Gm Oral Glucose Tolerance Test Research Articles

Prevalence of gestational diabetes mellitus and its association with various risk factors in a tertiary care hospital in tribal population of Jharkhand

Background: Gestational diabetes mellitus (GDM) is associated with hypertension, preeclampsia, stillbirth, macrosomia, unexplained intrauterine death, instrumental and traumatic delivery leading to both maternal and foetal injuries, and increased risk of maternal and neonatal infections. The present study was conducted at Rajendra Institute of Medical Sciences, Ranchi to determine the prevalence of Gestational Diabetes Mellitus(GDM) and its associated risk factors in tribal population of Jharkhand. Aims and Objectives: The aim of the study was to determine the prevalence of GDM and to analyze its association with various risk factors. Materials and Methods: Detailed history of all patients was taken with emphasis on genetic and family history and history of the previous pregnancies. All the patients were screened by the single step 75 gm 2 hours oral glucose tolerance test (OGTT) as recommended by the World Health Organization. GDM was diagnosed if 2 hours PG is ≥140 mg/dL. Results: Most patients of GDM were from upper middle class 45.45%, followed by lower middle class (27.27%) and upper lower class (18.18%). For the non-GDM patients, most patients were from upper lower class (55.055%), followed by upper middle (24.71%). The prevalence of GDM was 12.12 % in the tribal population as compared to non-tribal population (10.44 %). In present study, in majority (89.00 %) of study subjects, result of 75 gm OGTT was negative. Result of 75 gm OGTT was positive in only 11 out of 100 study subjects (11.00 %). Conclusion: Tribal population in Jharkhand has very poor access to health-care services of the state. This study is first of its kind in our state which will set as an eye opener to further deliver better health-care facilities at grassroot level in Jharkhand.

Prevalence of Gestational Diabetes Mellitus among Pregnant Women Undergoing Oral Glucose Tolerance Test (OGTT) at Chitwan Medical College and Teaching Hospital

INTRODUCTION: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity in which spontaneous hyperglycemia develops during pregnancy. GDM is affecting approximately 14% of pregnancies worldwide, representing approximately 18 million births annually. GDM increases the risk of adverse maternal and perinatal outcome and also increases risk of future diabetes to the mother and their child. MATERIALS AND METHODS: The cross-sectional study was carried out over 8 months in 149 pregnant subjects of gestation period between 24 and 28 at Chitwan Medical College Teaching Hospital (CMCTH). All pregnant women were considered for 50gm Glucose Tolerance Test (GCT). Those pregnant subjects with GCT ≥ 140mg% only undergo 100 gm Oral Glucose Tolerance Test (OGTT) & plasma glucose were estimated at the interval of 0,1,2 and 3 hours respectively. The GDM was diagnosed after performing OGTT based on Carpenter-Coustan Criteria. RESULTS: In our study from 149 study population, the frequency of normal & abnormal GCT in pregnant women was 111(74.50%) & 38(25.50%) respectively. Out of 149 subjects only 38 pregnant women have abnormal GCT in which only 23 have done OGTT test. Among 23 subjects the presence of GDM was found in 9 subjects with 39.10% whereas GDM was not found in 14 subjects with 60.9%. The prevalence of GDM among 149 populations was found to be 9 which is 6.04%. CONCLUSIONS: The prevalence of GDM among 149 populations was found to be 6.04%. The real burden, risk factors, and potential preventative interventions of gestational diabetes mellitus must also be measured in large observational studies for finding the correlation to assess the severity of the disease.

Serum and salivary adipokines in type 2 diabetes – Results of a pilot study in India

Background and aimsAssociation of serum and salivary adiponectin, apelin, visfatin and vaspin were studied in type 2 diabetes (T2DM) among Asian Indians. Their concentrations in periodontitis were also studied. MethodsIn this cross-sectional analysis, men and women aged ≥35 years, with no history of diabetes, were screened for ≥3 risk factors for T2DM (n = 615). Eligible persons underwent a 75 gm oral glucose tolerance test and were categorized as Group A (Normal and Impaired Glucose Tolerant, n = 65) and Group B (Incident T2DM, n = 25). Screening for periodontitis was done. Saliva samples were collected in the morning. Participants refrained from food intake for about 2 hours prior to collection . Serum and saliva were stored for analysis. ResultsSerum adiponectin was low (p = 0.006) in T2DM and correlated with its salivary levels (r = 0.46, p < 0.001). Serum apelin levels were similar, but salivary concentrations were higher (p = 0.014) in T2DM. Higher serum (p = 0.016) and salivary (p = 0.03) visfatin levels were seen in T2DM. Vaspin levels showed no significant difference in the two groups, either in blood or saliva. Serum adipokines did not differ in the presence of periodontitis. In saliva, higher vaspin (p = 0.034) and lower visfatin (p = 0.018) concentrations were observed. ConclusionsThe selected adipokines were measurable in saliva, in lower concentrations. Salivary adiponectin and visfatin measurements may be useful in studies on T2DM.

Evaluation of Perinatal Outcome in Women with Impaired Glucose Homeostasis During Pregnancy

Background: Glucose tolerance testing in pregnancy identifies many women with glycaemic responses that exceed normal range but that do not meet the threshold required to diagnose Gestational Diabetes Mellitus. It is controversial whether maternal hyperglycemia less severe than in diabetes is associated with increased risk of adverse pregnancy outcome or not. Materials and methods: All women were subjected to Glucose Challenge Test(GCT) with 50 gram glucose either at first visit or between 24-28 weeks on the basis of risk profile. High risk cases were screened at first visit and the rest between 24-28 weeks. Patients with a GCT value ≥200mg/dl were not subjected for GTT and were diagnosed as GDM.Value of GCT &lt;140 mg/dl was taken as normal. Irrespective of GCT result, women were subjected to Oral Glucose Tolerance Test (OGTT) as recommended by WHO with 75 gram glucose using WHO criteria. Study group was identified with 4 categories with abnormal glucose homoeostasis as defined by the following criteria: 1. Abnormal GCT (&gt;140 mg/dl) with normal OGTT; 2. Normal GCT with only Impaired Fasting Glucose(IFG) in OGTT; 3. Normal GCT with Gestational Glucose Intolerance(GGI); 4. Patients diagnosed as GDM: a. If fasting is &gt;126mg/dl; b. If 2hr OGTT ≥ 140mg/dl &amp; ≤ 199 mg/dl; c. If value of either GCT or OGTT &gt;200 mg/dl. The control group comprised of women with normal GCT and normal OGTT. In all the above groups, adverse prenatal outcome and maternal outcomes were evaluated by the primary and secondary outcome measures. Results: There were 10 cases (15.3%) of hypertensive disorder of pregnancy in the study group (3 cases of gestational hypertension in abnormal GCT, 3 cases of pre eclampsia in each GGI and GDM and 1 antepartum eclampsia in GGI category) and 2 cases in control group (3%) (p=0.03). There were 2 cases of Fetal Growth Reduction (FGR) and 5 cases of Premature Rupture Of Membranes(PROM) in both study and control group. There was 1 case of cholestasis of pregnancy in study group. Term inductions were 11 and 13 in the study and control group respectively.Within the study group number of cases induced were more in GGI(n=7) and GDM(n=4) category. There were 14 caesarean sections (21.5%) and 2 (3%) instrumental deliveries among the study group. However there were 6 caesarean sections (9.2%) and no instrumental deliveries among control groups. The rate of elective LSCS is more in GDM (n=5) vs other 3 categories and the difference is significant (p=0.04) The overall number of LSCS (14 cases) was significantly higher in GDM. Conclusion: Cases with abnormal glucose homeostasis of lesser degree than GDM, like only abnormal GCT, IFG and GGI also were observed to have adverse maternal outcomes than controls, in form of hypertensive disorders of pregnancy, significantly higher LSCS rates, and increased risk of macrosomia. Instead of 2 step procedure, single step screening cum diagnostic test with 75 gm OGTT for diagnosing GDM could be an option to be universally practiced.

SUN-633 Increased Risk of Gestational Diabetes Mellitus in Egyptian Females Undergoing In Vitro Fertilization in Alexandria

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most frequent maternal complications during pregnancy. It has been estimated that most of the cases of hyperglycemia during pregnancy are attributed to GDM (75–90%). Pregnancy complicated with GDM is associated with adverse acute and long term consequences for both mother and infant. Risk factors for GDM include; a previous history of GDM, a family history of type 2 DM, advanced maternal age, overweight, and polycystic ovary syndrome (PCOS). This was an observational prospective study, using data of pregnant women conceived following in vitro fertilization (IVF) and spontaneously, aimed to determine the risk of GDM among Egyptian females following IVF compared to spontaneous pregnancy. The present study included two age and BMI- matched groups. Group I (GpI): 55 pregnant females conceived by IVF, and Group II (GpII): 55 pregnant females conceived spontaneously. We excluded females with a history of pre-pregnancy diabetes, glucose intolerance, corticosteroid therapy, twin pregnancy, and age above 39 years. In addition to detailed history taking, clinical examination and routine laboratory investigations, one- step oral glucose tolerance test (OGTT) was performed at gestational week 20 and 28 in all subjects. Fetal biometric measurements were performed in the third trimester using ultrasonography assessment. Results: On using the one-step strategy (75 gm OGTT test) to screen for GDM at 28 weeks of gestation; GDM was statistically significantly higher in Gp I (who had undergone IVF) compared to Gp II (spontaneous pregnancy) (20% and 5.5% respectively), p= 0.022. Moreover, it was also noticed that GDM occurred earlier on screening at 20 weeks of gestation in Gp I (16.4%) compared to (3.6%) in Gp II, p= 0.026. Among subjects who had undergone IVF (Gp I), 18.2% had a history of PCOS. There was no statistically significant difference in the incidence of GDM among subjects with PCOS compared to those without a history of PCOS at gestational week 20 and at week 28 in Gp I (p=0.661, and p=0.099 respectively). Data of fetal biometry done at the third trimester showed no significant statistical difference in head circumference, biparietal diameter, abdominal circumference or femur length between both groups. However, fetal body weight was significantly higher in the IVF group (Gp I) compared to (Gp II), p=0.003.Conclusion: These findings show that IVF may increase the risk for GDM, moreover, GDM occurs earlier, recommending selective early screening for GDM in this population.

Studying the relation between vitamin D deficiency and glycemic state among pregnant women with gestational diabetes

AimThis study was conducted to illustrate the relation between vitamin D deficiency and glycemic parameters. Materials and methodsThe study was carried out on 80 pregnant females who were attending obstetrics and gynecology out-patient clinic in el-Shatby hospital in Alexandria university, Egypt. They were divided into 2 groups: group 1 (n = 40) pregnant females diagnosed with gestational diabetes de novo at week 24–28 and group 2 (n = 40) pregnant females of the same age group who were not suffering from any glucose intolerance (control group). Each patient was subjected to detailed history taking, complete physical examination, One step 75 gm Oral glucose tolerance test, insulin, glycated hemoglobin(HbA1c),homeostatic model assessment of insulin resistance(HOMA-IR), 25 hydroxy-vitamin D, serum calcium, phosphorous and parathormone were assessed. ResultsA statistically significant higher fasting blood glucose (FBG), HbA1c%, fasting insulin and HOMA-IR was observed in patients with Gestational diabetes mellitus (GDM) versus control (p < 0.001). However, no significant difference was observed as regards Vitamin D levels in patients with GDM and control group. Among patients with GDM, vitamin D was found to correlate negatively with HbA1c (p < 0.001), insulin(p = 0.019) and HOMA-IR(p = 0.034). ConclusionNo definite causal relationship was observed between low vitamin D and subsequent occurrence of GDM.however, a significant correlation was found between the degree of vitamin D deficiency and the insulin resistance in patients with GDM.

Gestational Diabetes Mellitus and Associated Risk Factors in Patients Attending Diabetic Association Medical College Hospital in Faridpur

Background: The prevalence of gestational diabetes mellitus (GDM) is increasing all over the world and varies widely depending on the region of the country, dietary habits and socio-economic status. The prevalence of GDM with its associated risk factors has important health complications for both mother and child.Objectives: The aim of this study was to evaluate the prevalence of GDM and risk factors associated with it in women attending Diabetic Association Medical College Hospital in Faridpur for ante-natal care.Materials and Methods: In this cross-sectional study, screening for GDM was performed in 303 pregnant women. Women who consented to participate underwent a standardized 2-hour 75 gm oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and past history of GDM etc. was filled in. American Diabetes Association (ADA) criteria for 75 gm 2-hour OGTT was used for diagnosing GDM.Results: A total of 303 women participated in the study and GDM was diagnosed in 22 (7.3%) women. A single abnormal value was observed in additional 33 (10.89%) women. On bivariate analysis risk factors found to be significantly associated with GDM were age, household income, parity, educational level, socio-economic status, hypertension, BMI, weight gain, acanthosis nigricans, family history of diabetes and past history of GDM; but on multivariate analysis only upper middle class and presence of acanthosis nigricans were found to be significantly associated with GDM.Conclusion: This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help for new suggestions to prevent and manage gestational diabetes.J Enam Med Col 2017; 7(3): 126-133

Thrombocyte Functions in Pregnant Women with Gestational Diabetes Mellitus

Objective: We have aimed to show the changes of number, morphology and functions of platelets in presence of gestational diabetes mellitus comparing to patients that are not diagnosed with gestational diabetes mellitus in our study. Methodology: The 928 cases in 24th to 28th weeks of gestation followed regularly in the same clinic were included in the study. Mean platelet volume, platelet distribution width and plateletcrit values of cases that are diagnosed with gestational diabetes mellitus according to American Diabetes Association criteria and that are not diagnosed with gestational diabetes mellitus were compared to evaluate the platelet count, morphology, functions and activity. Results: Platelet count and plateletcrit values of cases diagnosed with gestational diabetes mellitus were significantly higher than those that were not diagnosed with gestational diabetes mellitus. No difference between mean platelet volume and platelet distribution width values of cases diagnosed with gestational diabetes mellitus and not diagnosed with gestational diabetes mellitus was found. Conclusion: 75 gm oral glucose tolerance test to prevent false negative results and evaluation of platelet count, function and activity for cases that are diagnosed with gestational diabetes mellitus could contribute importantly to predict and take necessary precautions for possible atherosclerotic vascular and end-organ damage.

High incidence of abnormal glucose metabolism in acute coronary syndrome patients at a moderate altitude: A sub-Himalayan study.

Background:Abnormal glucose metabolic status at admission is an important marker of future cardiovascular events and long-term mortality after acute coronary syndrome (ACS), whether or not they are known diabetics.Objective:The aims were to study the prevalence of abnormal glucose metabolism in ACS patients and to compare the different methods of diagnosing diabetes in ACS patients.Methods:We did a prospective study. About 250 consecutive nondiabetic patients (200 men and 50 women) with ACS admitted to a tertiary care institute of Himachal Pradesh in 1 year were enrolled. Admission plasma glucose, next morning fasting plasma glucose (FPG), A1C, and a standardized 75-g oral glucose tolerance test (OGTT) 72 h after admission were done. Glucose metabolism was categorized as normal glucose metabolism, impaired glucose metabolism (impaired fasting glucose or impaired glucose tolerance [IGT]), and diabetes. Diabetes was arbitrarily classified further as undiagnosed (HBA1c ≥6.5%) or possibly stress diabetes (HBA1c <6.5%). A repeat OGTT after 3 months in objects with IGT and stress hyperglycemia at a time of admission was done.Results:The mean age was 54 ± 12.46 years. The mean plasma glucose at admission was 124 ± 53.96 mg/dL, and the mean FPG was 102 ± 27.07 mg/dL. The mean 2-h postglucose load concentration was 159.5 ± 56.58 mg/dL. At baseline, 95 (38%) had normal glucose metabolism, 95 (38%) had impaired glucose metabolism (IGT and or IGT) and 60 (24%) had diabetes; 48 (19.2%) were undiagnosed diabetes and 12 (4.8%) had stress hyperglycemia. At follow up 58.66% and 55.55% of patients with impaired glucose tolerance and stress hyperglycemia continued to have impaired glucose tolerance respectively. About 75 gm OGTT has highest sensitivity and specificity to diagnose diabetes, whereas A1C most specific to rule out stress hyperglycemia.Conclusions:In this small hilly state of India, abnormal glucose metabolism (previously undiagnosed diabetes and IGT) is common in patients admitted with ACS. Abnormal glucometabolic status can be detected early in the postadmission period. Our results further suggest that 75-g OGTT remained the gold standard test to detect diabetes and could be used before discharge to diagnose diabetes.

Comparative Study of Fasting Plasma Glucose Concentration and Glucose Challenge Test for Screening Gestational Diabetes Mellitus

ABSTRACT Background To compare the sensitivity and specificity of fasting plasma glucose (FPG) with that of standard glucose challenge test (GCT). Materials and methods Eighty-nine eligible pregnant women underwent GCT between 24th and 28th gestational week, followed by a diagnostic 3 hours 100 gm oral glucose tolerance test within 1 week. Out patient clinic in Father Muller Medical College Hospital, Mangalore. Data was analyzed for significance by chi-square test. Results Fasting plasma glucose concentration at a threshold value of 90 mg/dl and GCT at recommended standard threshold of 140 mg/dl yielded sensitivities of 66.7% and 100% respectively and specificities of 87.3% and 46.5% respectively. Reducing the threshold value of FPG to 80 mg/dl increased the sensitivity of test to 91.7% with specificity of 54.9% which was comparable to standard GCT, in our study. Conclusion Measuring FPG concentration using a cut-off of. 80 mg/dl is an easier, tolerable and more cost effective procedure than GCT for detecting more severe cases of GDM, i.e. the diabetes mellitus group. In resource poor settings with population belonging to average risk or high risk category, FPG at a cut-off of 90 mg/dl can be used to screen GDM. How to cite this article Sham S, Bhat BPR, Kamath A. Comparative Study of Fasting Plasma Glucose Concentration and Glucose Challenge Test for Screening Gestational Diabetes Mellitus. J South Asian Feder Obst Gynae 2014;6(2):75-78.

Comparative study of 50 gram glucose challenge test and 75 gram oral glucose tolerance test in diagnosis of gestational diabetes mellitus in high risk group.

Background: Pregnancy is a complex endocrine-metabolic adaptation and diabetogenic condition involving impaired cellular insulin sensitivity, increased β-cell function, and moderate elevation of blood glucose level. The threshold for a positive glucose challenge test (GCT) necessitating further diagnostic testing remains controversial in gestational diabetes mellitus (GDM). Aims & Objective: To find the association of risk factors with GDM, to evaluate the diagnostic value of GCT as compared to oral glucose tolerance test (OGTT) in GDM, and also to determine the optimal cut-off value of GCT with best sensitivity and specificity for the prediction of GDM and also to find the association of GCT between FBS and 2nd hour OGTT glucose level. Material and Methods: The study was conducted at Hanagal Shri Kumareshwara Hospital, Bagalkot, Karnataka, India, from June 2009 to February 2010. 247 pregnant women were selected for the study. Selected women were subjected to screening by GCT. If the blood glucose level was greater than 140 mg/dl, the GCT was considered as positive and these patients were subjected to 75 gm OGTT to confirm the diagnosis of GDM. The diagnosis of GDM was based on WHO criteria. Results: In the present study out of 247 pregnant women selected, 199 women participated, of which 26(13.06%) of the pregnant women were diagnosed to have GDM. Mean age of the study subjects was 24.7±3.51 years. There was a positive association of GDM with age, BMI, glucosuria, polyhydraromnios, obstetrics score, previous GDM, past history of unexplained IUD, family history of DM, recurrent vaginal infection. Area under the curve is 0.994 (p>0.0001) which has best diagnostic accuracy at glucose level of 128 mg/dl, as the best cut off value. Second hour OGTT is more correlated with GCT than FBS. Conclusion: In this ethnic group, the high risk pregnant women for GDM should undergo initial 50 gm. GCT. If GCT value is more than 128 mg/dl, it should be followed by second hour 75 gram OGTT, for the diagnosis of GDM and it reduces the FBS estimation of blood sugar level and an extra prick too.

P02.124. A pilot randomized controlled trial of yoga for prediabetes

Methods We conducted an 8-week, randomized, waitlist controlled trial of yoga for prediabetes (diagnosed by two measures of fasting glucose between 100-125 mg/dl) in Bangalore, India. Forty-one participants were randomized to yoga (n=21, 1 lost to follow-up) or control (n=20, 2 lost to follow-up). All participants attended an 8-hour session on lifestyle changes. Participants in the yoga group also attended 3 to 6 hour-long yoga classes per week. Yoga classes included didactic training, postures and breathing exercises. We measured changes in prediabetes using a 75 gm oral glucose tolerance test (OGTT) with a 2-hour post-prandial blood draw. Fasting glucose and insulin were used to calculate homeostatic model assessmentinsulin resistance (HOMA-IR); we also measured mood and perceived stress.

No impact of oral quercetin on plasma glucose in patients with type 2 diabetes

Background Quercetin has been detected in a wide range of plant food products. It is believed that gut luminal concentrations of quercetin may be as much as 50-fold greater than those commonly attained in plasma. In vitro observations describe significant effects of various flavonoids, including quercetin, on several nutrient transporters that are active in human gut (SLGT1, GLUT2, GLUT5). This study was designed to assess the effect of orally administered quercetin on plasma glucose in patients (n=20) with type 2 diabetes. Methods A single-blind, placebo-controlled, within subject, repeated measures design was employed. Plasma glucose concentrations (0–4 hrs) during 75 gm oral glucose tolerance test were documented on two occasions; after concurrent consumption of oral quercetin placebo beverage at baseline and following the last of 5 consecutive days of oral quercetin (1500 mg) beverage. Glucose exposure estimates included; total (AUC0–4, hr*mg/dL) & incremental (iAUC0–4, hr*mg/dL) area-under-glucose-concentration time curve, partial areas, and individual glucose concentrations at key time points after glucose ingestion. Paired t-test and Wilcoxon match-pairs signed-ranks test were employed with p ≤ 0.05. Results No differences in plasma total or incremental glucose AUC (mean ± SD) were detected between placebo and quercetin exposure. AUC0–4 SD iAUC0–4 SD Placebo 871.9 269.6 309.5 158.9 quercetin 843.4 234.9 308.5 152.2 p-value 0.335 0.964 Additionally, no differences were detected in any of the other plasma glucose exposure estimates or concentrations. Conclusions Concurrent oral administration of quercetin (1500 mg) with glucose does not impact ultimate absorption of glucose in human patients with type 2 diabetes when absorption is assessed by measurement of changes in plasma glucose concentrations. Research was developed and funded by PepsiCo Global R&D.

P02-568 - Prediabetes in patients treated with antipsychotic drugs

BackgroundIn 2010, the American Diabetes Association (ADA) proposed that individuals with fasting glucose 100–125 mg/dl (5.6-6.9 mmol/l) or glucose 140–199 mg/dl (7.8–11.0 mmol/l) 2 hours after a 75 gm oral glucose tolerance test (OGGT) or hemoglobin A1c (A1c) 5.7–6.4% be classified as prediabetic to indicate a high risk for the development of diabetes.ObjectiveTo determine the prevalence of prediabetes in psychiatric patients receiving antipsychotics and to compare the clinical and metabolic features of patients with normal glucose tolerance, prediabetes and diabetes.MethodThe 2010 ADA criteria were applied to a large consecutive cohort of psychiatric patients treated at one institution in Belgium. All patients were evaluated with OGTT, A1c, insulin levels and lipid profiles.ResultsThe study sample was restricted to the 783 adult patients (mean age 37.6) without known history of diabetes. 413 (52.8%) patients had normal glucose tolerance, 290 (37%) were prediabetic and 80 (10.2%) were diabetic. The 3 groups were similar with regard to psychiatric diagnoses, severity of mental illness and antipsychotic treatment. A statistically significant crescendo gradient from normal to prediabetes and from prediabetes to diabetes was observed for age, body mass index, waist circumference, fasting insulin, homeostatic model of insulin resistance (HOMA-IR) and triglyceride levels. The intergroups differences for fasting insulin and HOMA-IR were confirmed for treatment with clozapine, olanzapine, quetiapine, risperidone and amilsulpride, but not for aripiprazole or first-generation antipsychotics.ConclusionPrediabetes is highly prevalent in adults treated with antipsychotic drugs and correlates with markers of intraabdominal adiposity and insulin resistance.

Battling with Rising Prevalence of Gestational Diabetes Mellitus: Screening and Diagnosis

ABSTRACT Introduction Gestational diabetes affects 2 to 4% of all pregnancies, with an increased risk of developing diabetes for both the mother and the child. The prevalence of gestational diabetes mellitus (GDM) in India varied from 3.8 to 21% with the geographical locations and diagnostic methods used. Objective To study the differences in the type of tests and timing of tests; failure to screen and diagnose; this could explain the varying prevalence reported from different centers indicating that there could be an underestimation due to missed diagnosis. Materials and methods A 15-question online survey (www.abcofobg.com) was developed to assess providers’ knowledge; practices and attitudes related to the screening and management of GDM. All data were entered into an electronic database without personal identifiers, to maintain confidentiality. The data was analyzed by using SPSS version 16.0. Results A total of 584 respondents were participated in the survey. Overall, 82.14% of doctors screened all their antenatal patients for GDM. A total of 65.48% of them ordered for a blood glucose test during first antenatal visit even in first trimester. During screening, 39.29% of doctors preferred 50 gm glucose challenge test and 26.19% of doctors preferred 75 gm glucose and 2-hour reading. When the test was positive, 47.62% of doctors ordered for 100 gm oral glucose tolerance test (OGTT) and 38.1% for 75 gm OGTT. A total of 40.48% of doctors used C and C criteria, 26.4 % used National Diabetes Data Group (NDDG) criteria and 32.14% took 140 at 2 hours for 75 gm OGTT criteria of cutoff to diagnose the GDM. Conclusion Preventive measures against type 2 diabetes (T2DM) should start with proper screening and diagnosis during pregnancy. Many tests with varied criteria are in use. There is an urgent need to institute uniform standards for the timing and type of tests done for identifying the cases of GDM. This is crucial to reduce the burden of T2DM in India for now and for generations to come.

Gestational Diabetes Mellitus: A Prospective Study

ABSTRACTBackgroundMaternal hyperglycemia is considered a risk factor for both fetus and mother which can lead to significant morbidity and sometimes, even mortality. Here, we present a two years study of gestational diabetes which was intended to see the incidence and its determinants in the Patan Hospital, Kathmandu, Nepal. Patan Hospital is a tertiary care level teaching hospital.Subjects and MethodsAll pregnant women visiting ANC clinic or admitted to the ward with the diagnosis of GDM from July 2005 to June 2007 at Patan Hospital were taken for the study. In Patan Hospital, pregnant ladies are routinely screened for diabetes with 50 gm glucose challenge test (GCT) and if the value is more than 140 mg/dl, they are subjected to 100 gm Oral Glucose Tolerance Test (OGTT). If two or more than two values are increased, they are managed as gestational diabetes. These cases of gestational diabetes are enrolled for the study. Data was collected by interview and laboratory investigations using standard set of questioner.ResultsOut of 13,382 consecutive deliveries, 53 patients were admitted with the diagnosis of gestational diabetes mellitus (GDM). Among them, 40.4% were Brahmin, 38.5% Newar, 11.5% Chettri and 9.6% from other cast. GDM was more common in the age group 26 to 35 years and was more prevalent in urban population than rural (urban 84.6% vs rural 15.4%). Similarly, it was more common in multipara patients. Only 28.8% of the cases were having polyhydramnios on ultrasound. Mean weight gain in pregnancy was 8.96 kg with a range of 3 to 20 kg approximately, 58% of patients had family history of diabetes, 48.7% of patients had history of GDM in previous pregnancy and 7.7% of patients had overt diabetes. Most of the patients needed insulin (92.3%) and only 7.7% of patients were managed with only diet and exercise. No significant fetomaternal complication was observed in our study.ConclusionThere was significant number of cases diagnosed as GDM. All patients who were diagnosed early and treated accordingly had less complications related to mother and child.

Prevalence of gestational diabetes mellitus in rural pregnant mothers in northern Ethiopia

In a community based survey of gestational diabetes in 18 rural villages of the eastern zone of Tigray administrative region, northern Ethiopia, a total of 890 pregnant women with gestational age of 24 weeks and above were examined for gestational diabetes mellitus based on WHO criteria. A 75 gm oral glucose tolerance test was performed on each subject with measurement of glucose at 0 and 2 h. Blood glucose was determined by glucose oxidase method using capillary blood (Accutrend alpha, Boehringer Mannheim). The mean age of the mothers was 27.4±7.1 years. Forty four percent of the subjects were multiparas. The prevalence rate of gestational diabetes mellitus was found to be 3.7% (95% CI 2.5–4.9). The mean blood glucose 2 h after glucose load in those pregnant diagnosed to have gestational diabetes mellitus was 154.6±14.4 mg/dl (J.W. Rich-Edwards, G.A. Colditz, M.J. Stampfer, W.C. Willett, M.W. Gillman, C. Hennekens, F.E. Speizer, J.E. Manson, Birth weight and the risk for type 2 diabetes mellitus in adult women, Annu. Intern. Med. 130 (1999) 278–284). The prevalence of gestational diabetes mellitus in this region of the country is high as compared to other parts of Africa. The possible role and contribution of exposure of the general population in this area to chronic malnutrition as a result of prolonged famine, drought and war, to the high prevalence of gestational diabetes mellitus warrants further study.

Toward universal criteria for gestational diabetes: Relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations

OBJECTIVES: Replacement of the two-step, 100 gm, 3-hour National Diabetes Data Group procedure by the one-step, 75 gm, 2-hour World Health Organization oral glucose tolerance test has been hindered by a paucity of data comparing the two tests during pregnancy. The current series compared 100 gm and 75 gm glucose loads and glucose measurements in venous plasma or capillary blood. STUDY DESIGN: After a 75 gm oral glucose tolerance test 30 gestational diabetics and 30 metabolically healthy pregnant women were randomly assigned to a second 75 or 100 gm test within 3 ± 1.3 (mean ± SD) days. Glucose levels at both tests was measured in capillary blood and venous plasma, as were insulin and C peptide. RESULTS: In controls 1-hour maternal glucose levels (112 vs 128 mg/dl) and 2-hour levels (104 vs 113 mg/dl) differed significantly after a 75 or 100 gm load (paired t test). In gestational diabetes mellitus, however, there was no difference (176 vs 178 mg/dl) but a low insulin/glucose quotient at 1 hour. Only 2-hour levels differed significantly (133 vs 149 mg/dl). In controls glucose measurement in capillary blood and venous plasma differed significantly at 1 hour (126 vs 115 mg/dl) and 2 hours (111 vs 104 mg/dl) independently of the glucose load. In gestational diabetes mellitus, however, glucose measurement in capillary blood and venous plasma differed neither in 1-hour levels (179 vs 174 mg/dl) nor in 2-hour levels (142 vs 139 mg/dl). CONCLUSION: In metabolically healthy women both different loading and different blood fractions lead to statistically different blood glucose levels at 1 and 2 hours. In gestational diabetes mellitus, however, 1-hour glucose levels do not differ after a 75 or 100 gm load or after glucose measurement in capillary blood or venous plasma. This is due to elevated insulin resistance shown by a low insulin/glucose quotient at 1 hour. For comparison of tests in gestational diabetes mellitus only, 2-hour values must be adjusted by 16 mg/dl after different loading. (Am J Obstet Gynecol 1998;178:830-5.)

MB fraction of cumulative creatine kinase correlates with insulin secretion in patients with acute myocardial infarction: Insulin as a possible determinant of myocardial MB creatine kinase

To test whether insulin is a regulatory factor of myocardial MB creatine kinase content, we investigated the correlation between the ability of insulin secretion and the MB fraction of cumulative CK released in patients with acute myocardial infarction. We analyzed 18 patients who underwent successful direct angioplasty within 10 hours of the onset of their first myocardial infarction. Exclusion criteria were age more than 75 years, heart failure, severe obesity, multivessel disease, and history of diabetes mellitus. Cumulative activity of serum MB CK divided by that of total CK was defined as MB%, which was considered to represent myocardial MB CK content. Two weeks or more after the onset of myocardial infarction, 75 gm oral glucose tolerance test with serial determination of plasma glucose and serum insulin (0, 0.5, 1, 2, 3 hours) was done. Urinary and plasma catecholamines and echocardiographic left ventricular (LV) mass were measured. MB% significantly correlated with insulinogenic index ( r = 0.564, p = 0.019), insulin area ( r = 0.594, p = 0.012), insulin area/glucose area ( r = 0.630, p = 0.007), and urinary adrenaline ( r = −0.542, p = 0.025) and tended to correlate with plasma adrenaline ( r = −0.431, p = 0.084). Age, body mass index, infarct size, glucose metabolism, and LV mass were not significant univariate predictors of MB%. Multivariate analysis showed that the ability of insulin secretion contributed to MB% more than catecholamines did and that insulin area/glucose area was the strongest independent predictor of MB% ( t = 3.01, p = 0.015). Thus MB fraction of cumulative CK released, indicative of myocardial MB CK distribution, strongly related to the ability of insulin secretion in subjects without overt insulin resistance. Regulation by insulin of myocardial MB CK is suggested.

Chronic hyperinsulinemia and the adrenal androgen response to acute corticotropin-(1–24) stimulation in hyperandrogenic women

OBJECTIVE: Many women with androgen excess demonstrate elevated circulating insulin levels independent of obesity. In addition, in these women some investigators have demonstrated a negative correlation between the circulating levels of the adrenal androgens,dehydroepiandrosterone or dehydroepiandrosterone sulfate and insulin. The mechanism by which insulin decreases adrenal androgens is unclear. The objective of this study was to determine whether chronic hyperinsulinemia in hyperandrogenic women results in an alteration in the adrenocortical response to corticotropin, resulting in decreased androgen secretion. STUDY DESIGN: We studied seven hyperandrogneic women with severe chronic hyperinsulinemia and eight hyperandrogenic normoinsulinemic patients. Nine healthy women served as controls for the basal hormonal levels and the response to a 3-hour, 100 gm oral glucose tolerance test. In all subjects insulin and glucose were measured hourly during the oral glucose tolerance test and the baseline sample was assayed for total testosterone, dehydroepiandrosterone sulfate, dehydroepiandrosterone, androstenedione, sex hormone-binding globulin, and free testosterone. In hypernadrogenic women cortisol, dehydroepiandrosterone, and androstenedione were also measured, before and 60 minutes, after acute intravenous administration of 0.25 mg corticotropin (1–24). RESULTS: There was no difference in the response of cortisol, dehydroepiandrosterone, or androstenedione to corticotropin-(1–24) stimulation between normoinsulinemic and hyperinsulinemic hyperandrogenic patients. As defined, the hyperinsulinemic patients had higher basal and peak insulin levels and areas under the insulin response curve compared with the normoinsulinemic patients or controls. Total testosterone and dehydroepiandrosterone did not differ among study groups. As expected, hyperandrogenic patients demonstrated lower sex hormone-binding globulin activity and higher free testosterone, androstenedione, and dehydroepiandrosterone sulfate basal levels compared with controls. CONCLUSIONS: The results of this study do not support the hypothesis that chronic hyperinsulinemia in hyperandrogenic patients significantly inhibits the andrenocortical secretion of dehydroepiandrosterone or androstenedione in response ot corticotropin stimulation or the basal circulating adrenal androgen levels. Additional studies, including a greater number of patients, may be needed to fully establish these conclusions.