Glucose Loading Test Research Articles

The Role of Glucose, Insulin and Body Fat in Assessment of Bone Mineral Density and Trabecular Bone Score in Women with Functional Hypothalamic Amenorrhea.

Background: For years, bone mineral density (BMD) has played a key role in assessing bone health, but the trabecular bone score (TBS) is emerging as an equivalent measure. However, BMD alone may not fully measure bone quality or predict osteoporosis risk. To evaluate the usefulness of TBS and BMD in estimating the risk of bone fracture in young women with FHA, this study examined the association between metabolic parameters and bone quality, which was measured using TBS and BMD. Methods: We analyzed the association of metabolic factors with tests assessing bone quality-TBS and BMD. Patients were checked for BMI, measured body fat, and determined serum glucose levels and insulin levels in a 75g glucose load test. Spearman correlation analysis was used. Results: Significant positive correlations were found between BMD and age (p < 0.001) and body fat (p < 0.001), as well as between TBS values and BMI (p < 0.001) and TBS and percent body fat (p < 0.001). Of the variables analyzed in the multivariate analysis, the only independent predictor of higher bone mineral density in the lumbar spine was found to be higher values of the trabecular bone index in the same segment (p < 0.001). Conclusions: The use of TBS provides a simple tool for estimating the risk of bone damage. Ultimately, early screening, diagnosis and treatment of patients with FHA may help prevent osteoporosis and fragility fractures in the long term.

Risk of Neonatal Hypoglycemia in Infants of Mothers With Gestational Glucose Intolerance.

To examine the relationship between gestational glucose intolerance (GGI) and neonatal hypoglycemia. This was a secondary analysis of 8,262 mother-infant dyads, with delivery at two hospitals between 2014 and 2023. We categorized maternal glycemic status as normal glucose tolerance (NGT), GGI, or gestational diabetes mellitus (GDM). We defined NGT according to a normal glucose load test result, GGI according to an abnormal glucose load test result with zero (GGI-0) or one (GGI-1) abnormal value on the 100-g oral glucose tolerance test, and GDM according to an abnormal glucose load test result with two or more abnormal values on the glucose tolerance test. Neonatal hypoglycemia was defined according to blood glucose <45 mg/dL or ICD-9 or ICD-10 diagnosis of neonatal hypoglycemia. We used logistic regression analysis to determine associations between maternal glucose tolerance category and neonatal hypoglycemia and conducted a sensitivity analysis using Δ-adjusted multiple imputation, assuming for unscreened infants a rate of neonatal hypoglycemia as high as 33%. Of infants, 12% had neonatal hypoglycemia. In adjusted models, infants born to mothers with GGI-0 had 1.28 (95% 1.12, 1.65), GGI-1 1.58 (95% CI 1.11, 2.25), and GDM 4.90 (95% CI 3.81, 6.29) times higher odds of neonatal hypoglycemia in comparison with infants born to mothers with NGT. Associations in sensitivity analyses were consistent with the primary analysis. GGI is associated with increased risk of neonatal hypoglycemia. Future research should include examination of these associations in a cohort with more complete neonatal blood glucose ascertainment and determination of the clinical significance of these findings on long-term child health.

Allicin Promotes Glucose Uptake by Activating AMPK through CSE/H2S-Induced S-Sulfhydration in a Muscle-Fiber Dependent Way in Broiler Chickens.

Allicin, a product of enzymatic reaction when garlic is injured, plays an important role in maintaining glucose homeostasis in mammals. However, the effect of allicin on glucose homeostasis in the state of insulin resistance remains to be elucidated. This study investigates the effect of allicin on glucose metabolism using different muscle fibers in a chicken model. Day-old male Arbor Acres broilers are randomly divided into three groups and fed a basal diet supplemented with 0, 150, or 300mgkg-1 allicin for 42 days. Results show that allicin improves the zootechnical performance of broilers at the finishing stage. The glucose loading test (2gkg-1 body mass) indicates the regulatory role of allicin on glucose homeostasis. In vitro results demonstrate allicin increases glutathione (GSH) level and the expression of cystathionine γ lyase (CSE), leading to endogenous hydrogen sulfide (H2S) production in M. pectoralis major (PM) muscle-derived myotubes. Allicin stimulates adenosine monophosphate-activated protein kinase (AMPK) S-sulfhydration and AMPK phosphorylation to promote glucose uptake, which is suppressed in the presence of d,l-propargylglycine (PAG, a CSE inhibitor). This study demonstrates that allicin induces AMPK S-sulfhydration and AMPK phosphorylation to promote glucose uptake via the CSE/H2S system in a muscle fiber-dependent manner.

Association of Neutrophil-Lymphocyte Ratio (NLR) with Prediabetes and Type-2 Diabetes Mellitus

Background: Diabetes mellitus and associated complications are related to systemic inflammation and insulin resistance. Recently NLR has been used as a marker of the systemic inflammatory process in chronic diseases. NLR is a widely available inexpensivehematological parameter and can be used in the prediction of diabetes-related complications. Objectives: The present study aimed to explore the association of NLR with the glycemic status of pre-diabetes and type 2 DM in comparison to normal healthy adults. Methods: A total of 105 study subjects were included.Fasting plasma glucose (FPG), 2 hours after 75gm glucose load (2 hrs PG), HbA1c, and Complete blood count (CBC) tests were done.Then the study subjects were categorized into Group 1 (Normal healthy adult), Group 2 (Pre-diabetes), and Group 3 (Diabetes). Each group contains 35 study subjects. Data (collected in preformed proforma) were analyzed by SPSS Version 22-0. Comparison of various parameters was done by Chi-Square test, ANOVA test, and Kruskal-Wallis test followed by post-hoc test. Spearmen correlation coefficient test was done to see the correlation of NLR with glycemic status (FPG, 2 hrs PG, and HbA1c). Results: Age and sex were not statistically significant.Median values of FPG, 2hrs PG, and HbA1c were significantly higher in Group 2 and Group 3 in comparison to Group 1(p-value &lt;0.001). Median values of NLR were significantly higher in Group 2 and Group 3 in comparison to Group 1 (p&lt;0.001). NLR was also positively correlated with 2hrs PG and HbA1c in Group 2 and Group 3 with p values 0.034, 0.013 &amp; 0.019, and 0.036 respectively. Group 1 showed no significant correlation with NLR. Conclusion: This study showed that NLR was higher in both pre-diabetes and type 2 DM with a positive correlation. It can be used in the prediction of dysglycemia-related complications in the future.

Preconception Stress and Pregnancy Serum Glucose Levels Among Women Attending a Fertility Center.

The association between women's stress and pregnancy glucose levels remain unclear, specifically when considering the preconception period as a sensitive window of exposure. We investigated whether preconception perceived stress was associated with glucose levels during pregnancy among women attending a fertility center (2004-2019). Before conception, women completed a psychological stress survey using the short version of the validated Perceived Stress Scale 4 (PSS-4), and blood glucose was measured using a 50-gram glucose load test during late pregnancy as a part of screening for gestational diabetes. Linear and log-binomial regression models were used to assess associations of total PSS-4 scores with mean glucose levels and abnormal glucose levels ( ≥ 140 mg/dL), adjusting for age, body mass index, race, smoking, education, physical activity, primary infertility diagnosis, number of babies, and mode of conception. Psychological stress was positively associated with mean abnormal glucose levels. The adjusted marginal means (95% CI) of mean glucose levels for women in the first, second, and third tertiles of psychological stress were 115 (110, 119), 119 (115, 123), and 124 (119, 128), and mg/dL, respectively (P for trend = .007). Also, women in the second and third tertiles of psychological stress had 4% and 13% higher probabilities of having abnormal glucose compared with women in the first tertile of psychological stress (P trend = .01). These results highlight the importance of considering preconception when evaluating the relationship between women's stress and pregnancy glucose levels.

Gestational Glucose Intolerance and Birth Weight-Related Complications.

To evaluate the risks of large-for-gestational-age birth weight (LGA) and birth weight-related complications in pregnant individuals with gestational glucose intolerance, an abnormal screening glucose loading test result without meeting gestational diabetes mellitus (GDM) criteria. In a retrospective cohort study of 46,989 individuals with singleton pregnancies who delivered after 28 weeks of gestation, those with glucose loading test results less than 140 mg/dL were classified as having normal glucose tolerance. Those with glucose loading test results of 140 mg/dL or higher and fewer than two abnormal values on a 3-hour 100-g oral glucose tolerance test (OGTT) were classified as having gestational glucose intolerance. Those with two or more abnormal OGTT values were classified as having GDM. We hypothesized that gestational glucose intolerance would be associated with higher odds of LGA (birth weight greater than the 90th percentile for gestational age and sex). We used generalized estimating equations to examine the odds of LGA in pregnant individuals with gestational glucose intolerance compared with those with normal glucose tolerance, after adjustment for age, body mass index, parity, health insurance, race and ethnicity, and marital status. In addition, we investigated differences in birth weight-related adverse pregnancy outcomes. Large for gestational age was present in 7.8% of 39,685 pregnant individuals with normal glucose tolerance, 9.5% of 4,155 pregnant individuals with gestational glucose intolerance and normal OGTT, 14.5% of 1,438 pregnant individuals with gestational glucose intolerance and one abnormal OGTT value, and 16.0% of 1,711 pregnant individuals with GDM. The adjusted odds of LGA were higher in pregnant individuals with gestational glucose intolerance than in those with normal glucose tolerance overall (adjusted odds ratio [aOR] 1.35, 95% CI 1.23-1.49, P <.001). When compared separately with pregnant individuals with normal glucose tolerance, those with either gestational glucose intolerance subtype had higher adjusted LGA odds (gestational glucose intolerance with normal OGTT aOR 1.21, 95% CI 1.08-1.35, P <.001; gestational glucose intolerance with one abnormal OGTT value aOR 1.77, 95% CI 1.52-2.08, P <.001). The odds of birth weight-related adverse outcomes (including cesarean delivery, severe perineal lacerations, and shoulder dystocia or clavicular fracture) were higher in pregnant individuals with gestational glucose intolerance with one abnormal OGTT value than in those with normal glucose tolerance. Gestational glucose intolerance in pregnancy is associated with birth weight-related adverse pregnancy outcomes. Glucose lowering should be investigated as a strategy for lowering the risk of these outcomes in this group.

1089-P: Gestational Glucose Intolerance and Risk of Childhood Overweight and Obesity

Infants of individuals with gestational glucose intolerance (GGI, abnormal glucose loading test [GLT] without gestational diabetes [GDM]) have increased risk of large for gestational age birthweight, but an association between GGI and childhood adiposity has not been consistently observed. We studied the risk of overweight and obesity in 2-5-year-old children exposed to varying degrees of maternal glycemia in utero in a retrospective hospital-based cohort. We defined normal glucose tolerance (NGT) as a GLT &amp;lt;140 mg/dl, GGI as GLT ≥ 140 mg/dl and zero (GGI-0) or 1 (GGI-1) abnormal values on a 3-hour 100-gram oral glucose tolerance test (OGTT), and gestational diabetes (GDM) as ≥2 abnormal values. We used logistic regression to investigate the risk of obesity, defined as body mass index (BMI) &amp;gt; 95th percentile, in children born to individuals with GGI and GDM as compared to NGT. In model 1, we adjusted for maternal age, gestational weight gain, parity, insurance, race/ethnicity, marital status, gestational age at delivery and infant sex; in model 2, we further adjusted for maternal 1st trimester BMI. Of n=12728 children, 48.5% were female, the mean (SD) gestational age at delivery was 39.4 (1.7) weeks, and the mean birthweight was 3341 (519) grams. A total of 10567 children were exposed to NGT in utero, 1156 to GGI-0, 428 to GGI-1, and 577 to GDM. Obesity was present in 12.9% of children exposed to NGT, 12.5% exposed to GGI-0, 16.6% exposed to GGI-1, and 18.5% exposed to GDM, respectively. In model 1, there was an increased odds of obesity in those exposed to GGI-1 (1.37 [1.04, 1.78], P=0.02) and GDM (1.61 [1.28, 2.02] P&amp;lt;0.001). After maternal BMI adjustment, we did not find a significant increased risk of obesity in any group compared to NGT (GGI-1: 1.15 [0.86, 1.51] P=0.33; GDM 1.24 (0.97, 1.57), P=0.08). After accounting for maternal BMI, children exposed to GGI and GDM in utero have a similar risk of obesity in early childhood to those born to NGT pregnancies. Disclosure J.Maya: None. S.Hsu: None. C.C.M.Schulte: None. K.James: None. T.Thaweethai: None. M.Hivert: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health. Funding National Institutes of Health (T32DK007028-47S1)

Abstract P244: Gestational Glucose Intolerance is Associated With Hypertensive Disorders of Pregnancy in a Large Hospital-Based Multiethnic Cohort

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with higher future cardiovascular risk. Treatment of gestational diabetes (GDM) has been shown to reduce the risk of HDP. It is unknown if women with gestational glucose intolerance (GGI), defined as abnormal GDM screening but without a GDM diagnosis, are at higher risk of HDP. Currently, GGI is not treated. Hypothesis: We tested the hypothesis that GGI pregnancies have increased odds of HDP. Methods: This is a retrospective cohort study of 41,706 singleton pregnancies delivered at an academic center. Based on the results of GDM screening and diagnostic tests, pregnancies were categorized as normal glucose tolerance (NGT, glucose loading test &lt; 140 mg/dl), GGI (glucose loading test ≥140 mg/dl with 0 or 1 abnormal value on oral glucose tolerance testing [OGTT] thus without GDM), or GDM (≥ 2 abnormal values on OGTT). GGI was further classified into groups with zero (GGI-0) or 1 (GGI-1) abnormal OGTT values. We used laboratory, blood pressure, and delivery reports to capture HDP and exclude chronic hypertension. Generalized estimating equations for logistic regression were used to measure the risk of HDP after adjustment for age, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A similar approach was used to test for associations between GGI and pre-eclampsia (PE). Results: A total of 84.5% of pregnancies were classified as NGT, 8.9% as GGI-0, 3.0% as GGI-1 and 3.6% as GDM. The unadjusted frequencies of HDP and PE were higher in GGI-1 (140 [11.2%] and 64 [5.1%] of 1,251) and GDM (165 [11.1%] and 94 [6.3%] of 1,485) compared to NGT (2,275 [6.5%] and 1,100 [3.1%] of 35,238) and GGI-0 (283 [7.6%] and 136 [3.6%] of 3,732). We observed greater odds of HDP in all 3 groups compared to NGT in adjusted models, and similar trends for PE (Figure 1). Conclusions: The risks of HDP and PE in GGI-1 are greater than for NGT pregnancies and similar to the risks in GDM. Our results suggest that women with GGI-1 should be considered for intervention, similar to GDM.

Frequency of Gestational Diabetes Mellitus in Pregnant Women Reporting to a Public Sector Tertiary Care Hospital of Quetta

Objective: To determine the frequency of gestational diabetes mellitus in pregnant women reporting to a public sector tertiary care hospital and find the association of gestational diabetes mellitus with age.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Pathology Department, Combined Military Hospital, Quetta Pakistan, from Jan 2016 to Mar2017.&#x0D; Methodology: Five hundred and thirty pregnant women who reported to the Pathology Department of the hospital for an Oral Glucose Tolerance Test at 24-28 weeks of gestation were included. The blood samples were taken after ten hours off fasting and one hour and two hours after loading with 75g of anhydrous glucose and analyzed using the enzymatic (Glucose Oxidase) method. Gestational diabetes mellitus was diagnosed using guidelines recommended by the International Association for Diabetes and Pregnancy Study Group /American Diabetic Association for a one-step diagnosis of gestational diabetes mellitus according to the new criteria.&#x0D; Results: The frequency of gestational diabetes mellitus was quite high 190(35.8%). Of these 530 pregnant women, 162(85.3%)women were diagnosed with Fasting Plasma Glucose, and 28 women were diagnosed with 1-hour or 2-hour after the glucose load test. Age-group of ≥ 30 years had the highest number of women with gestational diabetes mellitus.&#x0D; Conclusion: The frequency of gestational diabetes mellitus in our hospital-reported sample of pregnant women was 35.8%,associated with advanced age. The maximum number of women were diagnosed as having gestational diabetes mellitus based on the fasting Plasma Glucose cut-off value.

Gestational Glucose Intolerance and Risk of Future Diabetes.

Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy. We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks' gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance. Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54-2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09-2.16], P = 0.01; one, aHR 2.97 [2.07-4.27], P < 0.001; GDM, aHR 8.26 [6.49-10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively. GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.

Maternal Glycemic Spectrum and Adverse Pregnancy and Perinatal Outcomes in a Multiracial US Cohort.

Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non-PDM/GDM) in the Boston Birth Cohort (1998–2016). Women in the non-PDM/GDM group were subdivided by tertiles of 1 h, 50 g oral glucose load test at 24–32 weeks: T1: 50–95 mg/dL (n = 1166), T2: 96–116 mg/dL (n = 1151), T3: 117–201 mg/dL (n = 913). Using multivariable logistic regression, we examined the association of maternal glycemia with APOs—preterm birth (PTB) and hypertensive disorders of pregnancy (HDP)—and adverse perinatal outcomes—high birth weight (HBW), cesarean section (CS), and sub-analyses by race-ethnicity. Compared to women in T1, women in T2 and T3 had a higher prevalence of pre-existing hypertension (T1: 2.8% vs. T2: 5.2% vs. T3: 6.3%) and obesity (T1: 13.3% vs. T2: 18.1% vs. T3: 22.9%). Women in T2 and T3 had higher odds of HBW (adjusted odds ratio aOR T2: 1.47 [1.01–2.19] T3: 1.68 [1.13–2.50]) compared to women in T1. Additionally, women in T2, compared to T1, had higher odds of HDP (aOR 1.44 [1.10–1.88]). Among non-Hispanic Black (NHB) women, those in T2 and T3 had higher odds of HDP compared to T1 (aOR T2 1.67 [1.13–2.51]; T3: 1.68 [1.07–2.62]). GDM and PDM were associated with higher odds of HBW, CS, PTB, and HDP, compared to women in T1. In this predominantly NHB and Hispanic cohort, moderate maternal glycemia without PDM/GDM was associated with higher odds of HBW and HDP, even more strongly among NHB women. If confirmed, a review of current guidelines of glucose screening and risk stratification in pregnancy may be warranted.

1042-P: Large-for-Gestational-Age Birthweight in Gestational Glucose Intolerance

Background: Treatment of gestational diabetes (GDM) reduces the risk of large for gestational age (LGA) birthweight and associated complications in infants. Pregnant people with gestational glucose intolerance (GGI, abnormal glucose loading test (GLT) without GDM) usually remain untreated. We examined the risk of LGA among women with GGI in a large cohort. Methods: In a retrospective cohort study of 44,628 singleton pregnancies delivered at an academic center at &amp;gt;28 weeks' gestation, pregnancies with a GLT &amp;gt;140 mg/dl and either a normal 3-hour 100-gram oral glucose tolerance test (OGTT) or one abnormal OGTT value were classified as GGI, and those with 2 abnormal OGTT values as GDM. We used generalized estimating equations for logistic regression to examine the risk of LGA (birthweight &amp;gt;90th percentile for gestational age) in GGI versus normal glucose tolerance (NGT, GLT &amp;lt;140 mg/dl) pregnancies after adjustment for age, gender, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A second model adjusted for gestational weight gain (GWG) . Results: LGA was present in 7.7% of 36,964 pregnancies with NGT, 9.6% of 4357 with GGI and normal OGTT, 14.3% of 15with GGI and one abnormal OGTT value, and 14.5% of 1800 with GDM. The odds of LGA were higher in GGI than NGT pregnancies (adjusted OR 1.4 [1.3-1.5], p&amp;lt;0.001) . When compared separately with NGT, both types of GGI had elevated odds of LGA: normal OGTT adjusted OR 1.2 [1.1-1.4], p&amp;lt;0.001, one abnormal OGTT value adjusted OR 1.8 [1.5-2.1], p&amp;lt;0.001. The latter was similar to that in GDM compared to NGT: adjusted OR 1.8 [1.5-2.0], p&amp;lt;0.001. Increased odds of LGA were also present for GGI/GDM groups after GWG adjustment: normal OGTT OR 1.3 [1.2-1.5] p&amp;lt;0.001, 1 abnormal OGTT value OR 1.8 [1.5-2.1] p&amp;lt;0.0GDM OR 2.2 [1.9-2.5] p&amp;lt;0.001. Conclusion: Infants of untreated people with GGI have increased risk of LGA birthweight. The risk of LGA in GGI pregnancies with one abnormal OGTT value was similar to that in GDM in a clinical setting where only GDM was treated. Disclosure J.Maya: None. D.J.Selen: None. T.Thaweethai: None. S.Hsu: None. C.Yu: None. K.James: None. A.Kaimal: None. M.Hivert: Advisory Panel; American Heart Association, Research Support; American Diabetes Association. C.E.Powe: None. Funding MGH (Physician Scientist Development Award and Claflin Distinguished Scholar's Award)

109-OR: Physiologic Subtypes of Gestational Glucose Intolerance and Risk of Future Prediabetes

Background: Gestational glucose intolerance (GGI, abnormal initial gestational diabetes [GDM] screen) conveys an increased risk of future diabetes (DM) , even when GDM criteria is not met. We previously defined subtypes of GGI/GDM according to the underlying mechanism leading to hyperglycemia (insulin resistance vs. deficiency) . We aimed to determine if GGI subtypes are at differential risk for future prediabetes/DM; we hypothesized increased risk with insulin deficient subtypes. Methods: We defined GGI as glucose loading test 1-hr glucose ≥ 140 mg/dL at &amp;gt; 22 weeks’ gestation. We applied homeostasis model assessment (HOMA) to fasting glucose and insulin at 16-20 weeks’ gestation and classified pregnancies with GGI without GDM into subtypes according to the presence of insulin resistance and/or deficiency. We used Cox proportional-hazards models with time-varying exposures to assess risk of preDM/DM (HbA1c ≥ 5.7% at ≥ 3 months after delivery) in each GGI subtype compared to pregnancies with normal glucose tolerance after adjustment for age, race/ethnicity, health insurance, and first trimester BMI. Women were censored at the time of last HbA1c or GDM diagnosis. Results: Of 671 women with a median 9.9 years of follow-up, 29% (n=196) developed preDM/DM. Among pregnancies in 113 women with GGI, 54% had the insulin resistant subtype (IR) , 25% had the insulin deficient subtype (ID) , and 16% had the mixed pathophysiology subtype (MP) . Subtypes with insulin deficiency (ID + MP) and insulin resistance (IR) were both associated with increased risk of preDM/DM (ID + MP hazard ratio [HR]=1.8 [1.1-2.9], p=0.02 and IR HR=1.7 [1.1-2.6], p=0.01) . Each insulin deficient subtype also appeared to carry increased risk: ID HR=1.7 (0.9-3.1, p=0.12) and MP HR=2.1 (1.0-4.2, p=0.048) . Conclusions: GGI confers an increased risk of future prediabetes/DM, regardless of the mechanism leading to glucose intolerance. A combination of insulin resistance and deficiency may convey the highest risk of future prediabetes/DM. Disclosure D.J. Selen: None. T. Thaweethai: None. K. James: None. J.L. Ecker: None. J.B. Meigs: Consultant; Quest Diagnostics. C.E. Powe: None. Funding National Institutes of Health (T32DK007028) , Massachusetts General Hospital (Physician Scientist Development Award and Claflin Distinguished Scholar’s Award)

Conocimiento del cardiólogo clínico sobre diabetes mellitus tipo 2 de alto riesgo. ¿Qué sabemos y cómo podemos mejorar?

Introduction and objectivesType 2 diabetes mellitus (T2DM) is mainly a cardiovascular disease. The objective of this study was to assess the knowledge of clinical cardiologists about the diagnosis and management of T2DM in patients with ischemic heart disease or high/very high risk of cardiovascular disease. MethodsThe “self-audit” methodology was used. A scientific committee designed a questionnaire that was answered by the participants before and after viewing 4 training videos. The results between both moments were compared. ResultsA total of 140 clinical cardiologists non-expert in T2DM participated. Knowledge about the diagnosis and treatment of T2DM in patients with ischemic heart disease or high/very high risk of cardiovascular disease was good in some points, such as considering the body mass index to decide treatment, or the oral glucose load test in case of a glycosylated hemoglobin value of 5.8%-6.4%. After the training, establishing a control value of abdominal perimeter<88cm in women and<102cm in men, and a stricter control of arterial hypertension were significantly more valued, as did low-density lipoprotein cholesterol. Other aspects represent training opportunities, such as assessing the lipid profile more thoroughly or differentiating the cardiovascular protection profile of the different treatments of T2DM. ConclusionsThe clinical cardiologist's knowledge about the diagnosis and treatment of T2DM in patients with ischemic heart disease or high /very high risk of cardiovascular disease is high, but it presents opportunities for improvement and training.

Plasma-glycated CD59 as an early biomarker for gestational diabetes mellitus: prospective cohort study protocol

IntroductionThe significant maternal and neonatal outcomes of gestational diabetes mellitus (GDM) make it a major public health concern. Mothers with GDM are at greater risk of pregnancy complications and their...

Urinary phthalate and DINCH metabolite concentrations and gradations of maternal glucose intolerance.

Studies suggest a link between pregnancy phthalate exposures and gestational diabetes mellitus (GDM). Few studies have evaluated associations between phthalate biomarkers (individual or mixtures) with gradations of maternal glucose intolerance. In a subset of 606 women participating in LIFECODES pregnancy cohort, a combination of 50-gram 1-h non-fasting glucose load test (GLT) and 100-gram 3-h fasting oral glucose tolerance test was used to determine pregnancy glycemic status (median: 27weeks gestation): normoglycemia (n=136), impaired glucose tolerance (IGT) (n=296), and GDM (n=174). Nineteen metabolites of phthalates and their replacements were measured during each trimester. We used multivariable logistic regression models to evaluate associations between biomarkers (in quartiles) and maternal glycemic status (GDM v. normoglycemia and IGT v. normoglycemia), adjusting for potential confounders. We also used principal component analysis to evaluate associations jointly accounting for metabolites as chemical mixtures. Higher 1st trimester mono-3-carboxypropyl phthalate (MCPP) was associated with decreased odds of GDM (Q4 v. Q1: 0.30; 95% CI: 0.13, 0.67) and IGT (Q4 v. Q1 OR: 0.37; 95% CI: 0.17, 0.79). Higher 2nd trimester mono-isobutyl phthalate (MiBP) was associated with increased IGT (Q4 v. Q1 OR: 2.07; 95% CI: 1.06, 4.07), and 2nd trimester mono-3-hydroxybutyl phthalate (MHBP) was non-monotonically associated with increased GDM (Q2 v. Q1 OR: 3.21; 95% CI: 1.54, 6.87). Mixture analyses showed similar associations (Q4 v. Q1 for 2nd trimester dibutyl phthalates metabotlites mixtures OR: 2.08; 95% CI: 1.04, 4.22). Some phthalate biomarkershad trimester-specific associations with glycemic outcomes, with long and short term health implications.

Can negative results of 40 g glucose load test exclude auto-brewery syndrome? Comment to: "Auto-brewery syndrome caused by oral fungi and periodontal disease bacteria" by Takahashi etal. Acute Med Surg. 2021 May 3; 8: e652.

Can negative results of 40 g glucose load test exclude auto-brewery syndrome? Comment to: "Auto-brewery syndrome caused by oral fungi and periodontal disease bacteria" by Takahashi etal. Acute Med Surg. 2021 May 3; 8: e652.

Physiological subtypes of gestational glucose intolerance and risk of adverse pregnancy outcomes

Women with gestational glucose intolerance, defined as an abnormal initial gestational diabetes mellitus screening test, are at risk of adverse pregnancy outcomes even if they do not have gestational diabetes mellitus. Previously, we defined the physiological subtypes of gestational diabetes mellitus based on the primary underlying physiology leading to hyperglycemia and found that women with different subtypes had differential risks of adverse outcomes. Physiological subclassification has not yet been applied to women with gestational glucose intolerance. We defined the physiological subtypes of gestational glucose intolerance based on the presence of insulin resistance, insulin deficiency, or mixed pathophysiology and aimed to determine whether these subtypes are at differential risks of adverse outcomes. We hypothesized that women with the insulin-resistant subtype of gestational glucose intolerance would have the greatest risk of adverse pregnancy outcomes. In a hospital-based cohort study, we studied women with gestational glucose intolerance (glucose loading test 1-hour glucose, ≥140 mg/dL; n=236) and normal glucose tolerance (glucose loading test 1-hour glucose, <140 mg/dL; n=1472). We applied homeostasis model assessment to fasting glucose and insulin levels at 16 to 20 weeks' gestation to assess insulin resistance and deficiency and used these measures to classify women with gestational glucose intolerance into subtypes. We compared odds of adverse outcomes (large for gestational age birthweight, neonatal intensive care unit admission, pregnancy-related hypertension, and cesarean delivery) in each subtype to odds in women with normal glucose tolerance using logistic regression with adjustment for age, race and ethnicity, marital status, and body mass index. Of women with gestational glucose intolerance (12% with gestational diabetes mellitus), 115 (49%) had the insulin-resistant subtype, 70 (27%) had the insulin-deficient subtype, 40 (17%) had the mixed pathophysiology subtype, and 11 (5%) were uncategorized. We found increased odds of large for gestational age birthweight (primary outcome) in women with the insulin-resistant subtype compared with women with normal glucose tolerance (odds ratio, 2.35; 95% confidence interval, 1.43-3.88; P=.001; adjusted odds ratio, 1.74; 95% confidence interval, 1.02-3.48; P=.04). The odds of large for gestational age birthweight in women with the insulin-deficient subtype were increased only after adjustment for covariates (odds ratio, 1.69; 95% confidence interval, 0.84-3.38; P=.14; adjusted odds ratio, 2.05; 95% confidence interval, 1.01-4.19; P=.048). Among secondary outcomes, there was a trend toward increased odds of neonatal intensive care unit admission in the insulin-resistant subtype in an unadjusted model (odds ratio, 2.09; 95% confidence interval, 0.99-4.40; P=.05); this finding was driven by an increased risk of neonatal intensive care unit admission in women with the insulin-resistant subtype and a body mass index of <25 kg/m2. Infants of women with other subtypes did not have increased odds of neonatal intensive care unit admission. The odds of pregnancy-related hypertension in women with the insulin-resistant subtype were increased (odds ratio, 2.09; 95% confidence interval, 1.31-3.33; P=.002; adjusted odds ratio, 1.77; 95% confidence interval, 1.07-2.92; P=.03) compared with women with normal glucose tolerance; other subtypes did not have increased odds of pregnancy-related hypertension. There was no difference in cesarean delivery rates in nulliparous women across subtypes. Insulin-resistant gestational glucose intolerance is a high-risk subtype for adverse pregnancy outcomes. Delineating physiological subtypes may provide opportunities for a more personalized approach to gestational glucose intolerance.

98-OR: Gestational Glucose Intolerance without Gestational Diabetes Is a Risk Factor for Type 2 Diabetes

Background: Women with gestational diabetes (GDM) have an increased risk of adverse perinatal outcomes and future type 2 diabetes (T2D). Gestational glucose intolerance (GGI, abnormal initial GDM screen) without GDM has been linked to adverse perinatal outcomes but is not a recognized T2D risk factor. We tested whether GGI without GDM is associated with incident T2D. Methods: Using clinical data from women seen at our US medical center for prenatal and primary care (1998-2018), we assessed risk of T2D (defined using validated laboratory and outpatient diagnoses) according to GGI/GDM status during pregnancy. We defined GGI as 1-hr glucose loading test (GLT) ≥ 140 mg/dl at ≥ 24 weeks gestation. We subcategorized GGI by 3-hr oral glucose tolerance test (OGTT) result. We used Cox proportional-hazard models with time-varying exposures/covariates to assess T2D risk after delivery, adjusting for age, race/ethnicity, parity, insurance type, marital status, BMI, and blood pressure. Women were followed from 1st delivery until diagnosed with T2D or censored at time of last primary care visit. Results: Among 13988 women, 17109 pregnancies had normal glucose tolerance (NGT, GLT &amp;lt; 140mg/dL). Among 3619 GGI pregnancies (GLT ≥ 140 mg/dl), 2076 had a normal OGTT, 699 had 1 abnormal OGTT value, and 844 had GDM (≥ 2 abnormal OGTT values). Over a median of 8.3 years of follow-up, 2.2% (N=304 women) developed T2D. In our primary comparison, women with GGI without GDM (16% of pregnancies) had increased T2D risk compared to women with NGT (HR 2.1 [1.5-2.9], p&amp;lt;0.001). Among women with GGI, T2D risk increased with the number of abnormal OGTT values (normal OGTT: HR 1.8; 1 abnormal OGTT value: HR 2.8; GDM: HR 11.7; p≤0.01 for all compared to NGT). Conclusions: Pregnant women with GGI without GDM have a two-fold increased risk of future T2D compared to those with NGT. Clinical data universally available during pregnancy identifies a large, previously unrecognized group of women who may benefit from T2D screening and prevention. Disclosure D. J. Selen: None. T. Thaweethai: None. S. Hsu: None. K. James: None. A. Kaimal: None. J. B. Meigs: Consultant; Self; Quest Diagnostics. C. E. Powe: None. Funding National Institutes of Health (2T32DK007028-46, K23DK113218); Robert Wood Johnson Foundation; Massachusetts General Hospital

Insulin Resistant Gestational Glucose Intolerance Is Associated With Adverse Perinatal Outcomes

Background: Women with gestational diabetes mellitus (GDM) and gestational glucose intolerance (GGI, abnormal initial GDM screening test) and their infants have an increased risk of adverse perinatal outcomes including large for gestational age birth weight (LGA), pregnancy-related hypertension, neonatal intensive care unit (NICU) admission, and cesarean delivery. We expanded a prior analysis defining physiologic subtypes of GGI categorized by insulin resistance, insulin deficiency, or mixed pathophysiology. We aimed to determine if GGI subtypes are at differential risk for adverse outcomes.Methods: We applied homeostasis model assessment (HOMA2) to fasting glucose and insulin levels at 16–20 weeks’ gestation to assess insulin resistance and deficiency, defined using the 50th percentile in 220 women with a normal glucose loading test (GLT) at 24–30 weeks’ gestation. We defined GGI as GLT 1-hr glucose ≥140 mg/dL (n=245) and normal glucose tolerance (NGT) as GLT 1-hr glucose <140 mg/dL (n=1538). We classified women with GGI into subtypes according to the presence of insulin resistance and/or deficiency. We compared odds of adverse outcomes in each subtype to odds in women with NGT using logistic regression with adjustment for age, race/ethnicity, marital status, and 1st trimester BMI, plus infant sex in LGA models.Results: Of women with GGI, 49.0% had the insulin resistant subtype (IR, n=120), 30.6% had the insulin deficient subtype (ID, n=75), 15.9% had mixed pathophysiology (MP, n=39), and 4.5% had no evidence of IR or ID (n=11). GLT results and GDM diagnosis were similar among GGI subtypes. We found increased odds of LGA (primary outcome) in women with IR compared to women with NGT (OR 1.97 [1.17–3.32], p=0.01) in an unadjusted model; this was attenuated in an adjusted model with BMI (adjusted OR 1.43 [0.82–2.49], p=0.21). There was a trend toward increased odds of LGA in women with ID (adjusted OR 1.87 [0.92–3.80], p=0.09) and no increased odds in women with MP (adjusted OR 1.33 [0.50–3.57], p=0.57) compared to NGT. The odds of pregnancy-related hypertension in the IR subtype were increased (adjusted OR 1.68 [1.02–2.77], p=0.04) compared to women with NGT; women with ID (adjusted OR 0.91 [0.44–1.88], p=0.79) or MP (adjusted OR 1.13 [0.48–2.67], p=0.78) did not have increased odds. Neither infants of women with IR nor ID had increased odds of NICU admission overall, yet among women with BMI <25, infants of those with IR had increased odds of NICU admission compared to those of women with NGT (adjusted OR 3.37 [1.04–10.96], p=0.02); odds of NICU admission were not increased in infants of women with ID and BMI <25 (adjusted OR 0.50 [0.07–3.83], p=0.50). There was no difference in cesarean delivery across subtypes.Conclusion: Insulin resistant GGI is a high-risk subtype for adverse perinatal outcomes. Using HOMA2 to delineate subtypes may provide opportunities for a personalized approach to GGI/GDM.