75-gram Oral Glucose Tolerance Test Research Articles

Peri-conceptional diet patterns and the risk of Gestational diabetes mellitus in South Indian women.

To identify peri-conceptional diet patterns among women in Bangalore, and examine their associations with risk of gestational diabetes mellitus. BANGLES, started in June 2016, was a prospective observational study, in which women were recruited at 5-16 weeks' gestation. Peri-conceptional diet was recalled at recruitment, using a validated 224-item food frequency questionnaire. GDM was assessed by a 75-gram oral glucose tolerance test at 24-28 weeks' gestation, applying WHO 2013 criteria. Diet patterns were identified using principal component analysis and diet pattern-GDM associations were examined using multivariate logistic regression, adjusting for 'a priori' confounders. Antenatal clinics of two hospitals, Bangalore, South India. 785 pregnant women of varied socio-economic status. GDM prevalence was 22%. Three diet patterns were identified: a) High-diversity, urban (HDU) characterised by diverse, home-cooked and processed foods was associated with older, more affluent, better-educated and urban women; b) Rice-fried snacks-chicken-sweets (RFCS), characterised by low diet-diversity, was associated with younger, less-educated, and lower income, rural and joint families; c) Healthy, traditional vegetarian (HTV), characterised by home-cooked-vegetarian and non-processed foods was associated with less-educated, more affluent, and rural and joint families. The HDU pattern was associated with a lower GDM risk (aOR: 0.80 per SD, 95% CI: 0.64, 0.99, p=0.04) after adjusting for confounders. BMI was strongly related to GDM risk and possibly mediated diet-GDM associations. The findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI and increase diet-diversity. Both healthy and unhealthy foods in the patterns indicate low-awareness about healthy foods and a need for public-education.

Predictors of Antenatal Insulin Requirement in Women With Gestational Diabetes Mellitus: A Prospective Observational Cohort Study

Background: The treatment of gestational diabetes mellitus (GDM) includes medical nutrition therapy (MNT), and insulin if MNT fails to achieve glycemic control. Limited data are available on predictors of insulin requirement in pregnancy and the difference in obstetric outcomes between the two treatment groups. This study was conducted with the primary objective of identifying predictors of antenatal insulin requirement and the secondary objective of comparing perinatal outcomes in MNT-treated versus insulin-treated groups. Methods: It was a prospective cohort study at a tertiary care institute in eastern India. Antenatal women were diagnosed with GDM as per the Diabetes in Pregnancy Study Group of India criteria and received MNT for 1 - 2 weeks, depending on gestational age, followed by self-monitoring of blood glucose. Insulin therapy was added in those who could not meet the target blood glucose. Maternal and neonatal outcomes were studied in these two groups and an attempt was made to identify the predictors of antenatal insulin requirement. The perinatal outcomes in MNT-treated versus insulin-treated groups were also compared. Results: Data of 151 participants were analyzed. Eighty percent were controlled with MNT. Gestational age ? 33.28 weeks at diagnosis of GDM, maternal BMI ? 24.7 kg/m 2 and 75-gram oral glucose tolerance test (75-g OGTT) value ? 162 mg/dL were predictors of antenatal insulin requirement. The median age, weight, body mass index (BMI), value of 75-g OGTT at diagnosis of GDM, number of cesarean deliveries, gestational hypertension and neonatal hyperbilirubinemia were significantly higher in the insulin group. Conclusion: Gestational age at diagnosis of GDM, BMI and value of 75-g OGTT predicted antenatal insulin requirement. Gestational hypertension, rate of cesarean deliveries and neonatal hyperbilirubinemia were significantly higher in the insulin group. J Endocrinol Metab. 2022;12(1):32-39 doi: https://doi.org/10.14740/jem793

Relationship between carbohydrate intake and oral glucose tolerance test results among pregnant women

AimsEvaluate the relationship between self-reported carbohydrate intake and oral glucose tolerance test (OGTT) results in pregnancy. MethodsWe measured carbohydrate intake using 24-hour dietary recall and performed a 2-hour 75-gram OGTT in 95 pregnant women with risk factors for gestational diabetes (GDM) at a median of 26 weeks’ gestation. We tested for associations between carbohydrate intake in the 24 hours preceding the OGTT and 60-minute OGTT glucose, glucose at other timepoints, and glucose area under the curve (AUC) using linear regression, with adjustment for potential confounders. ResultsWe observed an inverse linear relationship between carbohydrate intake (median 237 grams [interquartile range: 196, 303]) and 60-minute OGTT glucose. For every 50 gram reduction in carbohydrate intake, there was an 8.9 mg/dl increase in 60-minute OGTT glucose (P < 0.01) in an adjusted model. Lower carbohydrate intake was also associated with higher 30-minute (adjusted β = −6.5 mg/dl, P < 0.01) and 120-minute OGTT glucose (adjusted β = −8.1 mg/dl, P = 0.01) and AUC (adjusted β = −767, P < 0.01). ConclusionsCarbohydrate intake in the day preceding an OGTT in pregnancy is associated with post-load glucose values, with lower carbohydrate intake predicting higher glucose levels and higher carbohydrate intake predicting lower glucose levels. Carbohydrate restriction or excess before an OGTT may affect GDM diagnosis.

The prevalence of metabolic associated fatty liver detected by FibroScan® in women with gestational diabetes in a multiethnic population

AimsMetabolic associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease and has been increasingly associated with gestational diabetes (GDM). This study aimed to assess the prevalence of MAFLD in women with GDM in the antenatal period. Methods108 pregnant women with GDM diagnosed on a 75-gram oral glucose tolerance test were enrolled from a multiethnic cohort attending a large obstetrics clinic in Sydney, Australia and had a single FibroScan® assessment after 24 weeks gestation to assess for hepatic steatosis and fibrosis. A control attenuated parameter (CAP) cut-off score of ≥ 233.5 dB/m was chosen to signify presence of hepatic steatosis which indicates MAFLD. Obstetric, anthropometric and metabolic measures were analysed. Results29 (26.9%) women had evidence of FibroScan®-detected MAFLD, whilst none had evidence of hepatic fibrosis. Increased maternal BMI (aOR 1.12, 95% CI: 1.04–1.20) was associated with the finding of MAFLD in this cohort. ConclusionsWe found a significant antenatal prevalence of FibroScan®-detected MAFLD in this cohort of multiethnic women with GDM. FibroScan® is a safe and rapid assessment tool which may have a role in screening for MAFLD in pregnancy in appropriate at-risk women.

Isolated and combined effects of high-intensity interval training and time-restricted eating on glycaemic control in reproductive-aged women with overweight or obesity: study protocol for a four-armed randomised controlled trial

IntroductionOverweight and obesity in reproductive-aged women is a global problem due to the increased risk of subfertility, pregnancy complications and cardiometabolic diseases. High-intensity interval training and time-restricted eating are two...

Prevalence and Incidence of Diabetic Retinopathy in Women with Gestational Diabetes and Overt Diabetes First Diagnosed in Pregnancy

Objectives. Due to the lack of evidence linking retinopathy to gestational and overt diabetes, the utility of dilated fundus examination for screening is not established. This study aimed to determine prevalence and progression of retinopathy among newly diagnosed diabetic pregnant women. Methodology. The study was a single-center observational, descriptive study at the outpatient department of a tertiary hospital. Newly diagnosed pregnant women were enrolled based on local criteria, using the 75-gram oral glucose tolerance test, HbA1C level, and random blood sugar test. Dilated fundus photo examination was used to document retinopathy. Fundus photo examination was done every trimester, at delivery and post-partum. Prevalence and incidence of diabetic retinopathy were measured and monitored. Results. Seventy-one women were classified to have gestational diabetes and with no diabetic retinopathy on first consult and remained free of retinopathy during pregnancy and post-partum. In two women diagnosed with ODM, one showed sight-threatening diabetic retinopathy, was asymptomatic and had a visual acuity of 20/20. Conclusion. GDM had no negative impact on retinal pathology and prevalence of diabetic retinopathy was higher among those with ODM. Our results suggest that screening in the GDM population is not advisable, and inconclusive in ODM.

Identification of Reactive Hypoglycemia with Different Basic BMI and Its Causes by Prolonged Oral Glucose Tolerance Test.

PurposeTo identify the population susceptible to reactive hypoglycemia and explain the possible reasons for their susceptibility.MethodsNinety-four patients were divided into normal weight, overweight and obese groups before a 75-gram prolonged oral glucose tolerance test (POGTT). The incidence of reactive hypoglycemia (blood glucose ≤3.1 mmol/L or 55 mg/dL at points of 0–4 hours) was compared among three groups, and blood glucose and insulin levels were monitored simultaneously from 0 - 4 hours to assess the level of insulin resistance and insulin sensitivity. Furthermore, the degree of insulin resistance among three groups and within each subgroup (whether hypoglycemia events occurred) was compared.ResultsAmong the three groups, the incidence of hypoglycemia was significantly different at 3 (P=0.033) and 4 hours (P=0.020). At 4 hours, the incidence of reactive hypoglycemia in the obese group was approximately 3 times that in the normal weight group. The insulin level in obese group at 4 hours was nearly 4 times higher than that in normal group, and the same result also exists in the same subgroup of different groups. In addition, the hypoglycemia subgroup of obese group had higher insulin level than non-hypoglycemia (P=0.000). The homeostasis model assessment of insulin resistance index increased with increasing BMI among the three groups (P=0.000), while the Matsuda index decreased (P=0.000). The comparison of the homeostasis model assessment of insulin resistance index between subgroups in each group showed that the P values were 0.021, 0.038 and 0.085, successively, and the P values for the Matsuda index were 0.019, 0.013 and 0.119, respectively.ConclusionObese people has higher rate of reactive hypoglycemia than other groups in POGTT, in which insulin resistance may play an important role. But patients who are evaluated for reactive hypoglycemia need to be observed for at least 3 or 4 hours.

Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis.

AimThis systematic review aimed to ascertain the diagnostic accuracy (sensitivity and specificity) of screening tests for early detection of type 2 diabetes and prediabetes in previously undiagnosed adults.MethodsThis systematic review included published studies that included one or more index tests (random and fasting tests, HbA1c) for glucose detection, with 75-gram Oral Glucose Tolerance Test (or 2-hour post load glucose) as a reference standard (PROSPERO ID CRD42018102477). Seven databases were searched electronically (from their inception up to March 9, 2020) accompanied with bibliographic and website searches. Records were manually screened and full text were selected based on inclusion and exclusion criteria. Subsequently, data extraction was done using standardized form and quality assessment of studies using QUADAS-2 tool. Meta-analysis was done using bivariate model using Stata 14.0. Optimal cut offs in terms of sensitivity and specificity for the tests were analysed using R software.ResultsOf 7,151 records assessed by title and abstract, a total of 37 peer reviewed articles were included in this systematic review. The pooled sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR-) for diagnosing diabetes with HbA1c (6.5%; venous sample; n = 17 studies) were 50% (95% CI: 42–59%), 97.3% (95% CI: 95.3–98.4), 18.32 (95% CI: 11.06–30.53) and 0.51 (95% CI: 0.43–0.60), respectively. However, the optimal cut-off for diagnosing diabetes in previously undiagnosed adults with HbA1c was estimated as 6.03% with pooled sensitivity of 73.9% (95% CI: 68–79.1%) and specificity of 87.2% (95% CI: 82–91%). The optimal cut-off for Fasting Plasma Glucose (FPG) was estimated as 104 milligram/dL (mg/dL) with a sensitivity of 82.3% (95% CI: 74.6–88.1%) and specificity of 89.4% (95% CI: 85.2–92.5%).ConclusionOur findings suggest that at present recommended threshold of 6.5%, HbA1c is more specific and less sensitive in diagnosing the newly detected diabetes in undiagnosed population from community settings. Lowering of thresholds for HbA1c and FPG to 6.03% and 104 mg/dL for early detection in previously undiagnosed persons for screening purposes may be considered.

Mechanisms for increased risk of diabetes in chronic liver diseases.

Patients with chronic liver disease (CLD), both non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC), are at high risk of diabetes (T2D), but mechanisms are still unknown. Muscle/liver insulin resistance (IR) and pancreatic dysfunction are the major metabolic defects leading to T2D. However, if the risk of T2D in CLD patients is because of reduced insulin response and/or to IR, and the impact of liver histology has not been investigated. We studied 220 non-T2D patients with chronic liver disease (129 NAFLD, BMI = 27.3 kg/m2 ; 91 CHC, BMI = 25.0 kg/m2 ) that received a 75-gram oral glucose tolerance test (OGTT) with the measurement of glucose and insulin concentrations for 2 hours, glucose tolerance (NGT vs IGT) and liver biopsy. The results were compared to 26 controls (CT-NGT, BMI = 25.6 kg/m2 ). We evaluated peripheral insulin sensitivity (OGIS), OGTT-insulin response (ΔAUC-I/ΔAUC-G) and disposition-index (DI = OGIS∙ΔAUC-I/ΔAUC-G) for the risk to develop T2D. NAFLD had increased muscle IR (associated to NASH, steatosis and fibrosis), higher than in CHC or CT-NGT (OGIS = 8.9 vs 11.3 and 10.5 mL/min kg, P < .0001). In NAFLD, OGTT-insulin response (ΔAUC-I/ΔAUC-G) was the highest while it was significantly decreased in CHC (2.2 vs 1.1 and 1.6, NAFLD vs. CHC and CT-NGT, P < .005). The highest T2D risk (low DI) was observed in CHC-IGT (7.5), CHC-NGT (13.5) and NAFLD-IGT (10.8) vs CT-NGT (14.9, all P < .0001), but not in NAFL-NGT or NASH-NGT. We observed an increased T2D risk in NAFLD-IGT, CHC-IGT and CHC-NGT mainly because of reduced OGTT-insulin response, while insulin response in NAFLD-NGT compensates the IR thus maintaining normal glycaemia.

853-P: Continuous Glucose Monitor Predicts Glycemic Variability in High-Risk Individuals with HbA1c &amp;lt;5.7%

Objective: Glycemic variability (GV) and 1 hour plasma glucose (1-h PG) ≥ 8.6 mmol/L during a 75-gram oral glucose tolerance test (OGTT) are associated with increased risk for type 2 diabetes (T2D). GV may be overlooked in high-risk individuals. The objectives of this study are: (1) to determine if continuous glucose monitoring (CGM) using the Abbott Freestyle Libre Pro can replace the OGTT in high-risk subjects with HbA1c &amp;lt; 5.7%; and (2) to determine if GV indices correlate with the OGTT-derived 1-h PG ≥ 8.6 mmol/L. Methods: Subjects were recruited with a HbA1c &amp;lt; 5.7% and at least one other risk factor including: overweight or obesity, PCOS, fatty liver, hypertension, family history of T2D, or history of gestational diabetes. The CGM, placed days prior to the OGTT, was worn up to 14 days. Anthropometric and vital signs were measured. HbA1c, fasting, 1-h and 2-h PG levels during an OGTT were obtained. Results: The 1-h PG correlated significantly with CGM glucose levels (r=0.883, p&amp;lt;0.001) and GV indices: mean amplitude of glucose excursions (MAGE) (r=0.665,p=0.006), lability index (LI) (r=0.601, p=0.014), and high blood glucose index (HBGI) (r=0.743, p=0.001) (Table 1). Conclusions: The 1-h CGM glucose and elevated GV indices significantly correlate with 1-h PG (&amp;gt; 8.6 mmol/L) in high-risk subjects with HbA1c &amp;lt; 5.7%. CGM could potentially replace the OGTT for detecting early dysglycemia in those with HbA1c &amp;lt; 5.7%. Disclosure B. Dorcely: None. E. Sifonte: None. A. Divakaran: None. K. Katz: None. R. Jagannathan: None. I.J. Goldberg: None. M. Bergman: None. Funding Abbott Diabetes Care; New York University Clinical and Translational Science Award (UL1 TR001445)

4164 Body mass index, not chemotherapy is the major predictor of insulin resistance in patients with hematological malignancies

OBJECTIVES/GOALS: Cancer survivors are at increased risk for type 2 diabetes mellitus.It is not clear if diabetes susceptibility is due to shared risk factors for cancer and diabetes, such as obesity, or if it is directly related to cancer and its treatment. We investigated the association between malignancy and insulin resistance, a major risk factor for diabetes. METHODS/STUDY POPULATION: 20 adult patients with treated hematological malignancies and 21 controls without cancer were included in the study. Individuals with pre-existing diabetes were excluded. All patients underwent a 2-hour 75-gram oral glucose tolerance test (OGTT). Hyperinsulinemic-euglycemic clamps were performed to measure the steady-state glucose infusion rate (M-value) as an indicator of whole-body glucose utilization during insulin stimulation. Insulin sensitivity index was calculated by dividing M-value over the steady-state plasma insulin (M/I). RESULTS/ANTICIPATED RESULTS: Fasting or postprandial plasma glucose levels during the OGTT did not differ significantly between malignancy patients and controls (Table 2). Difference in the insulin-stimulated glucose utilization (M-value) was not statistically significant among cancer patients and controls (median, 7.2 [IQR, 6.2-10.4] vs. 7.3 [IQR, 5.5-8.9] mg/kg/min; P = 0.261). M/I index was significantly higher in malignancy patients compared to controls (median, 42.4 mg/kg/min/(µU/ml) [IQR, 33.9-67.2] vs. 23.4 mg/kg/min/(µU/ml) [IQR, 12.9-29.2], P &lt;0.001), however insulin clearance was also lower in the controls. In multivariate analysis, only BMI was significantly associated with M-value (β = −0.2 (95% CI −0.4, −0.1), P = 0.004), and M/I (β = −2 (95% CI −3.4, −0.5), P = 0.009). DISCUSSION/SIGNIFICANCE OF IMPACT: Our data suggest that the major contributor to diabetes development after diagnosis of cancer in adults is obesity-induced insulin resistance, not malignancy related factors. These findings emphasize the importance of obesity management in long-term survival of cancer patients, as diabetes is a risk factor for mortality in this patient population.

1439-P: One-Hour Postload Plasma Glucose Level Predicts Future Type 2 Diabetes in Hong Kong Chinese: A 12-Year Follow-Up Analysis

Background: There is a resurgence of interest in the role of 1-hour post-load plasma glucose (PG) in risk stratification for type 2 diabetes and a cut-off of 8.6 mmol/L has been proposed to define dysglycaemia in addition to other existing criteria of prediabetes. We examined the efficacy of 1-hour PG level in predicting future type 2 diabetes in a longitudinal community-based cohort of Hong Kong Chinese. Methods: Between 2001-2003, 489 adults without diabetes underwent 75-gram oral glucose tolerance test (OGTT). Blood samples were collected at 0, 15, 30, 60 and 120 minutes for measurement of plasma glucose and insulin levels. Between 2012-2014, progression to diabetes was ascertained either by reviewing medical records or by repeating OGTT and HbA1c. Area under the receiver-operating characteristic (ROC) curve was calculated to assess the discrimination of each parameter (fasting PG, 1-hour PG, 2-hour PG, disposition index) for development of diabetes. High 1-hour PG was defined using threshold of 8.6 mmol/L. Results: Over 12-year follow-up, 46 people (9.4%) developed diabetes. The area under ROC curve were 0.79 (95% CI 0.71, 0.86) for fasting PG, 0.84 (95% CI 0.78, 0.89) for 1-hour PG, 0.79 (95% CI 0.72, 0.86) for 2-hour PG, and 0.78 (95% CI 0.71, 0.85) for disposition index with no difference between each parameter. In multivariate logistic regression, high 1-hour PG was associated with new-onset diabetes with odds ratio (OR) 4.87 (95% CI 1.91, 14.1, p=0.002), independent of impaired fasting glucose (OR 2.19 [95% CI 0.87, 5.32, p=NA), impaired glucose tolerance (OR 3.69 [95% CI 1.67, 8.27, p=0.001]) and other clinical variables including age, sex, smoking, family history of diabetes, history of gestational diabetes, waist and blood pressure. Conclusions: One-hour PG is similar to fasting and 2-hour PG in prediction of type 2 diabetes. High 1-hour PG identifies people with high risk of diabetes independent of other criteria of prediabetes and clinical risk factors. Disclosure A. Luk: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc., Roche Pharma. Other Relationship; Self; Merck Sharp &amp; Dohme Corp. E.S. Lau: None. A.P. Kong: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Abbott, AstraZeneca, Sanofi. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. E. Chow: None. R.C. Ma: Advisory Panel; Self; AstraZeneca. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Merck &amp; Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Tricida Inc. J.C. Chan: None.

Advancing Dinner Timing Is an Effective Strategy in Improving Glucose Tolerance in Free-Living Adults: A Randomized Cross-Over Trial

Abstract Objectives Eating at times that conflict with our physiology and coincide with the biological evening has been associated with increased disease risk. In free-living adults from the ONTIME-MT study (#NCT03036592) study, we tested the hypothesis that advancing the timing of dinner relative to bedtime, simulated by advancing an evening oral glucose tolerance test (OGTT), will result in improved glucose control. Methods In a randomized, cross-over study design, following an 8h fast, each participant underwent two evening 2-hour 75-gram oral OGTT: early and late (4h vs. 1h prior to habitual bedtime), simulating early and late dinner timing. Habitual bedtime was determined using one-week of electronic sleep logs via smartphone application. The OGTT order was randomized and separated by 1-week washout period. Light intensity was kept bright (≥450 lux) and dim (0–25 lux) in the early and late conditions, respectively. Melatonin was assessed at the start and end of each OGTT by radioimmunoassay. Postprandial glucose and insulin were determined using incremental area under the curve (AUC). Insulin sensitivity and beta-cell function were evaluated using standard metrices: insulin sensitivity index (ISI), corrected insulin response (CIR), and disposition index (DI). Values were compared using paired t-tests and differences were considered significant at P &amp;lt; 0.05. Results A total of 750 participants (mean age = 37 ± 14; 70% female; mean BMI = 26.12 ± 5.66) underwent OGTTs in two evening timing conditions. As expected, melatonin levels were higher in the late vs. early condition (4.49 ± 4.15-fold lower in the early vs. late meal condition. In the early condition, there was an 8.68% lower AUC for glucose (P = .0001) and 4.4% higher insulin AUC (P = 0.059), relative to the late condition. In addition, the CIR was 16% (P = .0001) higher and the DI was higher by 20% (P = .014) in the early compared to the late condition. The ISI was similar in both conditions (P = 0.66). Conclusions In this large study, glucose tolerance was better during early vs. late evening OGTT. Better glucose tolerance was primarily attributed to improved insulin secretion and beta-cell function. These results indicate that for the general population, advancing dinner relative to bedtime may be a novel and an effective strategy to improve glucose tolerance. Funding Sources ONTIME-MT was funded by the NIH R01 grant R01DK105072.

SUN-020 Waist Circumference Is Associated with Insulin Resistance in Young Korean Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder and associated with metabolic disturbances such as insulin resistance (IR) and obesity which are risk factors for cardiovascular diseases. Many studies have shown that waist circumference (WC) representing abdominal obesity is an important risk factor for IR. However, there were few studies whether WC were associated with IR in young women with PCOS. We aimed to evaluate the role of WC in IR among young Korean women with PCOS. We enrolled age- and body mass index-matched women with PCOS (n = 100) and controls (n = 100). WC was measured and the 75-gram oral glucose tolerance test (OGTT) was performed. Insulin sensitivity was assessed by the Stumvoll index which was calculated from an OGTT. Multiple linear regression analysis was performed to evaluate the association between WC and IR. WC, fasting glucose, post-load 2-hour glucose, fasting insulin, and post-load 2-hour insulin did not differ between women with PCOS and controls. Women with PCOS had lower values of the Stumvoll index than the controls. In correlation analysis, WC was negatively correlated with the Stumvoll index in women with PCOS, however not in controls. In multiple regression analysis, WC was negatively associated with the Stumvoll index even after adjustment for age, total cholesterol, and total testosterone in women with PCOS. In young Korean women with PCOS, WC was negatively associated with insulin sensitivity independent of hyperandrogenemia. Simply measuring of WC could be used to screen the high risk group having IR in young women with PCOS.

Implementing the 2013 WHO diagnostic criteria for gestational diabetes mellitus in a Rural Nigerian Population.

Introductionthe World Health Organization (WHO) reviewed the threshold values required for the diagnosis of Gestational Diabetes Mellitus (GDM) in 2013 and the implementation of the new diagnostic criteria have been associated with increase in the prevalence of GDM in some populations. The new cohort of pregnant women that will be labeled to have GDM by the 2013 WHO diagnostic criteria but not by the 1999 WHO diagnostic criteria will pose additional burden to specialized antenatal care, though their pregnancy outcome may not warrant such care. It is thus important to first determine the effect of the implementation of these new consensus diagnostic criteria on the prevalence of GDM in our environment.Methodsthis is a prospective hospital-based study that compared the implementation of both 1999 and 2013 WHO GDM diagnostic criteria among 117 pregnant women who were initially screened with 50-gram Glucose Challenge Test (50-g GCT). Women with a positive Glucose Challenge Test (GCT) result underwent a 75-gram Oral Glucose Tolerance Test (75-g OGTT), which was used as the actual diagnostic test for GDM using both 2013 WHO and 1999 WHO diagnostic criteria. Associations between variables were tested using Chi-square, Fisher's exact and t-test as appropriate. Significance level was set at P value < 0.05.Resultsthe prevalence rates of GDM in the study were 2.6% and 7.7% for 1999 WHO and 2013 WHO criteria respectively. Clinical characteristics were similar in women with GDM and women without GDM. The fasting component of the OGTT identified all the women with GDM.Conclusionthe implementation of the 2013 WHO diagnostic criteria is associated with a 2.5 to 3-fold rise in the prevalence of GDM. Selective risk-factor based screening may be clinically irrelevant with the adoption of the 2013 WHO diagnostic criteria. A minimum of fasting plasma glucose in resource poor settings can be considered to identify women with GDM since it appeared to have 100% sensitivity in our study.

382: Concomitant insulin and oral hypoglycemic use predicts the diagnosis of type II diabetes

Women with gestational diabetes (GDM) often remain diabetic postpartum (PP) but high rates of noncompliance frequently lead to under diagnosis. We sought to understand what antepartum factors were associated with persistent diabetes to inform more focused follow-up. This was a planned secondary analysis of a prospective cohort of women with GDM undergoing 75-gram oral glucose tolerance test (OGTT) at 6 weeks PP. A diagnosis of Type II DM was made if glucose level was >199 mg/dL. Bivariate analysis was initially performed to select variables for multivariable analysis. 446 included women, 157 (35%) completed an OGTT screening and 15.9% had persistent diabetes. Age, race, prior history of GDM and BMI were similar between the two groups (p >0.05). Neonates of women tended to be lighter amongst women with persistent diabetes (p=0.04) but this trend did not persist in multivariable analysis. Women who required both hypoglycemic medication and insulin to control their diabetes were at increased odds of Type II DM by more than 4 times (OR 4.3, 95%CI 1.4-12., p< 0.008). Women with concomitant insulin and oral hypoglycemic use are at a significantly higher risk of screening positive for type II DM in the PP period. With the reported low rates of compliance and the high rate of Type II DM in this cohort, these women should be strongly counseled about the short term and long-term potential risks of missing their postpartum screening.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Sitagliptin Decreases Visceral Fat and Blood Glucose in Women With Polycystic Ovarian Syndrome.

Women with polycystic ovarian syndrome (PCOS) have decreased growth hormone (GH), which can result in increased visceral adiposity (VAT) and impaired vascular function. GH-releasing hormone, a dipeptidyl peptidase-4 (DPP4) substrate, stimulates GH secretion. We tested the hypothesis that DPP4 inhibition increases GH and improves glucose levels and vascular function in women with PCOS. Eighteen women with PCOS participated in a double-blind, crossover study. They received sitagliptin either 100 mg or placebo daily for 1 month, with crossover treatments separated by an 8-week washout. During each treatment, women underwent a 75-gram oral glucose tolerance test (OGTT) and assessments of vascular function and body composition. Overnight GH secretion was assessed via venous sampling every 10 minutes for 12 hours and analyzed using an automated deconvolution algorithm. During OGTT, sitagliptin increased glucagon-like peptide-1 (P < 0.001), early insulin secretion (from mean [± SD] insulinogenic index 1.9 ± 1.2 to 3.2 ± 3.1; P = 0.02), and decreased peak glucose (mean -17.2 mg/dL [95% CI, -27.7 to -6.6]; P < 0.01). At 1 month, sitagliptin decreased VAT (from 1141.9 ± 700.7 to 1055.1 ± 710.1 g; P = 0.02) but did not affect vascular function. Sitagliptin increased GH half-life (from 13.9 ± 3.6 to 17.0 ± 6.8 min, N = 16; P = 0.04) and interpulse interval (from 53.2 ± 20.0 to 77.3 ± 38.2 min, N = 16; P < 0.05) but did not increase mean overnight GH (P = 0.92 vs placebo). Sitagliptin decreased the maximal glucose response to OGTT and VAT. Sitagliptin did not increase overnight GH but increased GH half-life and the interpulse interval. This study was registered at www.clinicaltrials.gov as NCT02122380 prior to enrollment of the first participant.

Association of hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus.

BACKGROUNDGestational diabetes mellitus (GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test (OGTT) at 24-28 wk gestation is the recommended screening test in the United Kingdom as per National Institute for Health and Care Excellence (NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is unclear.AIMTo determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth weight.METHODSAll deliveries between 2009 and 2013 at the local maternity unit of the University hospital were reviewed. Of the total number of 24,154 women without pre-existing diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study (n = 3537). Blood samples for fasting plasma glucose (FPG), 2-hour plasma glucose (2-h PG) and HbA1c had been obtained. Birth weight was categorised as low (≤ 2500 g), normal or Macrosomia (≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ2 test and comparison between group means was by one-way ANOVA.RESULTSAmongst the study cohort (3537 deliveries), 96 (2.7%) women had babies with LBW (< 2500 g). Women who delivered a LBW baby had significantly lower FPG (4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies (8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L, whereas maternal age, 2-h PG ≥ 7.8 mmol/L and HbA1c were not significant predictors.CONCLUSIONA low FPG and 2-h PG ≤ 3.5 mmol/L on 75-gram OGTT are significantly associated with low birth weight in women identified as high risk for GDM. Women of ethnic backgrounds (Asians) appear to be more susceptible to this increased risk and may serve as a separate cohort in whom we should offer more intensive follow up and screening for complications. Cost implications and resources for follow up would need to be looked at in further detail to support these findings.

The Acute Effect of a Ketone Monoester Supplement on Metabolic Control in Individuals with Obesity

OBJECTIVESTo determine whether acute ingestion of ketone monoester (KE; (R)‐3‐hydroxybutyl (R)‐3‐hydroxybutyrate) impacts plasma glucose and free fatty acid levels during a standard 75‐gram oral glucose tolerance test (OGTT) in individuals with obesity.METHODSFifteen participants (age = 47±10 years) with a body mass index &gt; 27 kg/m2 and a waist circumference &gt;88 cm (female) or &gt;102 cm (male) took part in a randomized crossover study. After an overnight fast, participants consumed a KE supplement (DeltaG®; 0.45 ml/kg body weight) or taste‐matched placebo 30 minutes before completing a 2‐hour OGTT with blood samples collected every 15–30 minutes. Participants and study personnel performing laboratory analyses were blinded to condition.RESULTSKE acutely raised blood D‐beta‐hydroxybutyrate to an average concentration of 2.4±1.2 mM within 30 minutes with levels remaining elevated throughout the entire OGTT. Compared to placebo, KE significantly decreased glucose area under the curve (AUC; −11%, P = 0.002), glucose incremental area under the curve (AUC; −23%, P = 0.008) and non‐esterified fatty acid (AUC; −21%, P = 0.009). Insulin and C‐peptide levels increased significantly over the 30 minutes period prior to the OGTT (P = 0.001 and 0.003 respectively) but no differences in total AUCs were observed as compared to placebo. No significant changes in lactate or triglycerides were observed.CONCLUSIONIn conclusion, a KE supplement that acutely increased D‐beta‐hydroxybutyrate levels attenuated the glycemic response to an OGTT in individuals with obesity. The reduction in glycemic response was accompanied by a reduction in non‐esterified fatty acids. These results suggest that ketone ester supplements could have therapeutic potential in the management and prevention of metabolic diseases.Support or Funding InformationThis project was funded by a Heart and Stroke Foundation of Canada Grant‐in‐Aid. JPL is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Salary Award (MSH‐141980) and a Michael Smith Foundation for Health Research (MSFHR) Scholar Award (16890).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Frequency of carbohydrate metabolism disorders in day-care patients with borderline fasting blood sugar levels and at least one risk factor for diabetes mellitus

In order to assess the diagnosis of carbohydrate metabolism disorders, day care patients from Tambov central regional hospital were investigated. The study was conducted during 6 months in 2018. The study included 91 patients and allowed the diagnosis of type 2 diabetes mellitus (DM) in 31 (34.0%) cases, 6 (6.5%) impaired fasting glucose and 22 (24.1%) impaired glucose tolerance. This survey highlighted the necessity to expand the screening populations at risk for developing type 2 diabetes. The rational for the 75-gram oral glucose tolerance test for all individuals with fasting plasma glucose ≥ 5.6 ≤ 6.0 mmol/l and having one or more risk factors for developing type 2 diabetes and / or metabolic syndrome is shown. Among these categories diabetes was detected in 4.3%, and prediabetes in 14.4% of cases.