Continuous glucose monitoring: criteria for the diagnosis of type 2 diabetes mellitus with clinical obesity after gestational diabetes.

Aim: We aim to compare the World Health Organization (WHO), American Diabetes Association (ADA), and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria to diagnose gestational diabetes mellitus in Metro Manila, Philippines.Materials and methods: We used a retrospective cohort study design and reviewed 75-g oral glucose tolerance test results of 919 pregnant women at selected hospital-based and free-standing laboratories in Metro Manila. We used three criteria for diagnosing GDM namely, WHO (fasting: 7.0 mmol/L; 2-hour value: 11.1 mmol/L), ADA (fasting: 5.28 mmol/L; 1-hour: 10 mmol/L; 8.61 mmol/L), or IADPSG (fasting: 5.11 mmol/L; 1 hour: 10 mmol/L; 2-hour value: 8.5 mmol/L) and computed and compared their diagnostic sensitivity, diagnostic specificity, positive predictive value (PPV) and negative predictive value (NPV).Results: Following the WHO criteria, we found 48 GDM patients; using ADA criteria, 150 have GDM; and using IADPSG criteria, 269 women have GDM. Applying the IADPSG criteria to the population would increase the rate of GDM from 5.22% (WHO) to 16.32% (ADA) to 29.27%. Giving the highest prevalence rate, we used IADPSG criteria as the standard to compute for diagnostic sensitivity, diagnostic specificity, NPV and PPV. Results showed that the diagnostic sensitivity of OGTT using ADA criteria is 55.97%, which is higher than using the WHO criteria (17.91%). ADA criteria also has a higher NPV of 84.66% as compared with WHO criteria NPV of 74.74%. In terms of diagnostic specificity, both ADA and WHO criteria have 100% specificity.Conclusions: The use of IADPSG criteria instead of ADA and WHO criteria would result in a considerable increase in the prevalence rate of GDM, which would lessen cases of misdiagnosis. Further, standardizing the criteria for diagnosis will prevent pregnancy complications due to GDM. A single global criterion for the diagnosis of GDM is a must to strengthen its diagnosis and protect both the mother and the baby from complications.

Comparison of continuous glucose monitoring to reference standard oral glucose tolerance test for the detection of dysglycemia in cystic Fibrosis: A systematic review

Early detection of dysglycemia is important to delay the progression to diabetes. Continuous glucose monitoring (CGM) may offer advantages over current diagnostic methods for prediabetes. However, reference intervals for CGM metrics among Asians with normoglycemia (NG), and their differences compared with prediabetes, have not been well characterized. Healthy Asian adults were classified using American Diabetes Association criteria via 75-g oral glucose tolerance test and HbA1c as NG, prediabetes, or diabetes. Participants without diabetes wore a blinded CGM device. Reference intervals (2.5th and 97.5th percentiles) for NG were determined. Continuous glucose monitoring metrics were compared between NG and prediabetes using the two-sample t-test or Mann-Whitney U test as appropriate. The area under the receiver operating characteristic (AUROC) curve and the Youden Index were used to identify optimal diagnostic thresholds for prediabetes. Of 160 participants, one was diagnosed with diabetes. A total of 151 individuals with adequate CGM data were analyzed, including 27 participants with prediabetes (median age 32 years, BMI 22 kg/m², HbA1c 5.4%, 36 mmol/mol). Reference intervals for NG included: mean glucose (78-106 mg/dL), TIR 70 to 180 mg/dL (69%-100%), TIR 54 to 140 mg/dL (86.4%-100%), TAR >140 mg/dL (0%-9.7%), and standard deviation (10.9-25.6 mg/dL). Among CGM metrics, TAR140 had the highest AUROC at 0.72 and an optimal threshold of 5.6%. Asians with NG spend most of their time within TIR 54 to 140. TAR140 may be a useful metric for distinguishing prediabetes from NG.

Predictors and consequences of weight retention in the early and late postpartum period in women with gestational diabetes

Bariatric surgery is associated with a high remission rate of type 2 diabetes mellitus. However, it is unclear whether patients showing remission of diabetes actually have normal blood glucose levels throughout the day. We therefore performed continuous glucose monitoring (CGM) in 15 ambulatory patients showing remission of diabetes after laparoscopic sleeve gastrectomy (LSG) without or with duodenojejunal bypass (DJB) at the time of diabetic remission (12.9 ± 1.8 months after bariatric surgery). The definition of remission of diabetes was based on the American Diabetes Association criteria. The mean, SD, and coefficient of variation (CV) of glucose calculated from CGM were 6.2 ± 0.6 mmol/L, 1.5 ± 0.4 mmol/L, and 23.7 ± 6.2%, respectively. These values were higher than those of healthy participants without diabetes previously reported. The percentages of time spent above 10.0 mmol/L and below 3.9 mmol/L were 2.6 (IQR 0-5.0)% and 0 (IQR 0-8.0)%, respectively. Thus, patients with remission of diabetes after LSG or LSG/DJB still had substantial periods of hyperglycemia and hypoglycemia throughout the day. Therefore, we must manage patients with diabetes carefully, even after apparent remission of type 2 diabetes in response to bariatric surgery.

Effect of Premeal Pistachio Supplementation on Cardiometabolic Risk Factors among Asian Indian Adults with Prediabetes: A Randomized Controlled Trial.

252: Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus

Correlation between Hemoglobin A1c (HbAlc) and Average Blood Glucose: Can HbAlc Be Reported as Estimated Blood Glucose Concentration?

It has been suggested that the early detection of individuals with prediabetes can help prevent cardiovascular diseases. The purpose of the current study was to examine the cardiometabolic risk profile in patients with prediabetes according to fasting plasma glucose (FPG) and/or hemoglobin A1c (HbA1c) criteria.Cross-sectional analysis from the 2022 patients in the Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes (PREDAPS Study) was developed. Four glycemic status groups were defined based on American Diabetes Association criteria. Information about cardiovascular risk factors–body mass index, waist circumference, blood pressure, cholesterol, triglycerides, uric acid, gamma-glutamyltransferase, glomerular filtration–and metabolic syndrome components were analyzed. Mean values of clinical and biochemical characteristics and frequencies of metabolic syndrome were estimated adjusting by age, sex, educational level, and family history of diabetes.A linear trend (P < 0.001) was observed in most of the cardiovascular risk factors and in all components of metabolic syndrome. Normoglycemic individuals had the best values, individuals with both criteria of prediabetes had the worst, and individuals with only one–HbA1c or FPG–criterion had an intermediate position. Metabolic syndrome was present in 15.0% (95% confidence interval: 12.6–17.4), 59.5% (54.0–64.9), 62.0% (56.0–68.0), and 76.2% (72.8–79.6) of individuals classified in normoglycemia, isolated HbA1c, isolated FPG, and both criteria groups, respectively.In conclusion, individuals with prediabetes, especially those with both criteria, have worse cardiometabolic risk profile than normoglycemic individuals. These results suggest the need to use both criteria in the clinical practice to identify those individuals with the highest cardiovascular risk, in order to offer them special attention with intensive lifestyle intervention programs.

The importance of the HbA1c assay for evaluation of long-term glucose control is well established (1–3). However, data for HbA1c and average plasma glucose, in spite of their strong correlation (4–7), show considerable scatter: for a given HbA1c level, average blood glucose generally varies by ∼5 mmol/l (7). This hampers interpretation of the HbA1c values of individual patients. In this study of a large sample of type 2 diabetic patients, we investigated the possibility of statistical association between HbA1c concentration and levels of the main glycatable circulating proteins other than hemoglobin (albumin and globulins). The diabetes outpatient clinics of our center are attended by most local diabetic patients requiring insulin or oral antidiabetics. We enrolled 4,158 diabetic patients who, in this complex in the years 1998–2003, were prescribed insulin or oral antidiabetics for type 2 diabetes diagnosed using American Diabetes Association criteria (8) and who, for glucose control monitoring, underwent regular determination of fasting HbA1c accompanied, for research purposes, by determination of total protein concentration, albumin, globulins, creatinine, hemoglobin, fructosamine, and glucose; age, sex, duration of diabetes, and type of therapy were also recorded. For this report, we considered for each patient the first such profile obtained within the study period. Urinary albumin excretion (normal range …

The Belgian Diabetes in Pregnancy follow-up study (BEDIP-FUS) aims to investigate the impact of body mass index (BMI), adiposity and different degrees of glucose intolerance on the metabolic profile and future risk for type 2 diabetes (T2D) in women and offspring five years after delivery in the BEDIP study. The BEDIP study was a prospective cohort study to evaluate different screening strategies for gestational diabetes (GDM) based on the 2013 WHO criteria. The aim of the BEDIP-FUS is to recruit 375 women–offspring pairs, stratified according to three different subgroups based on the antenatal result of the glucose challenge test (GCT) and oral glucose tolerance test (OGTT) during the BEDIP pregnancy. The follow-up visit consists of a 75 g OGTT, anthropometric measurements and questionnaires for the mothers, and a fasting blood sample with anthropometric measurements for the child. Primary outcome for the mother is glucose intolerance defined by the American Diabetes Association criteria and for the offspring the BMI z-score. Recruitment began in January 2021. The BEDIP-FUS study will help to better individualize follow-up in women with different degrees of hyperglycemia in pregnancy and their offspring.

PurposeGestational diabetes mellitus (GDM) is a prevalent complication during pregnancy. This study aimed to explore the associations between inflammatory indices during pregnancy and the development of GDM.MethodsData from the Fujian Birth Cohort Study between March 2019 and December 2022 were used. Participants who delivered a live-born singleton were included and categorized into GDM and non-GDM groups. Two inflammatory indices, the systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI), were calculated for each trimester of pregnancy via hematological parameters from complete blood count tests. The distributions of inflammatory indicators across trimesters were compared between the GDM and non-GDM groups. Additionally, multivariable logistic regression models were employed to investigate the associations between inflammatory indices and the incidence of GDM.ResultsA total of 17297 participants were included, 21.2% of whom were diagnosed with GDM. In the first trimester, the median SIIs for the GDM and non-GDM groups were 817.7×109/L and 756.9×109/L, respectively, whereas the median SIRIs were 1.6×109/L and 1.5×109/L, respectively. In both groups, the SII increased to its peak in the second trimester before declining, whereas the SIRI progressively increased throughout pregnancy. The SII and SIRI were greater in the GDM group than in the non-GDM group during the first two trimesters but lower in the third trimester. Nonlinear positive associations between first-trimester SII and SIRI levels and GDM were observed, with extreme quartile odds ratios of 1.32 (95% CI: 1.19, 1.48) and 1.39 (95% CI: 1.24, 1.55), respectively.ConclusionThe SII and SIRI increased and reached their peak values in the second and third trimesters of pregnancy, respectively. Elevated levels of the SII and SIRI in early pregnancy were linked to an increased risk of GDM, suggesting their potential utility as screening tools for GDM.

Background: Various micronutrients have a critical impact in glucose metabolism and their deficiencies elevate the risk of GDM development. Objective: To measure the levels of serum zinc and chromium in pregnant females and compare their mean values in patients with GDM and non-GDM. Methods: This comparative cross-sectional study was executed on 100 pregnant women, including 50 women with GDM and 50 normal healthy women, presented at presented in the OPD of Department of Endocrinology and Metabolism, Services Hospital, Lahore. All women underwent 75g oral glucose tolerance test and blood tests for evaluation of serum chromium and zinc concentrations. Results: Mean age of patients in GDM and non-GDM group was 27.42 ± 5.04 years and 26.90 ± 4.48 (p = 0.587) years, respectively. In patients with GDM, the chromium level was 0.06 ± 0.06 μg/L, while in non-GDM patients, it was 0.12 ± 0.11 μg/L, with a p-value of 0.003. Similarly, the zinc level was 0.87 ± 0.86 μg/dL in GDM patients and 1.60 ± 1.48 μg/dL in non-GDM patients (p = 0.002). Fasting blood sugar level, blood sugar levels after 1 and 2 hours of glucose intake, and insulin levels were significantly elevated in GDM group (p &lt;0.05, each). Conclusion: The findings present that lower serum levels of zinc and chromium are linked with GDM in Pakistani women. These results underscore the significance of routine screening for micronutrient deficiencies in pregnant females, especially those at high risk for GDM.

Whether individuals with insulin resistance (IR) but without criteria for diabetes exhibit reduced mitochondrial oxidative capacity is unclear; addressing this question could guide research for new therapeutics. We investigated 248 participants without diabetes from the Baltimore Longitudinal Study of Aging (BLSA) to determine whether impaired mitochondrial capacity is associated with prediabetes, IR, and duration and severity of hyperglycemia exposure. Mitochondrial capacity was assessed as the postexercise phosphocreatine recovery time constant (τPCr) by 31P-magnetic resonance spectroscopy, with higher τPCr values reflecting reduced capacity. Prediabetes was defined using the American Diabetes Association criteria from fasting and 2-h glucose measurements. IR and sensitivity were calculated using HOMA-IR and Matsuda indices. The duration and severity of hyperglycemia exposure were estimated as the number of years from prediabetes onset and the average oral glucose tolerance test (OGTT) 2-h glucose measurement over previous BLSA visits. Covariates included age, sex, body composition, physical activity, and other confounders. Higher likelihood of prediabetes, higher HOMA-IR, and lower Matsuda index were associated with longer τPCr. Among 205 participants with previous OGTT data, greater severity and longer duration of hyperglycemia were independently associated with longer τPC. In conclusion, in individuals without diabetes a more impaired mitochondrial capacity is associated with greater IR and a higher likelihood of prediabetes.

BackgroundLimited evidence exists on the effect of particulate air pollution on blood glucose levels. We evaluated the associations of residential and personal levels of fine particulate matter (PM2.5) and black carbon (BC) with blood glucose and diabetic status among residents of 28 peri-urban villages in South India. MethodsWe used cross-sectional data from 5065 adults (≥18 years, 54% men) included in the Andhra Pradesh Children and Parents Study. Fasting plasma glucose was measured once in 2010–2012 and prevalent prediabetes and diabetes were defined following the American Diabetes Association criteria. We estimated annual ambient PM2.5 and BC levels at residence using land-use regression models and annual personal exposure to PM2.5 and BC using prediction models based on direct measurements from a subsample of 402 participants. We used linear and logistic nested mixed-effect models to assess the association between exposure metrics and health outcomes. For personal exposures, we stratified analyses by sex. ResultsMean (SD) residential PM2.5 and BC were 32.9 (2.6) μg/m3 and 2.5 (2.6) μg/m3, respectively; personal exposures to PM2.5 and BC were 54.5 (11.5) μg/m3 and 5.8 (2.5) μg/m3, respectively. Average (SD) fasting blood glucose was 5.3 (1.3) mmol/l, 16% of participants had prediabetes, and 5.5% had diabetes. Residential PM2.5 and BC were not associated with higher blood glucose levels. Personal PM2.5 (20 μg/m3 increase) and BC (1 μg/m3 increase) were negatively associated with blood glucose levels in women (PM2.5: −1.93, 95%CI: −3.12, −0.73; BC: −0.63, 95%CI: −0.90, −0.37). In men, associations were negative for personal PM2.5 (−1.99, 95%CI: −3.56, −0.39) and positive for personal BC (0.49, 95%CI: −0.44, 1.43). We observed no evidence of associations between any exposure and prevalence of prediabetes/diabetes. ConclusionsOur results do not provide evidence that residential exposures to PM2.5 or BC are associated with blood glucose or prevalence of prediabetes/diabetes in this population. Associations with personal exposure may have been affected by unmeasured confounding, highlighting a challenge in using personal exposure estimates in air pollution epidemiology. These associations should be further examined in longitudinal studies.