. The purpose of the study was to investigate perceptions of control and views on insulin intensification among physicians and PWUD. Research design and methods Web surveys of 1012 PWUD on basal insulin and 300 physicians were conducted in Sweden, Switzerland, and the United Kingdom. Results Analyses revealed significant differences between physicians and PWUD. Physicians were significantly more likely than PWUD to indicate that HbA1c (85.0% vs. 78.9%, p < 0.05), complications from diabetes (89.3% vs. 75.3%, p < 0.001), and frequency/severity of hypoglycemia (93.3% vs. 68.6%, p < 0.001) were very/extremely important for deciding whether or not diabetes is well controlled. In contrast PWUD were significantly more likely to place importance on a variety of factors, including energy levels (74.5% vs. 33.0%, p < 0.001), insulin units/day (77.6% vs. 29.0%, p < 0.001) and how predictable life is (72.1% vs. 29.3%, p < 0.001). PWUD also perceived significantly greater obstacles to control and viewed uncontrolled T2D as more interfering in their lives compared to physicians. Physicians were most reluctant to intensify insulin when there is a lack of patient agreement. Worries about weight gain and feelings of 'getting sicker' were the most frequently reported reasons why PWUD on basal insulin were reluctant to intensify insulin. Conclusions Results revealed a significant disconnect between physicians and PWUD in their perceptions of diabetes control. While physicians generally expressed a more focused and clinical view of diabetes control, patients had a broader view. Results also provide insights into PWUD and physicians' reluctance to intensify insulin. The findings suggest that physician and patient education on differing perceptions could benefit communication and improve diabetes management.
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Affiliation(s)
- Meryl Brod
- a The Brod Group , Mill Valley , CA , United States
| | | | - Anthony H Barnett
- b Heart of England NHS Foundation Trust and University of Birmingham , Birmingham , United Kingdom
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16
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Katsarou A, Claesson R, Ignell C, Shaat N, Berntorp K. Seasonal Pattern in the Diagnosis of Gestational Diabetes Mellitus in Southern Sweden. J Diabetes Res 2016; 2016:8905474. [PMID: 28105444 PMCID: PMC5220490 DOI: 10.1155/2016/8905474] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
Aim. The aim of this study was to examine seasonal patterns in glucose tolerance and in the diagnosis of gestational diabetes mellitus (GDM). Methods. Altogether, 11 538 women underwent a 75-g oral glucose tolerance test (OGTT) in the twenty-eighth week of pregnancy during the years 2003-2005 in southern Sweden. GDM was defined by the 2-h capillary glucose concentration in the OGTT (≥8.9 mmol/L). Chi-squared test, analysis of variance, and regression analyses were used for statistical evaluations. Results. The seasonal frequency of GDM ranged from 3.3% in spring to 5.5% in summer (p < 0.0001). Mean 2-h glucose concentrations followed the same seasonal trend, with a difference of 0.15 mmol/L between winter and summer (p < 0.0001). The 2-h glucose level increased by 0.009 mmol/L for every degree increase in temperature (p < 0.0001). In regression analysis, summer (June-August) was associated with increased 2-h glucose level (p < 0.001) and increased frequency of GDM compared to the other seasons (odds ratio 1.51, 95% confidence interval 1.24-1.83, and p < 0.001). Conclusions. Our findings suggest seasonal variation in the 2-h glucose concentration in the OGTT and in the proportion of women diagnosed with GDM, with a peak in the summer.
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Affiliation(s)
- Anastasia Katsarou
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- *Anastasia Katsarou:
| | - Rickard Claesson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Office for Healthcare “Kryh”, Ystad, Sweden
| | - Claes Ignell
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynaecology, Office for Healthcare “Sund”, Helsingborg, Sweden
| | - Nael Shaat
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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17
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Berntorp K, Anderberg E, Claesson R, Ignell C, Källén K. The relative importance of maternal body mass index and glucose levels for prediction of large-for-gestational-age births. BMC Pregnancy Childbirth 2015; 15:280. [PMID: 26514116 PMCID: PMC4627395 DOI: 10.1186/s12884-015-0722-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/21/2015] [Indexed: 01/06/2023] Open
Abstract
Background The risk of gestational diabetes mellitus (GDM) increases substantially with increasing maternal body mass index (BMI). The aim of the present study was to evaluate the relative importance of maternal BMI and glucose levels in prediction of large-for-gestational-age (LGA) births. Method This observational cohort study was based on women giving birth in southern Sweden during the years 2003–2005. Information on 10 974 pregnancies was retrieved from a population-based perinatal register. A 75-g oral glucose tolerance test (OGTT) was performed in the 28 week of pregnancy for determination of the 2-h plasma glucose concentration. BMI was obtained during the first trimester. The dataset was divided into a development set and a validation set. Using the development set, multiple logistic regression analysis was used to identify maternal characteristics associated with LGA. The prediction of LGA was assessed by receiver-operating characteristic (ROC) curves, with LGA defined as birth weight > +2 standard deviations of the mean. Results In the final multivariable model including BMI, 2-h glucose level and maternal demographics, the factor most strongly associated with LGA was BMI (odds ratio 1.1, 95 % confidence interval [CI] 1.08–1.30). Based on the total dataset, the area under the ROC curve (AUC) of 2-h glucose level to predict LGA was 0.54 (95 % CI 0.48–0.60), indicating poor performance. Using the validation database, the AUC for the final multiple model was 0.69 (95 % CI 0.66–0.72), which was identical to the AUC retrieved from a model not including 2-h glucose (0.69, 95 % CI 0.66–0.72), and larger than from a model including 2-h glucose but not BMI (0.63, 95 % CI 0.60–0.67). Conclusions Both the 2-h glucose level of the OGTT and maternal BMI had a significant effect on the risk of LGA births, but the relative contribution was higher for BMI. The findings highlight the importance of concentrating on healthy body weight in pregnant women and closer monitoring of weight during pregnancy as a strategy for reducing the risk of excessive fetal growth.
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Affiliation(s)
- Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Eva Anderberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rickard Claesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. .,Department of Obstetrics and Gynecology, Office for Healthcare "Kryh", Ystad, SE-27182, Sweden.
| | - Claes Ignell
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Obstetrics and Gynecology, Office for Healthcare "Sund", Helsingborg, Sweden
| | - Karin Källén
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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von Malortie S, Berntorp K. [The Swedish National Board of Health and Welfare proposes reduced reference values for gestational diabetes]. Lakartidningen 2015; 112:DERL. [PMID: 25781602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Claesson R, Ekelund M, Ignell C, Berntorp K. Role of HbA1c in post-partum screening of women with gestational diabetes mellitus. J Clin Transl Endocrinol 2014; 2:21-25. [PMID: 29159105 PMCID: PMC5685018 DOI: 10.1016/j.jcte.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/20/2014] [Indexed: 02/01/2023]
Abstract
Aim To compare the performance of HbA1c with established glucose criteria during an oral glucose tolerance test (OGTT) and to assess HbA1c as a screening test for undiagnosed diabetes and pre-diabetes after gestational diabetes mellitus (GDM). Methods Glucose homeostasis was re-evaluated 1–5 years after delivery in 140 women with previous GDM, by means of OGTT and simultaneous HbA1c measurement. Glucose tolerance was defined according to World Health Organisation criteria. HbA1c ≥6.5% (≥48 mmol/mol) was used for diabetes diagnosis and HbA1c ≥5.7% (≥39 mmol/mol) to define abnormal glucose homeostasis. Results HbA1c had low sensitivity (14.3%) and high specificity (99.1%) in diabetes diagnosis. Sensitivity and specificity of HbA1c to detect abnormal glucose tolerance were 29.5% and 95.2%, respectively. The consistency in classifying abnormal glucose tolerance between HbA1c and OGTT criteria was 59% (κ = 0.227) and the area under the receiver operating characteristic curve was 0.708. The combined use of HbA1c and fasting glucose criteria showed similar performance to that of fasting glucose criteria alone. The latter identified 63% of the women with pre-diabetes or diabetes in the study cohort. However, by lowering the cut-point of HbA1c to ≥5.0% (≥31 mmol/mol), an additional proportion (27%) with isolated post-glucose load hyperglycaemia was identified. Conclusion Proposed thresholds of HbA1c had low diagnostic sensitivity. Combined with a fasting glucose test, the performance was no better than with using a fasting glucose test alone. Combining a fasting glucose test with a lower HbA1c cut-point may be an alternative approach for selection of women for an OGTT. We compare the performance of HbA1c with established glucose criteria during an oral glucose tolerance test (OGTT). We also assess HbA1c as a screening test for undiagnosed diabetes and pre-diabetes after gestational diabetes mellitus. Proposed thresholds of HbA1c had low diagnostic sensitivity relative to OGTT. Combining HbA1c with a fasting glucose test the performance was no better than using a fasting glucose test alone. Combining a fasting glucose test with a lower HbA1c cut-point may be an option for selection of women for an OGTT.
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Affiliation(s)
- Rickard Claesson
- Department of Clinical Sciences, Malmö, Lund University, Sweden.,Department of Obstetrics and Gynaecology, Office for Healthcare "Kryh", Ystad, Sweden
| | - Magnus Ekelund
- Department of Clinical Sciences, Malmö, Lund University, Sweden.,Department of Internal Medicine, Office for Healthcare "Sund", Helsingborg, Sweden
| | - Claes Ignell
- Department of Clinical Sciences, Malmö, Lund University, Sweden.,Department of Obstetrics and Gynaecology, Office for Healthcare "Sund", Helsingborg, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences, Malmö, Lund University, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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Roth B, Berntorp K, Ohlsson B. The Expression of Serum Antibodies Against Gonadotropin-releasing Hormone (GnRH1), Progonadoliberin-2, Luteinizing Hormone (LH), and Related Receptors in Patients with Gastrointestinal Dysfunction or Diabetes Mellitus. Drug Target Insights 2014; 8:45-50. [PMID: 25452692 PMCID: PMC4227618 DOI: 10.4137/dti.s19352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/19/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022] Open
Abstract
Gonadotropin-releasing hormone (GnRH) 1 and 2 and luteinizing hormone (LH) receptors have been described in the gastrointestinal tract. We have previously demonstrated antibodies in serum against GnRH1 in patients with gastrointestinal dysfunction and diabetes mellitus, and antibodies against GnRH receptor, LH, and LH receptor in patients with infertility. The aim of this study was to search for the expression of serum antibodies against GnRH1 with an improved enzyme-linked immune sorbent assay (ELISA), and antibodies against progonadoliberin-2, GnRH2, GnRH receptor, LH, and LH receptor with newly developed ELISAs, in patients with gastrointestinal dysfunction or diabetes mellitus. Healthy blood donors served as controls. Medical records were scrutinized. Our conclusion was that IgM antibodies against GnRH1, progonadoliberin-2, and/or GnRH receptors were more prevalent in patients with functional gastrointestinal disorders, gastrointestinal dysmotility, and/or diabetes mellitus, whereas IgG antibodies against these peptides, and LH- and LH receptor antibodies, were expressed in the same magnitude as in controls.
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Affiliation(s)
- Bodil Roth
- Department of Clinical Sciences, Section of Internal Medicine, Skåne University Hospital, Malmö, Sweden. Lund University, Lund, Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences, Section of Endocrinology, Skåne University Hospital, Malmö, Sweden. Lund University, Lund, Sweden
| | - Bodil Ohlsson
- Department of Clinical Sciences, Section of Internal Medicine, Skåne University Hospital, Malmö, Sweden. Lund University, Lund, Sweden
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Ignell C, Claesson R, Anderberg E, Berntorp K. Trends in the prevalence of gestational diabetes mellitus in southern Sweden, 2003-2012. Acta Obstet Gynecol Scand 2014; 93:420-4. [DOI: 10.1111/aogs.12340] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/14/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Claes Ignell
- Department of Clinical Sciences; Lund University; Malmö Sweden
- Department of Obstetrics and Gynecology; Helsingborg Hospital; Helsingborg Sweden
| | - Rickard Claesson
- Department of Clinical Sciences; Lund University; Malmö Sweden
- Department of Obstetrics and Gynecology; Blekinge Hospital; Karlskrona Sweden
| | - Eva Anderberg
- Department of Clinical Sciences; Lund University; Lund Sweden
| | - Kerstin Berntorp
- Department of Clinical Sciences; Lund University; Malmö Sweden
- Department of Endocrinology; Skåne University Hospital; Malmö Sweden
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Ignell C, Shaat N, Ekelund M, Berntorp K. The impact of ethnicity on glucose homeostasis after gestational diabetes mellitus. Acta Diabetol 2013; 50:927-34. [PMID: 23732816 DOI: 10.1007/s00592-013-0484-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/20/2013] [Indexed: 01/21/2023]
Abstract
The objective of this study was to examine measures of insulin resistance and beta cell function in relation to ethnicity and the development of diabetes after gestational diabetes mellitus (GDM). Glucose homeostasis was assessed during a 75 g oral glucose tolerance test 1-2 years after delivery in 456 women with previous GDM (362 European, 94 non-European; including 41 Arab and 43 Asian women) and 133 control women. Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR). The insulinogenic index (I/G30) and the disposition index [(I/G30)/HOMA-IR] were used to quantify insulin secretion. Women developing diabetes after GDM were characterized by increased HOMA-IR [p = 0.010, adjusted for body mass index (BMI)], whereas the disposition index was decreased in all women with previous GDM irrespective of glucose tolerance, most pronounced in the presence of diabetes (BMI-adjusted p = 1 × 10(-5)). Non-European origin was associated with increased HOMA-IR (p = 0.001 vs. European), strengthened by adjustment for BMI in Asian women (p = 0.046 vs. p = 0.016), but eradicated among Arab women (p = 0.004 vs. p = 0.65). Non-European women exhibited an increased frequency of diabetes after GDM (17 % vs. European 4 %, p = 2 × 10(-5)). In addition to BMI, non-European and Asian origin was associated with the development of diabetes after GDM in a multivariate logistic regression analysis, whereas Arab origin was not. Our results highlight the importance of preventive measures to ensure a healthy lifestyle in women with GDM, particularly in high-risk ethnic groups.
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Affiliation(s)
- Claes Ignell
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden,
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Berntorp K, Frid A, Alm R, Fredrikson GN, Sjöberg K, Ohlsson B. Antibodies against gonadotropin-releasing hormone (GnRH) in patients with diabetes mellitus is associated with lower body weight and autonomic neuropathy. BMC Res Notes 2013; 6:329. [PMID: 23958111 PMCID: PMC3751565 DOI: 10.1186/1756-0500-6-329] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 08/16/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Esophageal dysmotility and gastroparesis are common secondary complications in patients with diabetes mellitus. Patients with dysmotility express antibodies against gonadotropin-releasing hormone (GnRH) in serum. The aim of the present study was to scrutinize patients with diabetes mellitus with regard to the presence of GnRH antibodies, and to examine associations between antibodies and clinical findings. RESULTS Thirty-nine consecutive patients with diabetes mellitus were included in the study after clinical examination and examination by esophageal manometry and gastric emptying scintigraphy. Serum was analyzed for the presence of antibodies against GnRH using an ELISA, and values are expressed as relative units (RU). Two age- and gender-matched healthy subjects per each patient served as controls. The prevalence of IgM GnRH antibodies in patients was 33% compared to 14% in controls (p = 0.027), with a higher antibody titer; 1.2 (0.6-5.0) and 0.2 (0.1-0.3) RU, respectively (p = 0.000). The expression of IgG antibodies was 15% in patients and none in controls (p = 0.000). Lower body mass index was associated with the presence of IgM antibodies (OR = 0.835, 95% CI = 0.699-0.998), and autonomic neuropathy with the presence IgG antibodies (OR = 9.000, 95% CI = 1.327-61.025). Esophageal dysmotility (69%) or gastroparesis (18%) were not associated with the presence of IgM antibodies (OR = 0.589, 95% CI = 0.143-2.424 and OR = 3.407, 95% CI = 0.633-18.350, respectively). Neither was esophageal dysmotility associated with IgG antibodies (OR = 2.500, 95% CI = 0.259-24.096). CONCLUSIONS Antibodies against GnRH are more common in patients with diabetes mellitus compared with healthy controls. IgM antibodies are associated with lower body mass index and IgG antibodies are associated with autonomic neuropathy.
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Affiliation(s)
- Kerstin Berntorp
- Department of Clinical Sciences, Division of Endocrinology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
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Claesson R, Ekelund M, Berntorp K. The potential impact of new diagnostic criteria on the frequency of gestational diabetes mellitus in Sweden. Acta Obstet Gynecol Scand 2013; 92:1223-6. [PMID: 23931629 DOI: 10.1111/aogs.12209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/08/2013] [Accepted: 06/16/2013] [Indexed: 11/26/2022]
Abstract
The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has suggested new diagnostic criteria for gestational diabetes mellitus. Many centers in Europe still use the World Health Organization (WHO) criteria. In southern Sweden we use the 2-h threshold of the European Association for the Study of Diabetes criteria based on universal screening with a 75-g oral glucose tolerance test. We have retrospectively scrutinized oral glucose tolerance tests in a subset of 174 women included in a previous study, diagnosed with gestational diabetes mellitus 1996-1999. A complete repeat oral glucose tolerance test was performed directly after diagnosis in 120 women. When applying the current Swedish criteria, and the IADPSG and the WHO criteria to the material, gestational diabetes mellitus was confirmed in 67% (80/120), 84% (101/120), and 80% (96/120), respectively. Hence, 26% (101/80) more women were identified by the IADPSG criteria and 20% (96/80) more women by the WHO criteria, compared with the criteria presently in use.
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Affiliation(s)
- Rickard Claesson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Obstetrics and Gynecology, Blekinge Hospital, Karlskrona, Sweden
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Leósdóttir M, Grufman H, Frid A, Berntorp K, Tydén P. [Patients with ischemic heart disease often suffers from diabetes]. Lakartidningen 2013; 110:1100-1102. [PMID: 23808082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Anderberg E, Carlsson KS, Berntorp K. Use of healthcare resources after gestational diabetes mellitus: a longitudinal case-control analysis. Scand J Public Health 2012; 40:385-90. [PMID: 22786924 DOI: 10.1177/1403494812449923] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To analyse whether gestational diabetes mellitus (GDM) was associated with increases in healthcare utilisation after delivery. METHODS A longitudinal case-control registry-based study of 579 women with GDM delivered in 1995-2001. Two controls for each case were selected from the Swedish National Board of Health and Welfare, matched for year of birth, year of delivery, and municipality of residence. Data regarding healthcare utilisation was provided by the Patients' Administrative System in Skåne County, Sweden, covering the period from the years of delivery up to year 2009. RESULTS Women with previous GDM had higher mean number of contacts and total cost in the years after delivery as compared to controls, also when excluding utilisation related to subsequent pregnancies and childbirth. By year 2009, 31% of women with prior GDM were diagnosed with diabetes, compared to 1% of controls. Women diagnosed with diabetes were more likely to use health care (odds ratio 14.22, 95% confidence interval 5.87-34.45) controlling for age and time since delivery, whereas cases not diagnosed with diabetes did not differ from controls. The average annual cost of healthcare utilisation was 101% higher (p<0.001) for women with diabetes 10 years after delivery compared to controls. CONCLUSIONS GDM was associated with higher healthcare utilisation postpartum for women who had a diabetes diagnosis. The results call for implementation of structured programmes to follow up women with GDM postpartum for early detection of diabetes and effective management, which may have the potential for improved health and savings in healthcare costs.
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Affiliation(s)
- Eva Anderberg
- Department of Obstetrics and Gynaecology, Lund University, Skåne University Hospital, Lund, Sweden.
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Ekelund M, Shaat N, Almgren P, Anderberg E, Landin-Olsson M, Lyssenko V, Groop L, Berntorp K. Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetes Res Clin Pract 2012; 97:394-8. [PMID: 22591707 DOI: 10.1016/j.diabres.2012.04.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/05/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
AIMS To examine whether genetic variants that predispose individuals to type 2 diabetes (T2D) could predict the development of diabetes after gestational diabetes mellitus (GDM). METHODS 13 SNPs (FTO rs8050136, CDKAL1 rs7754840 and rs7756992, CDKN2A/2B rs10811661, HHEX rs1111875, IGF2BP2 rs1470579 and rs4402960, SLC30A8 rs13266634, TCF7L2 rs7903146, PPARG rs1801282, GCK rs1799884, HNF1A rs1169288, and KCNJ11 rs5219) were genotyped in 793 women with GDM after a median follow-up of 57 months. RESULTS After adjustment for age and ethnicity, the TCF7L2 rs7903146 and the FTO rs8050136 variants significantly predicted postpartum diabetes; hazard ratio (95% confidence interval 1.29 (1.01-1.66) and 1.36 (1.06-1.74), respectively (additive model) versus 1.45 (1.01-2.08) and 1.56 (1.06-2.29) (dominant model)). Adjusting for BMI attenuated the effect of the FTO variant, suggesting that the effect was mediated through its effect on BMI. Combining all risk alleles to a weighted risk score was significantly associated with the risk of postpartum diabetes (hazard ratio 1.11, 95% confidence interval 1.05-1.18, p=0.00016 after adjustment for age and ethnicity). CONCLUSIONS The TCF7L2 rs7903146 and FTO rs8050136 polymorphisms, and particularly a weighted risk score of T2D risk alleles, predict diabetes after GDM. Further studies in other populations are needed to confirm our results.
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Affiliation(s)
- M Ekelund
- Department of Internal Medicine, Hospital of Helsingborg, Helsingborg, Sweden.
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Papadopoulou A, Lynch KF, Anderberg E, Landin-Olsson M, Hansson I, Agardh CD, Lernmark Å, Berntorp K. HLA-DQB1 genotypes and islet cell autoantibodies against GAD65 and IA-2 in relation to development of diabetes post partum in women with gestational diabetes mellitus. Diabetes Res Clin Pract 2012; 95:260-4. [PMID: 22104260 DOI: 10.1016/j.diabres.2011.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/24/2011] [Indexed: 01/19/2023]
Abstract
AIMS To study HLA-DQB1 genes and islet cell autoantibodies against glutamic acid decarboxylase 65 (GADA) and insulinoma antigen-2 (IA-2A) in relation to diabetes post partum in mothers with diagnosed gestational diabetes mellitus (GDM). METHODS During 2003-2004, women undergoing a 75 g oral glucose tolerance test (OGTT) during pregnancy were invited to participate in the Mamma Study. Cut-off level defining GDM was a 2-h capillary blood glucose of 7.8 mmol/L. 1-2 years after delivery a 75 g OGTT was performed, GADA and IA-2A were measured and HLA-DQB1 genes analysed. Data were available for 452 mothers with previous GDM and 168 randomly selected control subjects. RESULTS HLA-DQB1*0602 was negatively associated with GDM (p=0.033) and with development of diabetes post partum (p=0.017), whereas high risk HLA were not associated with GDM or with diabetes. The presence of GADA post partum was positively associated with diabetes post partum (p=0.0009), but not with impaired glucose tolerance. CONCLUSIONS Mothers with GDM and HLA-DQB1*0602 were less likely to develop diabetes after pregnancy, and type 1 diabetes associated high risk HLA genes did not predict type 1 diabetes post partum. Additionally, GADA were positively associated with diabetes development.
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Ignell C, Berntorp K. Evaluation of the relationship between capillary and venous plasma glucose concentrations obtained by the HemoCue Glucose 201+ system during an oral glucose tolerance test. Scand J Clin Lab Invest 2011; 71:670-5. [PMID: 21961814 DOI: 10.3109/00365513.2011.619703] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 55 women with previous gestational diabetes mellitus, simultaneous capillary and venous plasma glucose concentrations were measured at 0, 30 and 120 min during a 75 g oral glucose tolerance test (OGTT). The aims of the study were to examine the relationship between capillary and venous glucose measurements, and to establish equations for the conversion of capillary and venous glucose concentrations using the HemoCue Glucose 201+ system. Additionally, the correlation between the capillary and venous glucose concentrations with the diagnostic cut-off limits proposed by the World Health Organization (WHO) in 1999 was evaluated. Capillary glucose concentrations were consistently higher than venous glucose concentrations at all time points of the OGTT (p < 0.001), and the correlations between the measurements were statistically highly significant (p < 0.001). The differences between the samples were greatest in the non-fasting state as revealed by the 95% prediction intervals (mmol/L) in Bland-Altman plots; ± 0.54 at 0 min, ± 2.01 at 30 min, and ± 1.35 at 120 min. Equivalence values for capillary plasma glucose concentrations derived from this study tended to be higher than those proposed by the WHO as diagnostic cut-off limits. Stratifying subjects by glucose tolerance status according to the WHO criteria revealed disagreements related to glucose values close to the diagnostic cut-off points. The study findings highlight the uncertainty associated with derived equivalence values. However, capillary plasma glucose measurements could be suitable for diagnostic purposes in epidemiological studies and when translating results on a group basis.
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Affiliation(s)
- Claes Ignell
- Department of Obstetrics and Gynaecology, Hospital of Helsingborg, Helsingborg, Sweden.
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Abstract
AIMS This paper is a report on a study exploring beliefs about health and illness in women with gestational diabetes born in Sweden and Africa living in Sweden. A further aim is to study the influence of beliefs on self-care and care seeking. BACKGROUND Extensive global migration leading to multicultural societies implies challenges to health care. Health/illness beliefs are culturally related and determine health-related behaviour, including self-care, which is crucial in management of gestational diabetes. The risk of developing gestational diabetes is increased in migrants, particularly of African origin, when residing in Western countries. No previous studies, except one, have been found comparing health/illness beliefs in women with gestational diabetes of different origin. DESIGN Exploratory descriptive study. METHODS Semi-structured interviews. Consecutive sample of women diagnosed with gestational diabetes, 13 born in Sweden and 10 born in Africa, from a diabetes clinic in Sweden. Qualitative content analysis of data was applied. RESULTS Beliefs were mainly related to individual and social factors. Health was described as freedom from disease and being healthy. Swedish women perceived heredity and hormonal changes as causing gestational diabetes, avoided work-related stress, had a healthy lifestyle, worried about the baby's health and development of type 2 diabetes, sought information, used more medications and health care and were on sick-leave more often because of pregnancy-related problems than African women, who did not know the cause of gestational diabetes, had a passive self-care attitude and followed prescriptions, often reported being told by staff that gestational diabetes would disappear after delivery and stated more pregnancy-related problems which they treated with rest or watchful waiting. CONCLUSIONS Health/illness beliefs differed and affected self-care and care seeking. Lower risk awareness in African-born women was related to limited knowledge about the body and gestational diabetes, which was further amplified by healthcare professionals informing them about gestational diabetes being transient. RELEVANCE TO CLINICAL PRACTICE Individual beliefs and risk awareness must be elicited, and adequate information must be given to prevent negative health effects of gestational diabetes.
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Affiliation(s)
- Katarina Hjelm
- Department of Health and Caring Sciences, Linnaeus University, Växjö; Sweden.
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Papadopoulou A, Lynch KF, Shaat N, Håkansson R, Ivarsson SA, Berntorp K, Agardh CD, Lernmark Å. Gestational diabetes mellitus is associated with TCF7L2 gene polymorphisms independent of HLA-DQB1*0602 genotypes and islet cell autoantibodies. Diabet Med 2011; 28:1018-27. [PMID: 21672010 PMCID: PMC3170100 DOI: 10.1111/j.1464-5491.2011.03359.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To test whether the TCF7L2 gene was associated with gestational diabetes, whether the association between TCF7L2 and gestational diabetes was independent of HLA-DQB1*0602 and islet cell autoantibodies, as well as maternal age, number of pregnancies, family history of diabetes and the HLA-DQB1 genotypes, and to test whether the distribution of HLA-DQB1 alleles was affected by country of birth. METHODS We genotyped the rs7903146, rs12255372 and rs7901695 single nucleotide polymorphisms of the TCF7L2 gene in 826 mothers with gestational diabetes and in 1185 healthy control subjects in the Diabetes Prediction in Skåne Study. The mothers were also typed for HLA-DQB1 genotypes and tested for islet cell autoantibodies against GAD65, insulinoma-associated antigen-2 and insulin. RESULTS The heterozygous genotypes CT, GT and TC of the rs7903146 (T is risk for Type 2 diabetes), rs12255372 (T is risk for Type 2 diabetes) and rs7901695 (C is risk for Type 2 diabetes), respectively, as well as the homozygous genotypes TT, TT and CC of the rs7903146, rs12255372 and rs7901695, respectively, were strongly associated with gestational diabetes (P < 0.0001). These associations remained statistically significant after adjusting for maternal age, number of pregnancies, family history of diabetes and HLA-DQ genotypes and were independent of the presence of islet cell autoantibodies. No interaction was observed between TCF7L2 and HLA-DQB1*0602, which was shown to be negatively associated with gestational diabetes in mothers born in Sweden (P = 0.010). CONCLUSIONS The TCF7L2 was associated with susceptibility for gestational diabetes independently of the presence of HLA-DQB1*0602 and islet cell autoantibodies and other factors such as maternal age, number of pregnancies, family history of diabetes and other HLA-DQ genotypes. The HLA-DQB1*0602 was negatively associated with gestational diabetes in mothers born in Sweden.
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Affiliation(s)
- A Papadopoulou
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Anderberg E, Landin-Olsson M, Kalén J, Frid A, Ursing D, Berntorp K. Prevalence of impaired glucose tolerance and diabetes after gestational diabetes mellitus comparing different cut-off criteria for abnormal glucose tolerance during pregnancy. Acta Obstet Gynecol Scand 2011; 90:1252-8. [PMID: 21679163 DOI: 10.1111/j.1600-0412.2011.01214.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of diabetes and impaired glucose tolerance after gestational diabetes mellitus in relation to different categories of glucose tolerance during pregnancy. DESIGN Prospective study. SETTING Four delivery departments and three hospitals in southern Sweden took part in recruitment and follow-up. POPULATION Women undergoing a 75g oral glucose tolerance test during pregnancy delivering in 2003-2005. METHODS At first follow-up, one to two years after delivery, 29% of eligible women with abnormal glucose tolerance during pregnancy had an oral glucose tolerance test - 160 with gestational diabetes and 309 with gestational impaired glucose tolerance - in addition to 167 control women. Cut-off levels defining gestational diabetes and impaired glucose tolerance were two-hour capillary blood glucose levels of 9.0 and 7.8mmol/l or plasma glucose 10.0 and 8.6mmol/l, respectively. MAIN OUTCOME MEASURES Frequency of abnormal test results at follow-up. RESULTS Diabetes was diagnosed in 11% and impaired glucose tolerance in 24% of women with gestational diabetes vs. 4 and 23% in those with gestational impaired glucose tolerance, respectively. Combining women with abnormal test results during pregnancy revealed diabetes or impaired glucose tolerance in 29% as compared to 10% among controls; the odds ratio (95% confidence interval) for having abnormal test results was 3.3 (1.8-5.9) in a multivariate logistic regression analysis. CONCLUSIONS Lowering the cut-off level for gestational diabetes to include the category of impaired glucose tolerance would identify a high percentage of women with diabetes and impaired glucose tolerance postpartum, who constitute target groups for intervention and/or diabetes prevention.
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Affiliation(s)
- Eva Anderberg
- Department of Obstetrics and Gynecology in Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Gustafsson RJ, Littorin B, Berntorp K, Frid A, Thorsson O, Olsson R, Ekberg O, Ohlsson B. Esophageal dysmotility is more common than gastroparesis in diabetes mellitus and is associated with retinopathy. Rev Diabet Stud 2011; 8:268-75. [PMID: 22189550 DOI: 10.1900/rds.2011.8.268] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Gastroparesis is a well-known complication of diabetes mellitus, both in symptomatic and asymptomatic patients. Esophageal dysmotility has also been described, but is not as well-characterized. The etiology and effect of these complications need to be clarified. The aim of the present study was to evaluate esophageal and gastric motility, complications, gastrointestinal symptoms, and plasma biomarkers in a cross-sectional study comprising patients with diabetes mellitus. METHODS Patients with diabetes were consecutively asked to participate, and eventually 84 volunteers were included in the study. Esophageal manometry and the gastric emptying test were performed in all patients. Type of diabetes, symptoms, diabetic complications, body mass index (BMI), and biomarkers were recorded. Patients were interviewed about gastrointestinal symptoms. RESULTS Esophageal dysmotility was present in 63% of patients and gastroparesis in 13% of patients. There was no difference in dysmotility between patients with type 1 and type 2 diabetes or between genders. Gastrointestinal symptoms did not correlate to objective findings. Age correlated negatively with gastric emptying rate (p = 0.004). Patients with esophageal dysmotility had longer duration of diabetes compared to those without dysmotility (p = 0.043). In logistic regression analysis, retinopathy was strongly associated with esophageal dysmotility, independent of duration (p = 0.003). CONCLUSIONS Esophageal dysmotility is more common than gastroparesis in diabetes mellitus independent of gender, symptoms, and type of diabetes. There is a strong association between retinopathy and esophageal dysmotility.
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Affiliation(s)
- Rita J Gustafsson
- Department of Clinical Sciences, Division of Gastroenterology, Skane University Hospital, Malmö, Lund University, Lund, Sweden
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Berntorp K, Haglund M, Larsen S, Petruckevitch A, Landin-Olsson M. Initiation of biphasic insulin aspart 30/70 in subjects with type 2 diabetes mellitus in a largely primary care-based setting in Sweden. Prim Care Diabetes 2011; 5:89-94. [PMID: 21440523 DOI: 10.1016/j.pcd.2011.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/24/2011] [Accepted: 02/16/2011] [Indexed: 11/20/2022]
Abstract
AIMS Despite a wealth of clinical trial data supporting use of the premixed insulin analogue, biphasic insulin aspart 30 (BIAsp 30) in the treatment of type 2 diabetes mellitus (T2DM), there is limited documentation of its use in primary care-based clinical practice. METHODS An observational study investigating the safety and efficacy of BIAsp 30 in routine clinical practice was conducted. Patients were followed up 3 and 6 months after initiating insulin treatment. Safety and efficacy measures were documented. RESULTS During the course of the study, 1154 patients were included (age range 20-95 years), of whom 89% completed the 6-month follow-up period. Mean HbA(1c) at baseline was 8.8% (73mmol/mol), and had improved to 7.2% (55mmol/mol) after 6 months of treatment. The rate of total hypoglycaemia at completion of the study was 4.1 events per patient year. Major hypoglycaemic events were rare (two in total). CONCLUSIONS BIAsp 30 was initiated safely and effectively in insulin-naïve patients with T2DM. The safety and efficacy profile observed in clinical trials was confirmed in this largely primary care-based setting in Sweden.
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Bryman I, Sylvén L, Berntorp K, Innala E, Bergström I, Hanson C, Oxholm M, Landin-Wilhelmsen K. Pregnancy rate and outcome in Swedish women with Turner syndrome. Fertil Steril 2011; 95:2507-10. [DOI: 10.1016/j.fertnstert.2010.12.039] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 01/15/2023]
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Alvarsson M, Berntorp K, Fernqvist-Forbes E, Lager I, Steen L, Orn T, Grill V. Effects of insulin versus sulphonylurea on beta-cell secretion in recently diagnosed type 2 diabetes patients: a 6-year follow-up study. Rev Diabet Stud 2010; 7:225-32. [PMID: 21409314 DOI: 10.1900/rds.2010.7.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Early insulin treatment is considered more beneficial than anti-diabetic medication with sulphonylureas, because the latter may exert negative effects on beta-cell function, while the former may help preserve it. In a previous study, we found that C-peptide response was increased in the insulin-treated group, whereas it was decreased in the glibenclamide group. However, it was not certain whether the advantage remained in the longer term. AIM In this study, we tested whether early insulin treatment is more beneficial than glibenclamide against a 6-year follow-up perspective. METHODS We designed a randomized clinical trial in subjects with newly diagnosed type 2 diabetes. Glucagon stimulatory tests, measuring C-peptide and islet amyloid polypeptide (IAPP), were performed after 2, and 3, days of temporary insulin and glibenclamide withdrawal. RESULTS 18 subjects initially randomized to glibenclamide, and 16 randomized to two daily injections of insulin, participated in end-of-study investigations. C-peptide response to glucagon deteriorated (p < 0.01 vs. baseline) in initially glibenclamide-treated patients (n = 18), but not in insulin-treated patients (p < 0.05 for difference between groups, after 2 days of treatment withdrawal). The IAPP response to glucagon declined in the glibenclamide group (p < 0.001), but not in insulin-treated subjects (p = 0.05 for difference between groups). CONCLUSIONS Early insulin treatment preserves beta-cell secretory function better than glibenclamide even in a 6-year perspective.
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Affiliation(s)
- Michael Alvarsson
- Department of Endocrinology and Diabetology, Karolinska University Hospital, Stockholm, Sweden.
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Anderberg E, Källén K, Berntorp K. The impact of gestational diabetes mellitus on pregnancy outcome comparing different cut-off criteria for abnormal glucose tolerance. Acta Obstet Gynecol Scand 2010; 89:1532-7. [PMID: 21050147 DOI: 10.3109/00016349.2010.526186] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE to examine pregnancy outcomes in relation to different categories of glucose tolerance during pregnancy. DESIGN prospective observational cohort study. SETTING patient recruitment and data collection were performed in four delivery departments in southern Sweden. POPULATION women delivering during 2003-2005; 306 with gestational diabetes mellitus, 744 with gestational impaired glucose tolerance and 329 randomly selected controls. METHODS all women were offered a 75 g oral glucose tolerance test during pregnancy. On the basis of their capillary 2-hour plasma glucose concentrations, three groups were identified: gestational diabetes mellitus (>10.0 mmol/l), gestational impaired glucose tolerance (8.6-9.9 mmol/l) and controls (<8.6 mmol/l). Data for the groups were compared using a population-based database. MAIN OUTCOME MEASURES maternal and fetal outcomes. RESULTS for the gestational diabetes mellitus group, adjusted odds ratios (95% confidence intervals) for hypertensive disorders during pregnancy and induction of labor and emergency cesarean section were 2.7 (1.3-5.8), 3.1 (1.8-5.2) and 2.5 (1.5-4.4), respectively; and for Apgar score <7 at 5 minutes, need for neonatal intensive care >1 day and large-for-gestational age infant were 9.6 (1.2-78.0), 5.2 (2.8-9.6) and 2.5 (1.3-5.1), respectively. The increases in odds ratios for the gestational impaired glucose tolerance group were less pronounced but still significant for hypertension during pregnancy, induction of labor, large-for-gestational age infant and use of neonatal intensive care >1 day, with odds ratios (95% confidence interval) 2.0 (1.0-4.1), 1.8 (1.1-3.0), 2.1 (1.1-3.9) and 2.1 (1.1-3.8), respectively. CONCLUSIONS these data indicate that even limited degrees of maternal hyperglycemia may affect the outcome of pregnancy.
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Affiliation(s)
- Eva Anderberg
- Department of Obstetrics and Gynecology in Lund, Skåne University Hospital, Lund University, Sweden.
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Ekelund M, Shaat N, Almgren P, Groop L, Berntorp K. Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia 2010; 53:452-7. [PMID: 19957074 DOI: 10.1007/s00125-009-1621-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS We studied the incidence of postpartum diabetes after gestational diabetes mellitus and investigated biochemical and clinical predictors of postpartum diabetes. METHODS We monitored 174 women with gestational diabetes by performing oral glucose tolerance tests during pregnancy as well as 1, 2 and 5 years postpartum. Women who developed impaired fasting glucose, impaired glucose tolerance or diabetes were compared with women who remained normoglycaemic at 5 years. Insulinogenic index, disposition index and HOMA-beta cell index were used to assess beta cell function; insulin resistance was estimated by HOMA index of insulin resistance. RESULTS At 5 years postpartum, 30% of the women had developed diabetes and 51% some form of abnormal glucose tolerance. Women who developed diabetes had higher fasting glucose and HbA(1c) during pregnancy than those who remained normoglycaemic. They also had lower HOMA-beta cell index, insulinogenic index and disposition index than the normoglycaemic women. HbA(1c) and fasting glucose during pregnancy as well as the number of previous pregnancies and family history of diabetes were independent predictors of postpartum diabetes. HbA(1c) > or =4.7% (Swedish Mono S) or > or =5.7% (National Glycohemoglobin Standardization Program) and fasting blood glucose > or =5.2 mmol/l were associated with a four- to sixfold increased risk. CONCLUSIONS/INTERPRETATION Among women with gestational diabetes mellitus, those at risk of future diabetes can be identified by HbA(1c) and fasting glucose values in the upper normal range during pregnancy. A family history of diabetes and previous pregnancies further increase this risk.
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Affiliation(s)
- M Ekelund
- Department of Internal Medicine, Hospital of Helsingborg, SE-251 87 Helsingborg, Sweden.
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Akalin S, Berntorp K, Ceriello A, Das AK, Kilpatrick ES, Koblik T, Munichoodappa CS, Pan CY, Rosenthall W, Shestakova M, Wolnik B, Woo V, Yang WY, Yilmaz MT. Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control. Int J Clin Pract 2009; 63:1421-5. [PMID: 19769698 DOI: 10.1111/j.1742-1241.2009.02165.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (<6.0%) may, in fact, be dangerous in certain patient populations. AIM To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes. METHODS A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions. RESULTS Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (<6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes. CONCLUSIONS Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels.
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Affiliation(s)
- S Akalin
- Department of Internal Medicine: Endocrinology and Metabolism, Marmara University, Istanbul, Turkey
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Hjelm K, Bard K, Berntorp K, Apelqvist J. Beliefs about health and illness postpartum in women born in Sweden and the Middle East. Midwifery 2009; 25:564-75. [DOI: 10.1016/j.midw.2007.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 06/20/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
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Papadopoulou A, Lynch KF, Shaat N, Nilsson A, Lernmark B, Berntorp K, Ivarsson SA, Agardh CD, Lernmark A. The type 1 diabetes protective HLA DQB1*0602 allele is less frequent in gestational diabetes mellitus. Diabetologia 2009; 52:1339-42. [PMID: 19347328 DOI: 10.1007/s00125-009-1351-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS We tested whether gestational diabetes mellitus (GDM) is associated with HLA-DQ genotypes. METHODS A total of 764 mothers with non-autoimmune (GAD65, insulinoma-associated protein 2 [IA-2] and insulin autoantibody-negative) GDM were ascertained between September 2000 and August 2004 in the population-based Diabetes Prediction in Skåne (DiPiS) study. HLA-DQB1 genotypes were determined in these mothers and in 1191 randomly selected non-diabetic control mothers also negative for islet autoantibodies. The data were analysed in relation to maternal age, country of birth, number of pregnancies/siblings and pregnancy weight gain. RESULTS The frequency of type 1 diabetes high-risk HLA-DQ alleles (DQB1*0201, DQB1*0302) did not differ between GDM mothers and controls. In contrast, the low-risk DQB1*0602 allele was less prevalent (OR 0.64, 95% CI = 0.51-0.80, p = 0.0006) in GDM than in control mothers. The difference in DQB1*0602 frequency between GDM mothers and controls remained after multiple logistic regression analysis correcting for maternal age, country of birth, number of pregnancies/siblings and weight gain during pregnancy (OR 0.67, 95% CI 0.51-0.88, p = 0.009). CONCLUSIONS/INTERPRETATION The negative association between mothers who have non-autoimmune GDM and HLA-DQ*0602 suggest that this allele may protect not only from type 1 diabetes but also from GDM.
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Affiliation(s)
- A Papadopoulou
- Department of Clinical Sciences, Unit of Diabetes and Celiac Disease, Lund University/CRC, Malmö, Sweden.
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Abstract
Increasing amounts of Digoxin, Lasix, Teofyllamin and CI-775 were added to human blood in vitro and the whole blood oxygen affinity was measured. We found no definite proof that any of the drugs was able to affect the oxygen affinity of the red cells even at unphysiologically high concentrations.
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Berntorp K, Lindgärde F, Malmquist J. High and low insulin responders: relations to oral glucose tolerance, insulin secretion and physical fitness. Acta Med Scand 2009; 216:111-7. [PMID: 6385632 DOI: 10.1111/j.0954-6820.1984.tb03779.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
High and low insulin responders, a total of 133 non-diabetic men, matched for age and body weight, were reinvestigated after an average period of 3 1/2 years by means of oral glucose tolerance tests, simultaneous insulin and C-peptide measurements and submaximal work tests. The number of individuals with impaired glucose tolerance did not increase during the observation period, and none became diabetic. Intergroup differences in glucose and insulin values were largely the same as in the initial screening procedure, although some regression towards the mean was observed. The high insulin group, compared with the low insulin group, had overall higher glucose, insulin and C-peptide levels, significantly higher increment 0-40 min of insulin but not C-peptide, and significantly lower maximal oxygen uptake. The present data indicate no difference in insulin secretory capacity but a decreased hepatic insulin extraction and a peripheral insulin insensitivity among the high insulin responders, related to a lower degree of physical fitness.
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Abstract
BACKGROUND The extended programmes for pregnant women with diabetes, needed to improve pregnancy outcome, might negatively influence the experience of expecting a baby. AIM To investigate opinions about care during pregnancy, childbirth and the postnatal period among women with diabetes mellitus (DM) and gestational DM (GDM). METHOD A four-part questionnaire was constructed, covering the childbearing year, with a focus on treatment and information. A total of 156 women were asked to participate (53 DM, 103 GDM), three refused. The questionnaire was anonymous. RESULTS The reply frequency was 94%. Of all answers, 95% fell in neutral-satisfied range (Lickert scale 2-5). Three answering patterns deviated positively (care on Specialist Antenatal Clinic, accessibility, and participation-responsibility-respect). Four patterns deviated negatively (information flow, preparation, postpartum care and postpartum check-up). Increased supervision caused problems with time for the family and at work. Comments showed focus on diabetes, forcing the healthy pregnancy aspects into the background. The answers concerning treatment indicated satisfaction (4 + 5 Lickert scale). Women with GDM felt badly prepared before the glucose tolerance test. It was doubtful whether they had been able to make an informed choice about participating. Lack of knowledge among staff was pointed out. Need for more written material was expressed. CONCLUSION Satisfaction with care was shown. A discussion about the implication of informed choice with both staff and mothers are needed. Sharper implementation of the diabetes-care-chain was also an area for improvement.
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Affiliation(s)
- Eva Anderberg
- Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden.
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Kilpatrick ES, Das AK, Orskov C, Berntorp K. Good glycaemic control: an international perspective on bridging the gap between theory and practice in type 2 diabetes. Curr Med Res Opin 2008; 24:2651-61. [PMID: 18691443 DOI: 10.1185/03007990802347209] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Good glycaemic control is crucial in reducing the risk of diabetes-related complications. Despite the availability of evidence-based treatment guidelines, glycaemic control appears to remain suboptimal in most countries. OBJECTIVES In this commentary we outline the extent to which diabetes guideline targets on HbA(1c) are being met in clinical practice and--where targets are being missed--to identify potential reasons for this shortfall. Furthermore, we discuss possible actions that may improve glycaemic control. METHODS A literature search of MEDLINE using 20 core terms was conducted to help assess the state of glycaemic control in patients with type 2 diabetes worldwide. RESULTS Despite clinical guidelines, evidence suggests that glycaemic control is suboptimal in most parts of the world, with average HbA(1c) values varying from 7.0% to 12.6% and thus above virtually all HbA(1c) recommendations. The potential reasons for this shortfall are numerous. However, lack of diabetes education and awareness of HbA(1c) appear to be particularly important. A number of education initiatives from around the world have been shown to improve HbA(1c) levels significantly and thus improve standards of care. CONCLUSIONS Poor glycaemic control in patients with type 2 diabetes appears to be a worldwide problem. As the global rise in diabetes (and its complications) seems destined to affect many less affluent countries, it is essential that appropriate steps are taken to address the barriers to good glycaemic control and ultimately improve outcomes for all people with type 2 diabetes.
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Affiliation(s)
- E S Kilpatrick
- Department of Clinical Biochemistry, Hull Royal Infirmary, Hull, UK.
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Hedeland H, Berntorp K, Arheden K, Kristoffersson U. Pseudohypoparathyroidism type I and Albright's hereditary osteodystrophy with a proximal 15q chromosomal deletion in mother and daughter. Clin Genet 2008; 42:129-34. [PMID: 1356667 DOI: 10.1111/j.1399-0004.1992.tb03224.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [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: 11/29/2022]
Abstract
A 33-year-old woman and her 71-year-old mother were both found to have pseudohypoparathyroidism type I with Albright's hereditary osteodystrophy associated with a cytogenetic deletion of the proximal part of one chromosome 15, resembling that found in Prader-Willi syndrome. As there are overlapping clinical features between these two syndromes a causal relationship cannot be excluded. However, molecular analyses with 10 probes from this region did not detect any uniparental disomy or deletion, features frequently found in Prader-Willi syndrome.
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Affiliation(s)
- H Hedeland
- Department of Endocrinology, University of Lund, Malmö General Hospital, Sweden
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Alvarsson M, Sundkvist G, Lager I, Berntorp K, Fernqvist-Forbes E, Steen L, Orn T, Holberg MA, Kirksaether N, Grill V. Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up. Diabetes Obes Metab 2008; 10:421-9. [PMID: 17394534 DOI: 10.1111/j.1463-1326.2007.00719.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. METHODS Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. RESULTS Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 +/- 0.8 vs. +0.3 +/- 1.0 kg, p < 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p < 0.01) and 2 (p < 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p < 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered. CONCLUSIONS In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial.
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Affiliation(s)
- M Alvarsson
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
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El-Mansoury M, Berntorp K, Bryman I, Hanson C, Innala E, Karlsson A, Landin-Wilhelmsen K. Elevated liver enzymes in Turner syndrome during a 5-year follow-up study. Clin Endocrinol (Oxf) 2008; 68:485-90. [PMID: 18167134 DOI: 10.1111/j.1365-2265.2007.03166.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To study the prevalence and incidence of elevated liver enzymes and their relationship with body weight, metabolic factors and other diseases in Turner syndrome (TS). DESIGN Five-year follow-up. PATIENTS Women with TS (n = 218, mean age 33 +/- 13, range 16-71 years) from outpatient clinics at university hospitals in Sweden. MEASUREMENTS Fasting blood samples for aspartate (AST) and alanine aminotransferase (ALT), bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transferase (GT), viral hepatitis serology and hepatic auto-antibodies, vitamin B12, blood glucose, lipids and hormones. RESULTS Seventy-nine subjects (36%) had one or more liver enzyme levels higher than the reference level, the most prevalent being GT. Karyotype 45,X was present in 51% of all TS women and in 48% of those with elevated liver enzymes. Body weight, body mass index (BMI), total cholesterol, triglycerides, and apolipoproteins A and B at start were higher in TS women with elevated liver enzymes than in TS women with normal levels. At 5 years, AST, ALT and GT were increased and another 23% of patients had developed elevated liver enzymes, that is, 59% in total (36% + 23%), while in 6%, the elevated liver enzymes had been normalized and all 6% also had lowered cholesterol levels. Multivariate analysis showed that GT was correlated with total cholesterol; P = 0.0032 at start and P = 0.0005 at 5 years, independently of other factors. Liver biopsy in six TS women showed one cholangitis, one hepatitis C, two steatosis and two normal biopsies. Withdrawal of oestrogen substitution did not influence the liver enzymes. CONCLUSIONS Pathological liver enzymes were common in TS women, with a prevalence of 36% at 33 years of age, an annual incidence over 5 years of 3.4%. There was no relation to karyotype, alcohol, viral hepatitis, E(2) or autoimmunity, but a connection with total serum cholesterol.
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Affiliation(s)
- Mostafa El-Mansoury
- Department of Internal Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
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Shaat N, Lernmark A, Karlsson E, Ivarsson S, Parikh H, Berntorp K, Groop L. A variant in the transcription factor 7-like 2 (TCF7L2) gene is associated with an increased risk of gestational diabetes mellitus. Diabetologia 2007; 50:972-9. [PMID: 17342473 DOI: 10.1007/s00125-007-0623-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 01/21/2007] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Genetic and epidemiological studies suggest an association between gestational diabetes mellitus and type 2 diabetes. Both are polygenic multifactorial disorders characterised by beta cell dysfunction and insulin resistance. Our aim was to investigate whether common genetic variants that have previously been associated with type 2 diabetes or related phenotypes would also confer risk for gestational diabetes mellitus. MATERIALS AND METHODS In 1,881 unrelated pregnant Scandinavian women (649 women with gestational diabetes mellitus, 1,232 non-diabetic control subjects) we genotyped the transcription factor 7-like 2 (TCF7L2 rs7903146), adiponectin (ADIPOQ +276G > T), peroxisome-proliferator activated receptor, gamma 2 (PPARG Pro12Ala), PPARG-coactivator, 1 alpha (PPARGC1A Gly482Ser), forkhead box C2 (FOXC2 -512C > T) and beta3-adrenergic receptor (ADRB3 Trp64Arg) polymorphisms using TaqMan allelic discrimination assay or RFLP. RESULTS The CC, CT and TT genotype frequencies of the TCF7L2 rs7903146 variant differed significantly between women with gestational diabetes mellitus and control women (46.3, 43.6 and 10.1% vs 58.5, 35.3 and 6.2%, p = 3.7 x 10(-6), corrected p value [Pc] for multiple testing Pc = 2.2 x 10(-5)). The T-allele was associated with an increased risk of gestational diabetes mellitus (odds ratio 1.49 [95% CI 1.28-1.75], p = 4.9 x 10(-7) [Pc = 2.8 x 10(-6)]). Compared with wild-type CC-genotype carriers, heterozygous (CT-genotype) and homozygous (TT-genotype) carriers had a 1.6-fold (95% CI 1.26-1.93, p = 3.7 x 10(-5) [Pc = 0.0002]) and a 2.1-fold (95% CI 1.41-2.99, p = 0.0001 [Pc = 0.0008]) increased risk of gestational diabetes mellitus, respectively. The other polymorphisms studied were not significantly associated with gestational diabetes mellitus (ADIPOQ +276G > T: 1.17 [1.01-1.36], p = 0.039 [Pc = 0.23]; PPARG Pro12Ala: 1.06 [0.87-1.29], p = 0.53; PPARGC1A Gly482Ser: 0.96 [0.83-1.10], p = 0.54; FOXC2 -512C > T: 1.01 [0.87-1.16], p = 0.94; and ADRB3 Trp64Arg: 1.22 [0.95-1.56], p = 0.12). CONCLUSIONS/INTERPRETATION The TCF7L2 rs7903146 variant is associated with an increased risk of gestational diabetes mellitus in Scandinavian women.
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Affiliation(s)
- N Shaat
- Department of Clinical Sciences/Diabetes & Endocrinology, Malmö University Hospital, Lund University, Malmö, Sweden.
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Hjelm K, Berntorp K, Frid A, Aberg A, Apelqvist J. Beliefs about health and illness in women managed for gestational diabetes in two organisations. Midwifery 2007; 24:168-82. [PMID: 17360084 DOI: 10.1016/j.midw.2006.12.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 10/16/2006] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE to explore beliefs about health, illness and health care in women with gestational diabetes mellitus (GDM) managed in two different organisations based on diabetology or obstetrics. DESIGN an explorative qualitative study using semi-structured interviews. SETTING clinic A: a specialist diabetes clinic with regular contact with a diabetologist and antenatal care provided by a midwife; clinic B: a specialist maternity clinic providing regular contact with a midwife, a structured programme for self-monitoring of blood glucose and insulin treatment, and a 1-day diabetes class by an obstetrician, a diabetologist, a midwife and a dietician. The clinics were located at two different university hospitals in Sweden. PARTICIPANTS a consecutive sample of Swedish women diagnosed with GDM; 13 managed in clinic A and 10 managed in clinic B. MEASUREMENT AND FINDINGS women described their perceptions of as well-being, being healthy and freedom from disease. All respondents reported a delay in the provision of information about GMD and an information gap about GDM and the management of the condition, from diagnosis until the start of treatment at the specialist clinic. Respondents from clinic A expressed fear about future development of type 2 diabetes. Women from clinic B discussed different causes of GDM, and many claimed that health-care staff informed them that GDM was a transient condition during pregnancy. Respondents from clinic A reported a conflict in their treatment of pregnancy and GDM as two different conditions. KEY CONCLUSIONS beliefs differed and were related to the health-care model chosen. Women with GDM monitored at a specialist maternity clinic believed GDM to be a transient condition during pregnancy only, whereas women monitored at a diabetes specialist clinic expressed fear about a future risk of developing type 2 diabetes. IMPLICATIONS FOR PRACTICE relevant information about GDM should be provided without delay after initial diagnosis and thereafter repeatedly. It is important to recognise the context of information given on GDM, as it will substantially influence the beliefs and attitudes of women towards GDM as a transient condition during pregnancy or as a potential risk factor for diabetes.
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Affiliation(s)
- Katarina Hjelm
- Department of Community Medicine, University of Lund, Sweden.
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