<strong>Background</strong><span><strong>:</strong></span><span> With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes...<strong>Background</strong><span><strong>:</strong></span><span> With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes.</span><span> </span><span>Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus</span><span> </span><span>(ODM) and gestational diabetes mellitus</span><span> </span><span><span>(GDM) at the late pregnancy. </span><b><span>Methods</span></b></span><b><span>:</span></b><span> From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study.</span><span> </span><span>Patients were classified into two groups.</span><span> </span><span>31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group.</span><span> </span><span>Clinical characteristics and outcomes were compared between ODM and GDM.</span><span> </span><span>We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use,</span><span> </span><span>blood pressure, clinical nutrition indexes, blood pressure.</span><span> </span><span>Glycosylated hemoglobin</span><span> </span><span>(HbA1c), fasting blood glucose</span><span> </span><span>(FBG), total protein</span><span> </span><span>(TP),</span><span> </span><span>albumin</span><span> </span><span>(ALB), prealbumin</span><span> </span><span>(PALB), hemoglobin</span><span> </span><span>(HGB),</span><span> </span><span>urea nitrogen</span><span> </span><span>(BUN), serum creatinine</span><span> </span><span>(CREA), and dynamic blood glucose monitoring were measured.</span><span> </span><span><span>And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. </span><b><span>Results</span></b></span><b><span>:</span></b><b><span> </span></b><span>In the ODM group,</span><span> </span><span>HbA1c, FBG, average blood glucose,</span><span> </span><span>two-hour postprandial blood glucose</span><span> </span><span>(2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than th</span><span>ose</span><span> of GDM and two groups compared with statistical significance</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05)</span><span>. </span><span>The number of patients treated with insulin</span><span> </span><span>(10/31) in ODM is significantly more than that in GDM</span><span> </span><span>(1/32) (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>45%</span><span> </span><span>(14/31) of ODM have a family history of diabetes patients.</span><span> </span><span>The ratio is significantly higher than 13%</span><span> </span><span>(4/32) of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>There was significant difference in urinary ketone positive rate between the two groups</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05), but there was no significant difference in urinary microalbumin abnormal rate between them</span><span> </span><span>(P</span><span> </span><span>></span><span> </span><span>0.05).</span><span> </span><span>The number of preeclampsia in ODM</span><span> </span><span>(8/31) is significantly higher than that of GDM (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>The level of HGB in ODM is lower than that of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05). There was no difference in the pregnancy outcomes between the two groups.</span><span> </span><b><span>Conclusion</span></b><b><span>:</span></b><span> Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner,</span><span> </span><span>higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients,</span><span> </span><span>higher risk of preeclampsia,</span><span> </span><span>lower HGB level than GDM,</span><span> </span><span>while GDM ha</span><span>s</span><span> higher positive rate of urine ketone than ODM.</span>展开更多
BACKGROUND In contrast to overt diabetes mellitus(DM),gestational DM(GDM)is defined as impaired glucose tolerance induced by pregnancy,which may arise from exaggerated physiologic changes in glucose metabolism.GDM pre...BACKGROUND In contrast to overt diabetes mellitus(DM),gestational DM(GDM)is defined as impaired glucose tolerance induced by pregnancy,which may arise from exaggerated physiologic changes in glucose metabolism.GDM prevalence is reported to be as high as 20%among pregnancies depending on the screening method,gestational age,and the population studied.Maternal and fetal effects of uncontrolled GDM include stillbirth,macrosomia,neonatal diabetes,birth trauma,and subsequent postpartum hemorrhage.Therefore,it is essential to find the potential target population and associated predictive and preventive measures for future intensive peripartum care.AIM To review studies that explored the cellular and molecular mechanisms of GDM as well as predictive measures and prevention strategies.METHODS The search was performed in the Medline and PubMed databases using the terms“gestational diabetes mellitus,”“overt diabetes mellitus,”and“insulin resistance.”In the literature,only full-text articles were considered for inclusion(237 articles).Furthermore,articles published before 1997 and duplicate articles were excluded.After a final review by two experts,all studies(1997-2023)included in the review met the search terms and search strategy(identification from the database,screening of the studies,selection of potential articles,and final inclusion).RESULTS Finally,a total of 79 articles were collected for review.Reported risk factors for GDM included maternal obesity or overweight,pre-existing DM,and polycystic ovary syndrome.The pathophysiology of GDM involves genetic variants responsible for insulin secretion and glycemic control,pancreaticβcell depletion or dysfunction,aggravated insulin resistance due to failure in the plasma membrane translocation of glucose transporter 4,and the effects of chronic,low-grade inflammation.Currently,many antepartum measurements including adipokines(leptin),body mass ratio(waist circumference and waist-to-hip ratio),and biomarkers(microRNA in extracellular vesicles)have been studied and confirmed to be useful markers for predicting GDM.For preventing GDM,physical activity and dietary approaches are effective interventions to control body weight,improve glycemic control,and reduce insulin resistance.CONCLUSION This review explored the possible factors that influence GDM and the underlying molecular and cellular mechanisms of GDM and provided predictive measures and prevention strategies based on results of clinical studies.展开更多
文摘<strong>Background</strong><span><strong>:</strong></span><span> With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes.</span><span> </span><span>Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus</span><span> </span><span>(ODM) and gestational diabetes mellitus</span><span> </span><span><span>(GDM) at the late pregnancy. </span><b><span>Methods</span></b></span><b><span>:</span></b><span> From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study.</span><span> </span><span>Patients were classified into two groups.</span><span> </span><span>31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group.</span><span> </span><span>Clinical characteristics and outcomes were compared between ODM and GDM.</span><span> </span><span>We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use,</span><span> </span><span>blood pressure, clinical nutrition indexes, blood pressure.</span><span> </span><span>Glycosylated hemoglobin</span><span> </span><span>(HbA1c), fasting blood glucose</span><span> </span><span>(FBG), total protein</span><span> </span><span>(TP),</span><span> </span><span>albumin</span><span> </span><span>(ALB), prealbumin</span><span> </span><span>(PALB), hemoglobin</span><span> </span><span>(HGB),</span><span> </span><span>urea nitrogen</span><span> </span><span>(BUN), serum creatinine</span><span> </span><span>(CREA), and dynamic blood glucose monitoring were measured.</span><span> </span><span><span>And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. </span><b><span>Results</span></b></span><b><span>:</span></b><b><span> </span></b><span>In the ODM group,</span><span> </span><span>HbA1c, FBG, average blood glucose,</span><span> </span><span>two-hour postprandial blood glucose</span><span> </span><span>(2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than th</span><span>ose</span><span> of GDM and two groups compared with statistical significance</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05)</span><span>. </span><span>The number of patients treated with insulin</span><span> </span><span>(10/31) in ODM is significantly more than that in GDM</span><span> </span><span>(1/32) (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>45%</span><span> </span><span>(14/31) of ODM have a family history of diabetes patients.</span><span> </span><span>The ratio is significantly higher than 13%</span><span> </span><span>(4/32) of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>There was significant difference in urinary ketone positive rate between the two groups</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05), but there was no significant difference in urinary microalbumin abnormal rate between them</span><span> </span><span>(P</span><span> </span><span>></span><span> </span><span>0.05).</span><span> </span><span>The number of preeclampsia in ODM</span><span> </span><span>(8/31) is significantly higher than that of GDM (P</span><span> </span><span><</span><span> </span><span>0.05).</span><span> </span><span>The level of HGB in ODM is lower than that of GDM</span><span> </span><span>(P</span><span> </span><span><</span><span> </span><span>0.05). There was no difference in the pregnancy outcomes between the two groups.</span><span> </span><b><span>Conclusion</span></b><b><span>:</span></b><span> Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner,</span><span> </span><span>higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients,</span><span> </span><span>higher risk of preeclampsia,</span><span> </span><span>lower HGB level than GDM,</span><span> </span><span>while GDM ha</span><span>s</span><span> higher positive rate of urine ketone than ODM.</span>
文摘BACKGROUND In contrast to overt diabetes mellitus(DM),gestational DM(GDM)is defined as impaired glucose tolerance induced by pregnancy,which may arise from exaggerated physiologic changes in glucose metabolism.GDM prevalence is reported to be as high as 20%among pregnancies depending on the screening method,gestational age,and the population studied.Maternal and fetal effects of uncontrolled GDM include stillbirth,macrosomia,neonatal diabetes,birth trauma,and subsequent postpartum hemorrhage.Therefore,it is essential to find the potential target population and associated predictive and preventive measures for future intensive peripartum care.AIM To review studies that explored the cellular and molecular mechanisms of GDM as well as predictive measures and prevention strategies.METHODS The search was performed in the Medline and PubMed databases using the terms“gestational diabetes mellitus,”“overt diabetes mellitus,”and“insulin resistance.”In the literature,only full-text articles were considered for inclusion(237 articles).Furthermore,articles published before 1997 and duplicate articles were excluded.After a final review by two experts,all studies(1997-2023)included in the review met the search terms and search strategy(identification from the database,screening of the studies,selection of potential articles,and final inclusion).RESULTS Finally,a total of 79 articles were collected for review.Reported risk factors for GDM included maternal obesity or overweight,pre-existing DM,and polycystic ovary syndrome.The pathophysiology of GDM involves genetic variants responsible for insulin secretion and glycemic control,pancreaticβcell depletion or dysfunction,aggravated insulin resistance due to failure in the plasma membrane translocation of glucose transporter 4,and the effects of chronic,low-grade inflammation.Currently,many antepartum measurements including adipokines(leptin),body mass ratio(waist circumference and waist-to-hip ratio),and biomarkers(microRNA in extracellular vesicles)have been studied and confirmed to be useful markers for predicting GDM.For preventing GDM,physical activity and dietary approaches are effective interventions to control body weight,improve glycemic control,and reduce insulin resistance.CONCLUSION This review explored the possible factors that influence GDM and the underlying molecular and cellular mechanisms of GDM and provided predictive measures and prevention strategies based on results of clinical studies.
