Grams Of Glucose Research Articles

OP 48 Metabolic and hypertensive complications of pregnancy in women with nephrolithiasis

Introduction Kidney stones are associated with future development of hypertension, diabetes and the metabolic syndrome. The relationship between nephrolithiasis and pregnancy complications, including gestational dysglycemia and hypertension, has not previously been evaluated. Objectives We sought to assess whether kidney stone formation prior to pregnancy was associated with metabolic and hypertensive complications in pregnancy. We hypothesized that stone formation is a marker of metabolic disease and would be associated with maternal complications in pregnancy. Patients and methods We conducted a retrospective cohort study of women who received prenatal care and delivered infants at Massachusetts General Hospital from 2011 to 2016. Women with abdominal imaging (CT or ultrasound) prior to pregnancy were included in the analysis.Women with chronic kidney disease, hypertension and diabetes were excluded. Pregnancy outcomes of women with documented kidney stones on imaging (stone formers, n = 79) were compared to women without stones on imaging (controls, n = 642). We performed a stratified analysis of pregnancy outcomes in women with high (>25 kg/m2) vs. normal (⩽25 kg/m2) BMI in the first trimester. Results Mean glucose levels after a 50-gram glucose challenge were higher in stone formers (127 ± 29 mg/dl vs. 118 ± 27 mg/dl, p = 0.02) despite similar baseline body mass index (27.3 ± 5.5 kg/m2 vs. 27.6 ± 6.4 kg/m2, p = 0.62). Rates of hypertensive disorders of pregnancy were higher in stone formers (16% vs 6%, p Conclusion In women without preexisting diabetes and hypertension, a history of nephrolithiasis was associated with gestational dysglycemia and hypertensive disorders of pregnancy, especially in women with high first trimester BMI. Nephrolithiasis may be a marker of increased metabolic risk in women without traditional risk factors for pregnancy complications.

Diabetes medication pharmacology

Diabetes medication pharmacology

0261 MOOD MEDIATES THE RELATIONSHIP BETWEEN GLUCOSE AND PERFORMANCE DURING SLEEP LOSS

Sleep loss disrupts how the body utilizes glucose, and glucose bioavailability influences attention and cognitive self-control. Recent results from our lab demonstrated that 15 grams of glucose in solution sustained psychomotor vigilance during 40 hours of continuous wakefulness. The time course of this effect, relative performance sustainment for seven hours, went beyond expectations for direct neuronal nutrition. Mood, glucose, and performance are also mechanistically tied in various literatures. Therefore, we tested a mediation model of supplemental glucose on performance during sleep loss via self-reported mood. 20 college students stayed awake for 40 hours. Cognitive performance and mood were quantified while rested, then every three hours across the sleep deprivation period. Participants received 15 grams of glucose solution or an equivalent sucralose placebo at hours 18 and 36. Participant mood and cognitive function were analyzed by group across time using a bootstrapping mediation model. As observed in previous results, participants in the sucralose condition committed an average of 2.83 more lapses than the glucose condition 7 hours post-dose, 22 hours into continuous wakefulness (path C, p < .05). However, sucralose participants also reported 10.17 more subjective fatigue units than glucose participants at the same time point (path A), while their subjective fatigue score predicted their lapse rate (path B). When paths A and B are added to the original path C, the effect disappears (path C’ = .99), indicating a near complete mediation of that effect by subjective fatigue, z = 2.26, p < .05, K2=.40. Strategic glucose supplementation can temporarily sustain performance during total sleep deprivation within certain parameters. Specifically, performance sustainment is achieved via prevention of negative mood development (subjective fatigue). Glucose prevents the development of negative mood, which optimizes conditions for positive motivation. Positive motivation provides a small but measurable boost in performance as quantified by continuous engagement with the psychomotor vigilance task. Additional analyses to understand the magnitude and reach of this effect are underway. This work was completed as part of contract N62645-14-P-2046 under direction of the Naval Medical Research Unit - Dayton.

Prevalence of Gestational Diabetes Mellitus among Cohort of Pregnant Women Registered in Primary Health Center

Background: Gestational Diabetes Mellitus (GDM) is an important public health problem in India. The prevalence of GDM is constantly on the rise, globally. Women with GDM are at increased risk for adverse obstetric and perinatal outcome, necessitating universal screening. The aim of the study was 1) to find out the prevalence of GDM among women attending the antenatal clinic in the primary health Centre (PHC).2)to find out the association of GDM with known factors (age, family history, BMI, parity) Methods: A prospective study was conducted among pregnant women attending PHC, in which all the pregnant women without past history of diabetes was included and registered after informed consent. They were screened for GDM by Glucose challenge test with 75 grams of glucose, between 24 – 28 weeks of gestation. Structured questionnaire was used to gather information on demographic, obstetric, diabetes mellitus history. Data were analyzed by using SPSS Version 20. Results: A total 526 women participated in this study and the overall prevalence of GDM was found to be 3.8% and the prevalence of GDM was significantly high among the elderly pregnant women, Women with Gravida> 3, obese women and those with a positive family history of diabetes mellitus. Conclusions: The prevalence of GDM was 3.8%, and Screening for GDM should be promoted in all health centers.

The association of impaired gestational glucose tolerance with maternal and fetal outcomes

The aim of the present study was to examine the associations of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes.A total of 200 pregnant women were included in this cross-sectional study. A 50-gram oral glucose challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose tolerance test (OGTT) with 100 grams of oral glucose in those with an abnormal one-hour test result. The following were not significantly different between groups. Preterm labour (PL), pregnancy induced hypertension(PIH), pre-eclampsia, polyhydramnios, and macrosomia. However, a significant increase was noted in the fetal birth weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were also similar between the two groups. In conclusion, the present results suggest that single high glucose readings in OGTT may be as important as a diagnosis of GDM in terms of fetomaternal complication risk.

Incidence of postpartum glucose intolerance among women with gestational diabetes in Siriraj Hospital

Objectives: To determine the incidence of postpartum glucose intolerance among women with gestational diabetes (GDM) and its associated factors. Methods: A total of 110 GDM women who delivered at Siriraj Hospital were enrolled. A 2-hour 75-gram glucose tolerance test and were offered at 6-12 weeks postpartum to determine incidence of glucose intolerance, which include impaired glucose tolerance (IGT), and type 2 diabetes (T2DM). Demographic data, GDM risks and diagnosis data, and delivery data were collected. Incidence of glucose intolerance was estimated. Comparison was made between glucose intolerance groups to determine possible associated factors. Results: Mean age was 33.7±5.1 years, and 46% were nulliparous. According to pre-pregnancy BMI, 45.5% were overweight/obese, and 24.5% gained weight greater than recommendation. Majority was GDM A1 (85.5%), and 63.6% were diagnosed before 20 weeks of gestation. Mean postpartum follow up time was at 6.2 ± 0.9 weeks. Incidence of postpartum IGT and T2DM were 35.5% and 10% respectively. No difference was found between groups in terms of pre-pregnancy BMI, gestational weight gain, weight retention, and severity of GDM. However, HbA1c level was significantly greater among women with postpartum T2DM than IGT and normal results (6.1±0.5%, 5.6±0.4%, and 5.4±0.3% respectively, p 6% significantly increased the chance of T2DM (33.3% vs. 53.4%, p=0.001). Conclusion: Among GDM pregnant women, incidence of postpartum glucose intolerance was 45.5% (35.5% IGT and 10% T2DM). HbA1c level of >6% significantly increased the chance of postpartum T2DM.

Early glucose intolerance postpartum of gestational diabetes associated with overload test with 50 grams of glucose

Introduction. The glucose intolerance later gestational diabetes is a very important indicator that helps establish the prognosis of diabetes in pregnant women who have had gestational diabetes (1). In this study we followed for one year to all gestational diabetes who were treated at the Hospital of Fuerteventura in endocrinology consultation,Canary Island, Spain. The aim was to study what factors might be related to glucose intolerance in the immediate postpartum.Materials and methods. All pregnant women served with the diagnosis of gestational diabetes during April 2012 to May 2013, diagnosed according to the criteria of the ADA (2), were subjected to routine procedure of specialized gynecology and endocrinology unit, first: test loading test with 50 grams of glucose, and if blood glucose was greater whom 140 mgdl,SOG was performed with 100 grams glucose three hours. All these patients were followed up with a minimum of a monthly review by both gynecology and endocrinology as was given a standard diet and as controls if necessary insulin treatment. In addition glycemia in the first quarter, glycated hemoglobin in the second and third quarter was measured, if there was family history of diabetes, as well as history of previous gestational diabetes, presence of other diseases, hypertension in pregnancy, if they had done treatment with diet or insulin. Finally, it determines if the birth was eutocic or dystocia. All the analyzes were performed in the Hospital Fuerteventura laboratory by standard autoanalyzer. SPSS v.24 program for frequency valuations and statistical analyzes. Was measured frequencies, all dependent and independent variables and logistic regression analysis, ANOVA and linear correlation with statistical significance of ≤0.05 was performed.Results. Of the 60 diabetic gestational included in the study, 49 completed the assessment of oral glucose tolerance test at 0 and 120 minutes, 81'7%, of these 57.1% were normal, 41.8% had glucose intolerance which were 26.5% impaired fasting glucose and 14’3 were intolerant, 2.5 were diabetic. In these patients: 57.6 percent had a normal vaginal delivery and 39.0% were dystocia. When we analyze all the variables according to the diagnosis of glucose intolerance, just correlated test 50 grams of glucose, ANOVA (p &lt;0.033) with degrees of impaired glucose tolerance and there was a correlation positive linear between higher blood glucose value post 50 grams of glucose and glucose intolerance in the immediate postpartum. When we analyze dystocia, there was no correlation with any of the studied variables.Discussion. Interestingly in this study it is among correlation values loading test with 50g glucose and the presence of glucose intolerance and diabetes immediately after birth of gestational diabetes. It is known that after 50 grams of glucose greater than 200 glucose has an almost certain chance of having gestational diabetes (2) and according to some centers especially in the United States is not necessary to make a confirmatory SOG (2), however, their relationship to the immediate postpartum, it has not been seen in another study that we know until now and therefore part of their predictive value for gestational diabetes, could already give us an indication of glycemic alteration itself will happen in the immediate postpartum (3). Compared with other studies, the prevalence of glucose intolerance is similar to other high-risk populations, such as the Indian population (4), which gives the Canarian population at high risk of developing diabetes in the future. This study shows that the overload test with 50 grams of glucose is not only indicative of a very high suspicion of gestational diabetes, but can also help establish the prognosis of a future change in glucose metabolism in gestational diabetes.

Pregnancy urinary phthalate metabolite concentrations and gestational diabetes risk factors

BackgroundEpidemiologic studies suggest phthalate metabolite concentrations are associated with type 2 diabetes. GDM is a strong risk factor for type 2 diabetes. Little is known about phthalates and GDM risk factors (i.e. 1st trimester body mass index (BMI), gestational weight gain (GWG), and 2nd trimester glucose levels). MethodsA total of 350 women participating in Lifecodes pregnancy cohort (Boston, MA), delivered at term and had pregnancy urinary phthalate metabolite concentrations. Nine specific gravity-adjusted urinary phthalate metabolites were evaluated. General linear regression was used to assess associations between quartiles of phthalate metabolites and continuous 1st trimester BMI and late 2nd trimester blood glucose. Linear mixed models were used for total GWG. Multivariable logistic regression was used for phthalate concentrations and categorized GWG and impaired glucose tolerance defined as glucose≥140mg/dL based on a 50-gram glucose load test. Models were adjusted for potential confounders. ResultsThere were no associations between 1st trimester urinary phthalate metabolite concentrations and 1st trimester BMI. Mono-ethyl phthalate concentrations averaged across pregnancy were associated with a 2.17 increased odds of excessive GWG (95% CI: 0.98, 4.79). Second trimester mono-ethyl phthalate was associated with increased odds of impaired glucose tolerance (adj. OR: 7.18; 95% CI: 1.97, 26.15). A summary measure of di-2-ethylhexyl phthalate metabolite concentrations were inversely associated with impaired glucose tolerance (adj. OR: 0.25; adj. 95% CI: 0.08, 0.85). ConclusionsHigher exposure to mono-ethyl phthalate, a metabolite of the parent compound of di-ethyl phthalate, may be associated with excessive GWG and impaired glucose tolerance; higher di-2-ethylhexyl phthalate was associated with reduced odds of impaired glucose tolerance.

Plasma Levels of Alanine Aminotransferase in the First Trimester Identify High Risk Chinese Women for Gestational Diabetes.

Alanine aminotransferase (ALT) predicts type 2 diabetes but it is uncertain whether it also predicts gestational diabetes mellitus (GDM). We recruited 17359 Chinese women with ALT measured in their first trimester. At 24–28 weeks of gestation, all women underwent a 50-gram 1-hour glucose challenge test (GCT) followed by a 75-gram 2-hour oral glucose tolerance test if GCT result was ≥7.8 mmol/L. Restricted cubic spline analysis was used to examine full-range risk associations of ALT levels with GDM. Relative excess risk due to interaction, attributable proportion due to interaction and synergy index were used to estimate additive interaction between high ALT and overweight/obesity for GDM. Finally, 1332 (7.7%) women had GDM. ALT levels were positively associated with GDM risk without a clear threshold. Using ALT levels <22 U/L as the referent, the middle ALT levels (≥22 to <40 U/L) [odds ratio (OR) (95% confidence intervals): 1.41(1.21–1.65)] and high ALT levels (≥40 U/L) [1.62 (1.31–2.00)] were associated with increased GDM risk. Maternal overweight/obesity greatly enhanced the OR of ALT ≥22 U/L from 1.44 (1.23–1.69) to 3.46 (2.79–4.29) with significant additive interactions. In conclusion, elevated ALT levels in the first trimester even within normal range predicted GDM risk, further enhanced by overweight/obesity.

Hemoglobin A1C as a Diagnostic Test for Gestational Diabetes [17C

INTRODUCTION: ACOG recommends gestational diabetes mellitus (GDM) testing using a 1-hour 50-gram oral glucose challenge test (24–28 weeks gestation) and if elevated (>140 mg/dL), a 3-hr 100-gram oral glucose tolerance test. Objective was to determine if HbA1c testing can replace ACOG guidelines, offering a more tolerable, less time-consuming test for GDM. METHODS: This is a prospective cohort study of patients presenting <14 weeks gestation for prenatal care between 11/2011 and 6/2014. HbA1c levels obtained at initial visit and 24–28 weeks gestation were compared between patients with and without GDM and tested as a replacement for ACOG guidelines. RESULTS: Study was comprised of 146 of 364 consented patients meeting inclusion criteria (mean age: 25 years, obesity: 41.5%, and DM family history: 50%). Initial HbA1c values compared to 24–28 weeks revealed a small but significant decrease (5.2 vs 5.1, P<.001). However, mean HbA1c levels were higher in patients with GDM (5.3 vs 5.1, P=.027). Elevated HbA1c (>5.5) and positive GDM showed significant, but weak agreement (Kappa=0.69, P=.041), (sensitivity: 25% and specificity: 92.5%). ROC curve analysis determined optimal threshold 5.15 yielding sensitivity: 66.7%; specificity: 66.4%, PPV: 15.1%, and NPV: 95.7%. Analysis of mean change from initial to 24–28 HbA1c resulted in no main effect for GDM, but a significant GDM by HbA1c interaction (P=.002). GDMA patients demonstrated increased mean HbA1c and non-diabetics decreased mean HbA1c. CONCLUSION: While our data showed that patients with GDM had elevated levels of HbA1c at 24–28 weeks gestation, this test is not a reliable replacement for ACOG guidelines.

Screening and Statistical Optimization of Physiochemical Parameters for the Production of Xylanases from Agro-Industrial Wastes

Xylanases are mostly produced through submerged fermentation; nonetheless solid-state fermentation has increased profound attention and consideration of scholars having high conversion level biomass to energy conservation. This study depicted the purification of xylanases and their possible utilization in industry. The present study was carried out to examine the culture influence of fungal strain Fomes fomentarius (F. fomentarius) using different agro-industrial residues (wheat straw, rice husk, sugarcane bagasse and siris pods). F. fomentarius showed maximum enzyme production after 72 h of fermentation, when grown on wheat straw in solid state fermentation process while maximum activity showed on pH 6.0 at 30°C. The other parameters optimized by statistical design (RSM) showed maximum xylanase activity (146 ± 8 IU/mL) at 65% moisture content, 4 mL inoculums size, 175 mg Ammonium sulphate, 200 mg Calcium carbonate and 1.4 grams of glucose. Xylanase was salted out at 60% ammonium sulphate concentration and enzyme was further purified by Sephadex G-100 gel filtration chromatography with 2.2 fold increase in activity. The purified xylanase from F. fomentarius had optimum pH 6.0 and 40°C. Xylanase showed higher specificity for oat spelt xylan with kinetic constants Km 1.25 mg/mL and Vmax 54 mM/min. Xylanases have an industrial important enzyme used extensively in food, feed and paper industry.

The Utility of Glycated Hemoglobin, Determined in the Second Trimester of Pregnancy, in Diagnosing Gestational Diabetes

Abstract Background and Aims: Gestational diabetes (GD) identifies a pregnancy with high obstetrical risk due to the possible complications that may appear and which are associated with significant perinatal mortality and morbidity. The role of HbA1c in diagnosing GD is still debatable. Our aim was to evaluate the clinical utility of HbA1c assessed in the second trimester of pregnancy (before performing the oral glucose tolerance test - OGTT) in establishing the macrosomia risk, and also for diagnosing GD. Material and methods: This was an observational study on a group of 165 pregnant women followed from the first trimester of pregnancy in whom we measured HbA1c in the second trimester, before running an OGTT with 100 grams of glucose and who delivered at term (37 - 41 weeks of pregnancy). Finally, HbA1c and OGTT were performed only in 132 women, these being the subjects of our study. Results: The average value of HbA1c was 4.85±1.23%. HbA1c was higher in the group having gestational diabetes (6.58±0.74%) in comparison to the group not having GD (4.52±0,80%). The Receiver Operating Characteristic (ROC) curve for HbA1c determined in the second trimester, for diagnosis of GD, has an area under the curve (AUC) of 0.939. Conclusions: HbA1c value could be considered as a sensitive and specific predictive factor in appreciating the macrosomia risk and could be set as an extra criterion in GD diagnosis.

PP.05.23

Objective: The purpose of this study was to investigate the relationship between insulin resistance and left ventricular (LV) hypertrophy in hypertensive patients. Design and method: We studied 1019 hypertensive patients (46,5% men, mean age 56,8 ± 11 year old), newly diagnosed untreated hypertension or under hypertension (mean systolic/diastolic arterial pressure 150,5 ± 21/93,3 ± 12,3 mmHg). In all patients BMI (mean 28 ± 1,5 kg/m2) and waist circumference (98 ± 3 cm) were measured. Fasting blood samples were taken for the evaluation of serum glucose and insulin at baseline and in 120 minutes after oral administration of 75 grams of glucose. Moreover, All patients were assessed by ultrasonography for left ventricle mass index (LVMI) measurement. Based on the presence or not of LV hypertrophy the population of the study was divided in two groups (group A: LVMI = < 115 g/m2 for men and = < 95 g/m2 for women, group B: LVMI > 115 g/m2 for men and > 95 g/m2 for women).Conclusions: Insulin resistance after oral glucose intake was significantly higher in hypertensive patients with LV hypertrophy compared with control.

Eighteen grams of glucose are necessary to treat severe hypoglycaemia: experience from the Emergency Medical Services Department

Eighteen grams of glucose are necessary to treat severe hypoglycaemia: experience from the Emergency Medical Services Department

Second Generation Ethanol Production from Brewers’ Spent Grain

Ethanol production from lignocellulosic biomasses raises a global interest because it represents a good alternative to petroleum-derived energies and reduces the food versus fuel conflict generated by first generation ethanol. In this study, alkaline-acid pretreated brewers’ spent grain (BSG) was evaluated for ethanol production after enzymatic hydrolysis with commercial enzymes. The obtained hydrolysate containing a glucose concentration of 75 g/L was adopted, after dilution up to 50 g/L, for fermentation by the strain Saccharomyces cerevisiae NRRL YB 2293 selected as the best producer among five ethanologenic microorganims. When the hydrolysate was supplemented with yeast extract, 12.79 g/L of ethanol, corresponding to 0.28 g of ethanol per grams of glucose consumed (55% efficiency), was obtained within 24 h, while in the non-supplemented hydrolysate, a similar concentration was reached within 48 h. The volumetric productivity increased from 0.25 g/L·h in the un-supplemented hydrolysate to 0.53 g/L h in the yeast extract supplemented hydrolysate. In conclusion, the strain S. cerevisiae NRRL YB 2293 was shown able to produce ethanol from BSG. Although an equal amount of ethanol was reached in both BSG hydrolysate media, the nitrogen source supplementation reduced the ethanol fermentation time and promoted glucose uptake and cell growth.

Is There Any Relationship between Plasma Pentraxin 3 Levels and Gestational Diabetes Mellitus?

Background: Pentraxin 3 (PTX3) is a novel vascular inflammatory marker which increases in vascular events such as diabetes mellitus. The aim of this study was to investigate the relationship between serum PTX3 levels and gestational diabetes mellitus (GDM). Methods: This prospective observational study was comprised of 88 pregnant women with singleton pregnancies. The subjects were classified into 3 groups according to their response to a 50-gram glucose challenge test (GCT) and a 100-gram oral glucose tolerance test: control group (n = 28), impaired glucose tolerance group (n = 30), and GDM group (n = 30). Serum PTX3 levels were measured to examine the relationship between GDM and GCT values. Results: Significant differences in PTX3 levels were observed among the 3 groups in the sample (F = 7.598; p = 0.001). The mean PTX3 value was found to be significantly higher in the GDM group (3.17 ± 1.16 ng/ml) than in the control group (2.20 ± 0.83 ng/ml; p = 0.001). A significant positive correlation between PTX3 and GCT values was detected (r = 0.289; p = 0.008). Conclusion: Maternal serum PTX3 levels were found to be significantly related to high blood glucose levels. This may be an indicator of vascular pathology in GDM around the time of an oral glucose tolerance test.

Different strategies for diagnosing gestational diabetes to improve maternal and infant health.

Gestational diabetes mellitus (GDM) is carbohydrate intolerance resulting in hyperglycaemia with onset or first recognition during pregnancy. If untreated, perinatal morbidity and mortality may be increased. Accurate diagnosis allows appropriate treatment. Use of different tests and different criteria will influence which women are diagnosed with GDM. To evaluate and compare different testing strategies for diagnosis of gestational diabetes mellitus to improve maternal and infant health while assessing their impact on healthcare service costs. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014) and reference lists of retrieved studies. We included randomised trials if they evaluated tests carried out to diagnose GDM. We excluded studies that used a quasi-random model. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We identified six small trials, including 694 women. These trials were assessed as having varying risk of bias, with few outcomes reported. We prespecified six outcomes to be assessed for quality using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach; data for only one outcome (diagnosis of gestational diabetes) were available for assessment. One trial compared three different methods of delivering glucose: a candy bar (39 women), a 50-gram glucose polymer drink (40 women) and a 50-gram glucose monomer drink (43 women). We have reported results reported by this trial as separate comparisons. 75-gram oral glucose tolerance test (OGTT) versus 100-gram OGTT (one trial, 248 women): Women given the 75-gram OGTT had a higher relative risk of being diagnosed with GDM (risk ratio (RR) 2.55, 95% confidence interval (CI) 0.96 to 6.75). This difference was borderline in terms of statistical significance, and evidence was considered to be of very low quality when assessed by GRADE. No data were reported for the following additional outcomes prespecified for assessment in GRADE: caesarean section, macrosomia > 4.5 kg or however defined in the trial, long-term type 2 diabetes maternal, long-term type 2 diabetes infant and economic costs. Candy bar versus 50-gram glucose monomer drink (one trial, 60 women): More women receiving the candy bar, rather than glucose monomer, preferred the taste of the candy bar (RR 0.60, 95% CI 0.42 to 0.86). Infant outcomes were not reported. 50-gram glucose polymer drink versus 50-gram glucose monomer drink (three trials, 239 women): Mean difference (MD) in gestation at birth was -0.80 weeks (one trial, 100 women; 95% CI -1.69 to 0.09). Total side effects were less common with the glucose polymer drink (one trial, 63 women; RR 0.21, 95% CI 0.07 to 0.59), and no clear difference in taste acceptability was reported (one trial, 63 women; RR 0.99, 95% CI 0.76 to 1.29). Significantly fewer women reported nausea following the 50-gram glucose polymer drink compared with the 50-gram glucose monomer drink (one trial, 66 women; RR 0.29, 95% CI 0.11 to 0.78). No other measures of maternal morbidity or outcomes for the infant were reported. 50-gram glucose food versus 50-gram glucose drink (one trial, 30 women): Women receiving glucose in their food, rather than as a drink, reported fewer side effects (RR 0.08, 95% CI 0.01 to 0.56). No clear difference was noted in the number of women requiring further testing (RR 0.14, 95% CI 0.01 to 2.55). No other measures of maternal morbidity or outcome were reported for the infant. 75-gram oral glucose tolerance test (OGTT) World Health Organization (WHO) criteria versus 75-gram OGTT American Diabetes Association (ADA) criteria (one trial, 116 women): No clear differences in included outcomes were observed between women who received the 75-gram OGTT and were diagnosed using criteria based on WHO (1999) recommendations and women who received the 75-gram OGTT and were diagnosed using criteria recommended by the ADA (1979). Outcomes measured included diagnosis of gestational diabetes (RR 1.47, 95% CI 0.66 to 3.25), caesarean birth (RR 1.07, 95% CI 0.85 to 1.35), macrosomia defined as > 90th percentile by ultrasound or birthweight equal to or exceeding 4000 g (RR 0.73, 95% CI 0.19 to 2.79), stillbirth (RR 0.49, 95% CI 0.02 to 11.68) and instrumental birth (RR 0.21, 95% CI 0.01 to 3.94). Evidence is insufficient to permit assessment of which strategy is best for diagnosing GDM.

Is Non Fasting Glucose Challenge test sensitive enough to diagnose Gestational Diabetes Mellitus?

Background: There is a no consensus over the most sensitive and practical approach to diagnose Gestational Diabetes Mellitus (GDM). The standard 75 grams glucose tolerance test (GTT) is widely practiced to diagnose GDM. However, non-fasting 75-gram Glucose Challenge Test (GCT) with the 2-hour cutoff value of ≥ 140mg/dL is also recommended by some professional bodies. The aim of this study was to investigate the sensitivity and specifiity of GCT when compared to GTT for diagnosing GDM. Methods: Pregnant women in period of gestation between 24- 28 weeks were recruited by simple random sampling method. Non fasting 75g GCTs were performed in all followed by fasting 75g GTTs within a week time. International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria of GTT were used as t he reference test to diagnose GDM and 2-hour value of GCT was compared. Findings: According to IADPSG criteria, 21.5% (59/274) of pregnant women had GDM, in compared to 13.1% (36/274) detected by GCT. Sensitivity and specifiity of GCT were 40.6% and 94.4% respectively. The area under the ROC curve for the ability of 2-hour value of GCT to predict GDM detected by GTT was 0.758 (SE 0.039). According to GTT values, FBS ≥ 92 mg/dL alone recognized 11.7% (32/274) of study sample as having GDM. Additional 9.1% (25/274) and 0.7% (2/274) of GDM cases were detected with 1-hour value≥180 mg/dL and 2-hour hour value ≥ 153 respectively. Conclusion: GCT with 2-hour cutoff value ≥ 140mg/dL is not sensitive enough to diagnose GDM recognized by GTT.

Influence of the time of day and fasting duration on glucose level following a 1-hour, 50-gram glucose challenge test in pregnant women.

BackgroundPrevious studies have shown that the time of day (TD) of glucose measurement and the fasting duration (FD) influence the glucose levels in adults. Few studies have examined the effects of the TD and FD on the glucose level following a 1-hour, 50-gram glucose challenge test (GCT) in pregnant women in screening for or diagnosing gestational diabetes mellitus (GDM). The objective of this study was to investigate the influence of the TD (morning, afternoon, night) and the FD (the time of the last food ingestion as follows: ≤1 hour, 1–2 hours, and >2 hours) by examining their combined effects on the glucose levels following a 50-gram GCT in pregnant women.Methods and ResultsWe analyzed the data of 1,454 non-diabetic pregnant Taiwanese women in a prospective study. Multiple linear regression and multiple logistic regression were used to estimate the relationships between the 9 TD-FD groups and the continuous and binary glucose levels (cut-off at 140 mg/dL) following a 50-gram GCT, after adjusting for maternal age, nulliparity, pre-pregnancy body mass index, and weight gain. Different TD and FD groups were associated with variable glucose responses to the 50-gram GCT, some of which were significant. The estimate coefficients (β) of the TD-FD groups “night, ≤1 hr” and “night, 1–2 hr” revealed significantly lower glucose concentrations [β (95% confidence interval [CI]): −6.46 (−12.53, −0.38) and −6.85 (−12.50, −1.20)] compared with the “morning, >2 hr” group. The TD-FD groups “afternoon, ≤1 hr” and “afternoon, 1–2 hr” showed significantly lower odds ratios (OR) of a positive GCT; the adjusted ORs (95% CI) were 0.54 (0.31–0.95) and 0.58 (0.35–0.96), respectively.ConclusionsOur findings demonstrate the importance of standardizing the TD and FD for the 1-hour, 50-gram GCT. In screening for and diagnosing GDM, the TD and FD are modifiable factors that should be considered in clinical practice and epidemiological studies.

Inflammation and Glycemic Tolerance Status in Pregnancy: The Role of Maternal Adiposity

Background/Aims: Although the association between inflammation and insulin resistance is well known, the data related to the role of inflammation in gestational diabetes mellitus (GDM) are conflicting. The aim of this study was to investigate the association of several inflammatory mediators with the glycemic status in pregnancy. Methods: Leukocyte count, ferritin, C-reactive protein (CRP), fibrinogen and interleukin-6 levels were measured in 70 patients with normal glucose tolerance, in 57 patients with impaired glucose tolerance and in 35 patients with GDM as determined based on 50-gram oral glucose tolerance test (OGTT) and 100-gram OGTT results. Results: A significant difference among the groups was seen only with regard to CRP and fibrinogen levels; however, no significant differences were observed after adjustment for body mass index (BMI). CRP was found to be strongly associated with current BMI in all three groups. Conclusion: Maternal serum levels of inflammatory mediators are not related to GDM at the time of the glucose challenge test in the late second or early third trimester. The significant difference in the levels of CRP in different strata of glycemic tolerance was not observed after adjustment for BMI. Adiposity may have a central role in GDM, causing an inflammatory response.