75-g Oral Glucose Tolerance Test Research Articles

Association between serum LDL-C concentrations and risk of diabetes: A prospective cohort study.

Low-density lipoprotein cholesterol (LDL-C) and diabetes mellitus are both modifiable risk factors for cardiovascular disease; however, whether elevated LDL-C levels confer a risk for diabetes remains unclear. We aimed to examine the association between serum LDL-C concentrations at baseline and the risk of developing diabetes at follow-up in the general population of Chinese adults. This study included 5274 adults aged ≥ 40 years from a community cohort who were without diabetes and followed for a median of 4.4 years. A standard 75-g oral glucose tolerance test was conducted at baseline and follow-up visits to diagnose diabetes. Logistic regression models and a restricted cubic spline were used to examine the association between baseline serum LDL-C levels and the risk of diabetes development. Subgroup analyses were conducted stratifying on age, sex, body mass index, hypertension, family history of diabetes, and LDL-C levels. A total of 652 participants (12%) developed diabetes during the follow-up period. Compared to quartile 1 of serum LDL-C, quartiles 2, 3, and 4 were associated with a 30%, 33%, and 30% significantly higher risk of diabetes, respectively after adjustment for confounders including homeostatic model assessment for insulin resistance. The linear relationship between baseline LDL-C down to 30.1 mg/dL and incident diabetes was demonstrated by restricted cubic spline analysis, and each 1-SD increase in LDL-C concentration (28.5 mg/dL) was associated with a 12% increase in the risk of diabetes (odds ratio 1.12, 95% confidence interval 1.03-1.22). In this community-based general population, higher serum LDL-C levels were linearly associated with an elevated risk of incident diabetes.

Patients with gestational diabetes mellitus may be treated in both early and late pregnancy, especially in patients with pre-pregnancy overweight: A cross-sectional study in Japan.

The significance of diagnosing gestational diabetes mellitus (GDM) in early pregnancy is controversial. We used the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria to investigate whether clinical background and neonatal outcomes differ depending on when GDM is diagnosed in early or late pregnancy. This was a single-center, observational study conducted between November 2012 and March 2020 at St. Marianna University Hospital (Kawasaki, Japan). We compared the background and perinatal outcomes of patients with GDM depending on the time of diagnosis (at < 24 gestational weeks or ≥ 24weeks). Insulin sensitivity index, homeostasis model assessment of insulin resistance, and β-cell function were calculated from a 75-g oral glucose tolerance test. Stratified analysis was performed by pre-pregnancy BMI in patients with early GDM. As a result, in the 507 patients, 89.9% gave birth at our hospital. The pre-pregnancy BMI was significantly higher in patients with early GDM than in those with late GDM (the median [interquartile range], 22.7 [20.3, 26.3] and 21.5 [19.3, 23.8] kg/m2, respectively; p = 0.001). Perinatal outcomes were not different between the two groups. However, in the subgroup analysis of patients with early GDM, the prevalence of large-for-gestational-age infants was significantly higher in the group with overweight (15.4% vs 2.1%, respectively; p = 0.008). In conclusion, patients with GDM using the IADPSG criteria in early pregnancy may be treated, especially in patients with pre-pregnancy overweight.

Predicting gestational diabetes mellitus by first trimester HbA1c: a retrospective study in women with moderate to severe obesity

Abstract This study aimed to investigate the utility of first trimester HbA1c in predicting gestational diabetes mellitus (GDM) in obese women with Grade II–III obesity. HbA1c was measured during the first trimester in 160 obese women. A 75g oral glucose tolerance test (OGTT) was performed between 24–28 weeks gestation and GDM diagnosed by WHO criteria.The prevalence of GDM was 24%. An HbA1c of ≤28mmol/mol had 100% negative predictive value for GDM. An HbA1c of ≥33mmol/mol had a 69.2% sensitivity and 63.6% specificity for GDM. At higher HbA1c cut‐offs, the odds ratio (OR) for developing GDM increased; at a threshold of ≥39mmol/mol, the OR for GDM was 10.1 (95% CI 2.5–40.5).Women with a first trimester HbA1c of ≤28mmol/mol are at very low risk of developing GDM and may not require an OGTT at 28 weeks, while those with HbA1c ≥39mmol/mol may benefit from early glucose monitoring in pregnancy. Copyright © 2023 John Wiley &amp; Sons.

Association between one abnormal value on 3-hour oral glucose tolerance test and adverse perinatal outcomes in twin gestation

AimTo investigate whether women with twin gestation and one abnormal value on the diagnostic 3-hour oral glucose tolerance test (OGTT) are at an increased risk of adverse perinatal outcomes. MethodsThis was a retrospective multicenter study of women with twin gestation, comparing four groups: (1) normal 50-g screening, (2) normal 100-g 3-hour OGTT, (3) one abnormal value on the 3-hour OGTT, and (4) GDM. Multivariable logistic regressions adjusted for maternal age, gravidity, parity, previous CDs, fertility treatments, smoking, obesity and chorionicity were used. ResultsThe study included 2,597 women with twin gestations, of which 79.7% had a normal screen, and 6.2% had one abnormal value on the OGTT. In adjusted analyses, women with one abnormal value were found to have higher rates of preterm delivery < 32 weeks, large for gestational age neonates, and composite neonatal morbidity of at least one fetus, however, similar maternal outcomes as those with a normal screen. ConclusionOur study provides evidence that women with twin gestation and one abnormal value on the 3-hour OGTT are at an increased risk of unfavorable neonatal outcomes. This was confirmed by multivariable logistic regressions. Further research is needed to determine whether interventions such as nutritional counseling, blood glucose monitoring, and treatment with diet and medication would improve perinatal outcomes in this population.

1216-P: Effects of Aging after Age 65 on Glucose Tolerance, Insulin Sensitivity, and ß-Cell Function in Japanese—The Bunkyo Health Study

The number of new-onset diabetes cases in elderly adults is on the rise, and it is particularly prominent in Japan in which the ageing rate is the highest in the world. With ageing, both insulin sensitivity and insulin secretion deteriorate, however, it remains unclear whether these factors are further exacerbated with ageing in persons older than 65 years. The purpose of this study was to determine age-related changes in glucose tolerance and its related factors in Japanese elderly adults after age 65. Here, we studied 1438 old adults who were not taking oral hypoglycemic agents and were not diagnosed with diabetes. All subjects were assessed for glucose tolerance, insulin sensitivity (Matsuda index and Adipo-IR (fasting insulin x fasting free fatty acid (FFA)) and β-cell function (insulinogenic index) by 75g oral glucose tolerance test (OGTT). We divided participants according to age (65-69 years (n=465), 70-74 years (n=422), 75-79 years (n=326), and 80-84 years (n=225)) and compared clinical characteristics by ANOVA and post-hoc analysis. The mean BMI of all subjects was normal range (22.7±3.0kg/m2). The prevalence of newly diagnosed diabetes increased with age (7.5%, 11.1%, 12.0%, 18.7%, respectively). Fasting plasma glucose, serum insulin levels and insulinogenic index were comparable among the groups; however, area under the curve (AUC)-glucose and AUC-insulin during the 75g OGTT were significantly higher and Matsuda index and disposition index were significantly lower in the 70-74, 75-79 and 80-84 years groups than in the 65-69 years group. Similarly, percent body fat, fasting FFA and Adipo-IR were significantly higher in the 75-79 and 80-84 years groups than in the 65-69 years group. In conclusion, ageing in Japanese after age 65 is associated with exacerbation of body fat accumulation, adipose tissue and systemic IR, which, combined with decreased β-cell compensatory function, leads to worsening glucose tolerance. Disclosure H.Naito: None. M.Sato: None. S.Kadowaki: None. T.Funayama: Speaker's Bureau; Daiichi Sankyo, Boehringer Ingelheim Japan, Inc., Novo Nordisk. H.Watada: Research Support; Boehringer Ingelheim Japan, Inc., Mitsubishi Tanabe Pharma Corporation, LifeScan Diabetes Institute, Eli Lilly Japan K.K., Sun Pharmaceutical Industries Ltd., Teijin Pharma Limited, Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Kowa Company, Ltd., Merck Sharp &amp; Dohme Corp., Sanwa Kagaku Kenkyusho, Speaker's Bureau; Mitsubishi Tanabe Pharma Corporation, Taiho Pharmaceutical Co. Ltd., Novo Nordisk, Abbott Japan Co., Ltd., Astellas Pharma Inc., Merck Sharp &amp; Dohme Corp., Kissei Pharmaceutical Co., Ltd., AstraZeneca, Ono Pharmaceutical Co., Ltd., Boehringer Ingelheim Japan, Inc., Sanofi, Sun Pharmaceutical Industries Ltd., Eli Lilly Japan K.K. Y.Tamura: None. H.Kaga: None. Y.Someya: None. H.Tabata: None. S.Kakehi: None. Y.Yoshizawa: None. M.Kiya: None. T.Tajima: None. N.Ito: None. Funding Strategic Research Foundation at Private Universities (S1411006); Ministry of Education, Culture, Sports, Science and Technology of Japan (18H03184); Mizuno Sports Promotion Foundation; Mitsui Life Social Welfare Foundation

279-OR: Placental IGFBP1 Is Associated with Insulin Sensitivity during Pregnancy and Is an Early Biomarker for Gestational Diabetes

Pregnancy is associated with a profound reduction in insulin sensitivity (IS) that contributes to gestational diabetes (GDM), but the placental factors that lower IS in pregnancy are not fully known. We conducted genome-wide RNA sequencing in 450 placenta samples from a prospective pregnancy cohort (Gen3G). Participants provided plasma samples in the 1st trimester and completed 75g oral glucose tolerance tests in the late 2nd trimester, from which IS was estimated via the Matsuda index. We used regression analyses to test differential expression of 15,232 placental genes related to maternal IS, adjusting for gestational age at delivery, fetal sex, maternal age, gravidity, BMI, and 37 surrogate variables (to account for technical variability). Among the top differentially expressed genes, lower placental expression of IGFBP1 was significantly associated with lower maternal IS (P=1.7×10-4). In 837 Gen3G women, lower IGFPB1 circulating protein was strongly associated with lower IS (r=0.50, P&amp;lt;0.001) and predicted GDM risk (1st trimester median levels: 23,884 pg/mL in no GDM vs 14,363 pg/mL in GDM, adjusted OR=0.55 [0.39-0.75] per quartile increase; P=1.5×10-4). The association between plasma IGFBP1 and IS was replicated in two pregnancy cohorts: SPRING (n=165 with GDM risk factors, r=0.54, P&amp;lt;0.001) and MOMS (n=97 matched GDM cases and controls, r=0.55, P&amp;lt;0.001). The association of lower plasma IGFBP1 with greater risk of GDM was replicated in SPRING (adjusted OR=0.66 per quartile increase, P=0.07) and MOMS (adjusted OR=0.45 per quartile increase, P&amp;lt;0.001). In SPRING, plasma IGFBP1 protein were markedly elevated in the 1st and 2nd trimesters compared to postpartum (P&amp;lt;0.001), consistent with placental origin. Our results suggest that the placenta expresses high levels of IGFBP1, which influences IGF-1 bioavailability and is released in maternal circulation to regulate IS in pregnancy, highlighting it as a promising early plasma biomarker of GDM risk. Disclosure M.Hivert: None. S.Karumanchi: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health. F.White: None. C.Allard: None. K.James: None. S.Majid: None. J.C.Florez: Consultant; AstraZeneca, Novo Nordisk, Other Relationship; AstraZeneca, Merck &amp; Co., Inc. A.Edlow: Consultant; Mirvie, Inc, Research Support; Merck &amp; Co., Inc. L.Bouchard: None. P.Jacques: None. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD094150)

1263-P: Gender Differences in the Impact of Low Muscle Mass on Type 2 Diabetes Incidence—Eighteen-Year Follow-up Data from the Prospective Korean Genome and Epidemiology Study

Background: Current evidence suggests that diminished muscle mass is associated with an increased risk of diabetes. This study aimed to investigate whether the effect of low muscle mass (LMM) on incident diabetes varied depending on the tracking period using a prospective, longitudinal design. Methods: We recruited 6968 subjects without diabetes, aged 40 to 69 years, from the Korean Genomes and Epidemiology study and followed them to monitor the development of type 2 diabetes mellitus (T2DM). A standard 75-g oral glucose tolerance test was conducted at every 2-year follow-up visit. Skeletal muscle mass was assessed using bioelectrical impedance analysis, and a weight-adjusted skeletal muscle mass was defined as muscle mass index (MMI). We assessed the relationship between LMM, the sex-specific lowest tertile of MMI, and the risk of developing T2DM using Cox regression models. Results: Of 6968 (47.4% men), 1846 progressed diabetes during the 18-year follow-up. LMM was associated with an increased risk of T2DM at 10 years and 10-18 years of follow-up in both genders after adjustment for confoundings. After additional adjustment for waist circumference, men with LMM were at significant risk of incident diabetes during the 10-year follow-up (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.28-1.86) but lost significance in 10-18 years., whereas women with LMM were at significantly increased risk (HR 1.32, 95% CI 1.03-1.69) only in 10-18 years. Over 18 years, LMM in men was consistently associated with an increased risk of diabetes from the initial period (at 2-year follow-up), whereas LMM in women has been shown to increase risk in the late period (from 12-year follow-up). Conclusion: This study showed that LMM is an independent risk factor for T2DM with gender differences over time. LMM was a constant risk factor for diabetes in men, whereas it affected the later onset of diabetes in women. Disclosure E.Kim: None. Y.Cho: None. O.Hong: None. S.Moon: None. J.Han: None. S.Yoo: None. N.H.Cho: None.

281-OR: Neonatal Outcomes in Early and Incident Gestational Diabetes Mellitus—Are They Normalized with Treatment from 24–28 Weeks’ Gestation?

Aim: To compare neonatal outcomes between women with early GDM (eGDM: diagnosed&amp;lt;20 weeks’ gestation), incident GDM (iGDM: diagnosed ≥ 24 weeks’ gestation) and normoglycemia Methods: Pregnant women with GDM risk factors were enrolled &amp;lt;20 weeks’ gestation into an eGDM treatment trial across 17 sites in Australia, India, Europe. Women undertook a 2-h 75g oral glucose tolerance test on entry &amp; at 24-28 weeks’ gestation. GDM was defined by WHO 2013 criteria. Logistic regression compared outcomes between women with eGDM, iGDM and normoglycemia adjusted for age, body mass index (BMI), site, smoking status, parity and tertiary qualifications. Women randomized to receive eGDM treatment were excluded from this analysis. Results: Baseline characteristics differed by age, BMI, parity and glycemia across the 3211 women (Table 1). Similar proportions of eGDM and iGDM women received pharmacotherapy. eGDM group gestational weight gain was lower; eGDM and iGDM neonatal outcomes were similar; neonatal intensive care unit admission and respiratory distress were higher in offspring of eGDM than normoglycemic women. Conclusions: Adverse neonatal outcomes are increased in pregnancies complicated by eGDM with delayed treatment. Disclosure D.Simmons: Consultant; Sanofi, Speaker's Bureau; Abbott Diabetes. M.Mclean: None. A.Sweeting: None. V.Mohan: None. J.Harreiter: None. Tobogm core investigator group: n/a. J.Immanuel: None. N.Cheung: None. W.Hague: None. H.Teede: None. C.J.Nolan: None. H.E.Backman: None. E.Hibbert: None. M.J.Peek: None. Funding National Health and Medical Research Council (1104231, 2009326); Region Örebro Research Committee (OLL-970566, OLL-942177); Medical Scientific Fund of the Mayor of Vienna (15205); South Western Sydney Local Health District Academic Unit (2016); Western Sydney University Ainsworth Trust (2019)

1293-P: Diagnosing GDM in the Indian Population with Country-Specific Glucose Cut-Off Values

Introduction: In India, about 5 million pregnancies are affected with gestational diabetes mellitus (GDM), which triggers unfavourable pregnancy outcomes. Infants that experience intrauterine hyperglycemia are more likely to develop obesity and diabetes. Insulin resistance is associated with the Indian phenotype's propensity to accumulate excessive central fat. This study aimed to ascertain how different plasma glucose concentrations affected the ability of participants in an Indian birth cohort to predict unfavourable outcomes for both mothers and babies. Methods: We looked at a prospective cohort of pregnant women in public hospitals in Bihar, India. Pregnant women between 24 and 36 weeks underwent a 2-hour 75g oral glucose tolerance test. Following delivery, we measured the skinfold thickness of infants at the biceps, triceps, and subscapular regions of the body. For predicting the risk of SSFT new-borns and caesarean deliveries with the FBS and PPBS, 240 reliable Poisson models were built. FBS≥87 up to 92 mg/dL and PPBS≥134 up to 153 mg/dL with a one-unit increase were tested with sum of skinfold thickness (SSST) and C section delivery. Results: We discovered that 46.91% of the mothers underwent caesarean sections, and 10.65% of the new-borns had SSFT. Results show that after correcting for age, parity, socioeconomic status, height, and maternal obesity, FBS87 mg/dL and PPBS of 134 mg/dl were linked with risk of higher SSST in new-borns and caesarean delivery. Conclusion: In India, pregnant women are more likely to experience negative birth outcomes due to lower glucose cut-off readings than in other international classification systems. These results provide information for revising the cutoff points in light of the contextual conditions in LMIC nations. Disclosure S.C.Jha: None. N.Kumar: None.

72-OR: Higher Genetic Risk for Type 2 Diabetes Is Associated with Faster Decline of Beta-Cell Function

Objective: Polygenic risk score (PRS) for type 2 diabetes (T2D) has been reported to be associated with beta cell function, but whether it is also associated with the longitudinal change of beta cell function is largely unknown. We aimed to evaluate the association of PRS and the trajectory of beta cell function in a community based prospective cohort. Method: We analyzed 6,323 participants without T2D at baseline from Ansan-Ansung cohort with 75-g 2-hour oral glucose tolerance tests taken biennially for 14 years. Disposition index (DI), derived from insulinogenic index at 60 minutes and Matsuda index, was used as a marker for beta cell function. PRS was calculated using 1.2 million variants from trans-ancestry T2D genome-wide association study using Bayesian regression (PRS-CSx). Participants were stratified into low (1st quintile), intermediate (2nd to 4th quintiles) and high genetic risk (5th quintile). Lifestyle was categorized as unfavorable, intermediate and favorable lifestyle according to Life’s Essential 8. Linear mixed model was applied. Result: During a median follow-up of 13 years, 379 (30.6%), 875 (23.0%) and 171 (13.4%) participants developed T2D in high, intermediate and low genetic risk group, respectively. Participants in high genetic risk group, compared to low genetic risk group, had a 33% lower DI at baseline (53 [95% CI 50, 56] vs 79 [74, 84]; P = 7.9×10-15), and a 1.7-fold faster rate of decline in log2(DI) per year (-0.035 [-0.028, -0.042] vs -0.020 [-0.013, -0.027]; P = 0.0026). Notably, we found significant interaction between the rate of decline in DI and T2D PRS (P = 8.5×10-5). Healthy lifestyle was associated with decreased rate of decline in DI across all genetic risk group. Conclusion: Having a high genetic risk for T2D was associated with not only a lower DI at baseline, but also a faster rate of decline in DI. Genetic information could be used to identify those at risk for rapid decline of beta cell function and emphasize lifestyle modification. Disclosure H.Lee: None. J.Choi: None. H.Son: None. K.Park: None. N.H.Cho: None. S.Kwak: None. Funding Ministry of Health &amp; Welfare, Republic of Korea

1102-P: Joint Effect of GLP-1R and Exposure to Gestational Diabetes on Glucose Regulation in Adolescents—The EPOCH Study

Exposure to gestational diabetes (GDM) and polymorphisms of the glucagon-like-peptide-1 receptor gene (GLP-1R) are both associated with type 2 diabetes risk. In adults, GLP-1R mutations were associated with altered first phase insulin secretion and glucose levels during an oral glucose tolerance test (OGTT). We explored a potential joint association between GLP-1R and GDM exposure on glucose regulation in youth. Exploring Perinatal Outcomes among Children (EPOCH) participants with (N = 86) and without (N = 189) GDM exposure had 2-hour 75g OGTT at ~17 years. DNA was genotyped by microarray. Plink 2.0 was used to extract genotyped and imputed GLP-1R polymorphisms. Glucose and insulin measured at 0, 30 and 120 minutes were used to calculate areas under the curve (AUC), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), insulinogenic index (IGI), and disposition index (DI). Linear models tested the interaction of GLP-1R rs1042044 homozygosity of the minor allele and GDM on each outcome. Homozygotes exposed to GDM had higher baseline, 30, 120 minute and AUC for glucose (p &amp;lt; 0.0001), and lower insulin AUC (p = 0.046) than others (Figure 1), but not significantly different HOMA-IR, IGI and DI. Our data indicates a joint effect of GDM exposure and GLP-1R on glucose levels in youth, potentially due to reduced first phase insulin secretion. Further studies are needed to replicate this finding. Disclosure K.K.Harrall: None. D.H.Glueck: None. K.A.Sauder: None. M.Cree-green: Consultant; Pollie Inc, Research Support; Amino Corp LLC. D.Dabelea: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK068001)

Association between serum lipid profile during the first and second trimester of pregnancy as well as their dynamic changes and gestational diabetes mellitus in twin pregnancies: a retrospective cohort study

BackgroundAbnormal lipid metabolism is associated with gestational diabetes mellitus (GDM) in singleton pregnancies. Data were lacking on twin pregnancies with GDM. We explored the association between serum lipid profiles in the first and second trimesters as well as their dynamic changes and GDM in twin pregnancies.MethodsThis was a retrospective cohort study of 2739 twin pregnancies that underwent a 75-g oral glucose tolerance test (OGTT) and were selected from the Beijing Birth Cohort Study from June 2013 to May 2021. Cholesterol (CHO), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured at mean 9 and 25 weeks of gestation. We described maternal lipid levels in different tertiles that were associated with the risk of GDM stratified for age, pre-BMI, and fertilization type. GDM patients were divided into two groups according to OGTT: elevated fasting plasma glucose only (FPG group) and the rest of the GDM (non-FPG group). We estimated the relative risk of GDM with multivariable logistic regression models.ResultsIn this study, we found that 599 (21.9%, 599/2739) twin pregnancies developed GDM. They had increased CHO, TG, LDL, and LDL/HDL, decreased HDL levels in the first trimester, and increased TG as well as decreased HDL in the second trimester in univariate analyses, each P < 0.05. In multivariate analysis, when TG > 1.67 mmol/l (upper tertile) in elderly individuals, nonoverweight and ART groups increased the risk of GDM by 2.7-fold, 2.3-fold and 2.2-fold, respectively, compared with TG < 0.96 mmol/l (lower tertile). This effect remained in the abovementioned groups in the second trimester. Moreover, high TGs increased the risk of GDM in the FPG group (OR = 2.076, 95% CI 1.130–3.815) and non-FPG group (OR = 2.526, 95% CI 1.739–3.67) in the first trimester when TG > 1.67 mmol/l, and the rising risk in the non-FPG group as the TG tertile increased remained in the second trimester. HDL predominantly showed a negative association with elevated FPG in the second trimester (p < 0.05).ConclusionsTwin pregnancies with GDM have higher lipid levels. Increased TGs in the first and second trimesters are strongly associated with GDM, especially in elderly individuals, nonoverweight and ART groups. Lipid profiles varied among different GDM subtypes.

Maternal Hyperglycemia in Pregnancy and Offspring Internalizing and Externalizing Behaviors.

To examine the associations between exposure to gestational diabetes mellitus (GDM) and maternal glycemic markersduring pregnancy and offspring behaviors at 3 and 5years. We hypothesized that exposure to maternal hyperglycemia would be associated with more behavioral problems in offspring. We included 548 mother-child pairs from the prospective pre-birth Gen3G cohort (Canada). Glycemic markers were measured during a 75g oral glucose tolerance test (OGTT) in the second trimester of pregnancy. Based on OGTT, we classified 59 women (10.8%) as having GDM according to international diagnostic criteria. Mothers reported offspring behavior using the Strengths and Difficulties Questionnaire (SDQ) at 3 and 5years, and the Child Behavior Checklist (CBCL) at 5years. We used linear mixed models and multivariate regression to assess the associations between GDM or glycemic markers and children's behavior, adjusted for child sex and age, and maternal demographic factors, body mass index and family history of diabetes. Exposure to GDM was associated with higher SDQ externalizing scores at 3 and 5years [B = 1.12, 95% CI (0.14, 2.10)] in fully adjusted linear mixed models. These results were supported by the CBCL at 5years. Higher levels of maternal glucose at 1h and 2h during OGTT were associated with greater SDQ externalizing scores. Fasting glucose levels were not associated with child behavior scores. We did not observe associations between glycemic markers and internalizing behaviors. Exposure to higher levels of maternal glycemia during pregnancy was associated with more externalizing behaviors in children at 3 and 5years.

Normal glucose tolerant women with low glycemia during the oral glucose tolerance test have a higher risk to deliver a low birth weight infant.

Data are limited on pregnancy outcomes of normal glucose tolerant (NGT) women with a low glycemic value measured during the 75g oral glucose tolerance test (OGTT). Our aim was to evaluate maternal characteristics and pregnancy outcomes of NGT women with low glycemia measured at fasting, 1-hour or 2-hour OGTT. The Belgian Diabetes in Pregnancy-N study was a multicentric prospective cohort study with 1841 pregnant women receiving an OGTT to screen for gestational diabetes (GDM). We compared the characteristics and pregnancy outcomes in NGT women according to different groups [(<3.9mmol/L), (3.9-4.2mmol/L), (4.25-4.4mmol/L) and (>4.4mmol/L)] of lowest glycemia measured during the OGTT. Pregnancy outcomes were adjusted for confounding factors such as body mass index (BMI) and gestational weight gain. Of all NGT women, 10.7% (172) had low glycemia (<3.9 mmol/L) during the OGTT. Women in the lowest glycemic group (<3.9mmol/L) during the OGTT had compared to women in highest glycemic group (>4.4mmol/L, 29.9%, n=482), a better metabolic profile with a lower BMI, less insulin resistance and better beta-cell function. However, women in the lowest glycemic group had more often inadequate gestational weight gain [51.1% (67) vs. 29.5% (123); p<0.001]. Compared to the highest glycemia group, women in the lowest group had more often a birth weight <2.5Kg [adjusted OR 3.41, 95% CI (1.17-9.92); p=0.025]. Women with a glycemic value <3.9 mmol/L during the OGTT have a higher risk for a neonate with birth weight < 2.5Kg, which remained significant after adjustment for BMI and gestational weight gain.

Association of abnormal glucose tolerance with liver-related disease and cardiovascular diseases in patients with chronic hepatitis C.

Hepatitis C complicated by diabetes mellitus (DM) is considered a risk factor for the progression of fibrosis and development of hepatocellular carcinoma (HCC) and cardiovascular diseases. However, several studies may have lacked appropriate diagnosis of glucose intolerance. We aimed to examine the risk associated with abnormal glucose intolerance in the development of liver-related diseases, including HCC and complications of liver cirrhosis, such as ascites, esophageal and gastric varices, and hepatic encephalopathy, and cardiovascular diseases in patients with hepatitis C accurately diagnosed with impaired glucose tolerance. This longitudinal retrospective study included 365 patients with chronic hepatitis C admitted to Ehime University Hospital for anti-hepatitis C therapy between September 1991 and January 2015. Patients were classified into normal glucose tolerance (NGT), prediabetes, and DM groups based on 75-g oral glucose tolerance test results. Both univariate and multivariate (adjusted for potential confounders) analyses revealed a significantly higher risk of developing HCC and cardiovascular events in the DM group than in the NGT group. However, in multivariate analysis, liver-related events, particularly liver cirrhosis complications, revealed no significant association. In addition, the prediabetes group had no significant risk of any outcome. Patients with hepatitis C complicated by DM, compared with patients with hepatitis C with NGT or complicated with prediabetes, have a higher risk ofHCC and cardiovascular disease events, but not liver-related events, particularlyin not developing liver cirrhosis complications. Therefore, appropriate follow-up is required for patients with hepatitis C based on their glucose tolerance status.

Screening for Late-Onset Gestational Diabetes: Are There Any Clinical Benefits?

(Abstracted from BJOG 2022;129(13):2176–2183 Gestational diabetes mellitus (GDM) affects approximately 1 in 16 women in the United Kingdom. Screening for GDM involves a 2-hour, 75-g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation; a fasting value of plasma glucose of ≥5.6 mM or 2-hour plasma glucose level of ≥7.8 mM indicates GDM. However, as pregnancy progresses, levels of hormones, particularly placental lactogen, change and increase insulin resistance.

The Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios of Pregnant Women Who Underwent the 75-g Oral Glucose Tolerance Test to Predict Gestational Diabetes

Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Early diagnosis and treatment are important; the condition can cause both maternal and foetal complications. Today, single-/double-bolus oral 50–100-g glucose tolerance tests (OGTTs) are preferred. We explored whether the peripheral blood platelet/lymphocyte ratio (PLR) and/or neutrophil/lymphocyte ratio (NLR) could guide diabetes screening of a target group (rather than all pregnant women).&#x0D; Materials and Methods: This retrospective study was conducted at the Obstetrics and Gynecology Clinic of Sanko University Hospital from January 2010 to January 2020. Pregnant women in gestational weeks 24 to 28 who underwent 75-g OGTTs were included. Patients were evaluated by dividing them into two groups. Group 1 included 300 women with GDM. Group 2 included 300 healthy pregnant women who were negative on the OGTT test. We retrieved patient ages, gestational weeks, all blood count data derived during pregnancy, fasting blood glucose levels, heights and weights, and body mass indices. &#x0D; Results: Leukocyte and neutrophil counts were significantly higher in the diabetic patient group than in the control group (both p &lt; 0.01). The NLR and PLR differed significantly between the two groups (both p &lt; 0.01), but the demographic data did not. &#x0D; Conclusion: Increase in white blood cell count, and elevations in the PLR and NLR, independently predicted GDM. Blood NLR and PLR can also be used as a GDM screening test. The NLR and PLR (markers of inflammation) were significantly increased in pre-diabetic and diabetic patients. The NLR and PLR may usefully predict pre-diabetes and GDM.

Relationship between hematologic parameters related to systemic inflammation and insulin resistance-associated metabolic parameters in women with polycystic ovary syndrome.

The aim of the present study was to evaluate the associations between hematologic parameters related to systemic inflammation and insulin resistance-associated metabolic parameters in women with polycystic ovary syndrome (PCOS). Eighty-two women between the ages of 18 and 35 years who were diagnosed with PCOS were included in this study. A 2-hour 75-g oral glucose tolerance test (OGTT) was administered to all study participants; fasting and postprandial glucose and insulin levels were measured simultaneously during the 2-hour OGTT. Hematologic parameters were derived from a standard complete blood count and a differential count of fasting-state blood samples. The correlations between hematologic parameters and insulin resistance-associated clinical and metabolic parameters were evaluated using the Spearman rank correlation and partial correlation coefficients. Hematologic parameters related to systemic inflammation were compared between the two groups, categorized by the presence or absence of insulin resistance. Significant differences in the absolute neutrophil count, absolute monocyte count, platelet count, and neutrophil-lymphocyte ratio were found between the insulin-resistant group and insulin-nonresistant group. Correlation analysis found that all hematological parameters, except for the platelet-lymphocyte ratio, were associated with at least one insulin resistance-associated metabolic parameter. However, these significant correlations between hematological and metabolic parameters were attenuated after controlling for the effects of other covariates using partial correlation analysis. The association between hematologic parameters indicative of systemic inflammation and insulin resistance-associated metabolic parameters seems to be strongly influenced by other anthropometric covariates in women with PCOS.

Association between polycystic ovarian morphology and insulin resistance in women with polycystic ovary syndrome.

The aim of the present study was to determine whether polycystic ovarian morphology (PCOM) is related to insulin resistance in women with polycystic ovary syndrome (PCOS). A total of 147 Korean women aged 18 to 35 years and diagnosed with PCOS were included in this study. Fasting blood tests and standard 2-hour 75-g oral glucose tolerance tests were performed for all participants. PCOM-related parameters including total antral follicle count (TFC) and total ovarian volume (TOV) were assessed using transvaginal or transrectal ultrasonography. Correlation analysis was conducted to assess the relationships of TFC and TOV with insulin resistance-related clinical and biochemical parameters using Spearman rank correlation coefficients and linear regression analysis, with partial correlations used to control for the effects of confounding covariates. Fasting insulin levels, low-density lipoprotein levels, and insulin sensitivity assessment indices (ISAIs) were significantly correlated with TFC, but neither postprandial blood glucose levels nor insulin levels were significantly associated with TFC. No insulin resistance-related parameter was significantly correlated with TOV. These results did not change after adjustments for other anthropometric covariates. Fasting insulin and some ISAIs differed significantly between groups categorized by the median TFC value (TFC ≤54 and TFC >54). TFC, but not TOV, was found to be related to fasting insulin resistance-related parameters in women with PCOS.

Remnant Cholesterol Is Associated With Gestational Diabetes Mellitus: A Cohort Study.

The association between remnant cholesterol (RC) and gestational diabetes mellitus (GDM) risk is unclear. This study investigated the association between RC and GDM. We used data from the Tongji Maternal and Child Health Cohort, a prospective cohort study in China. Fasting lipid concentrations were measured around 16 weeks' gestation. RC was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. GDM was diagnosed by a 75-g oral glucose tolerance test at 24 to 28 weeks' gestation. Log-Poisson regression models were performed to estimate relative risks (RRs) of GDM across quartiles of RC levels and triglyceride (TG) levels after adjustment for potential confounders. TG and RC were mutually adjusted. Among 2528 women, 256 (10.1%) developed GDM. The adjusted RRs (95% CIs) for GDM across increasing quartiles of RC were 1.00 (reference), 1.35 (0.91, 1.99), 1.68 (1.16, 2.45), and 1.73 (1.19, 2.50), respectively. Compared to pregnant women without 3 risk indicators (TG <2.08 mmol/L, RC <0.40 mmol/L, and pre-BMI <24.0 kg/m2), the risk of GDM was elevated in those with normal pre-BMI but high RC (aRR: 1.54; 95% CI: 1.08, 2.19) or high TG (aRR: 2.15; 95% CI: 1.33, 3.49). For those with all 3 risk indicators, the risk of GDM was the highest (aRR: 4.80; 95% CI: 3.20, 7.18). Elevated RC levels were associated with the increased risk of GDM and independent of traditional risk factors. Pregnant women with high pre-BMI, high TG, and high RC were at greatly increased risk of GDM.