Hb AIc Research Articles

Relationship between Aortic Root Diameter and Type 2 Diabetes in Hypertensive Patients

Background: Diabetes mellitus (DM) involves a series of metabolic conditions associated with hyperglycaemia which is caused by defects in insulin secretion and./or insulin action. The aim of this work was assessment of the relationship between Aortic Root (AOR) diameter and type 2 diabetes mellitus (T2DM) in Hypertension (HTN) cases.
 Methods: This prospective case control study was carried out on 80 HTN cases. Cases were divided in to three groups: Group A (30 HTN cases) with type 2 DM with good metabolic control (Hb AIC ≤ 7.0), group B: (30 HTN cases) with type 2 DM with poor metabolic control (Hb AIC > 7.0) and C (Control group) 20 HTN, non-DM subjects of the same age and sex group with no other comorbid conditions.
 Results: FS had a significant decline in group A (P2 = 0.001) and in group B (P3 <0.001) than C. EF had a significant difference among all groups (P <0.001). Early wave declaration time (DT) had a significant decline in group A (P2 = 0.049) and in group B (P3= 0.023) than C. Tissue doppler early velocity wave had a significant difference among all groups (P = 0.004). Tissue doppler early velocity wave had a significant decline in group A and B than C. (P2 = 0.038. P3 = 0.003).
 Conclusions: AOR in HTN cases had a significant decline in DM cases compared with non-DM cases. In our results, glycaemic control didn’t play a significant role in aortic root.

Sugar Disease and Its Ramification on Kidneys

Diabetic nephropathy is characterized by proteinuria, hypertension, and progressive kidney failure.30% of T1DM and 10-40% of patients with T2 DM will eventually develop end-stage renal failure. Currently, 13 % of the US population has clinical evidence of CKD. The patient’s awareness of CKD is extremely low. The early detection of diabetic nephropathy is dependent on measuring urinary albumin excretion (UAE) rate. Kidneys damaged from diabetic nephropathy will experience a gradual decline in glomerular filtration rate. More patients with diabetes and hypertension are not able to control their BP using ACE (Angiotensin alone and may require the addition of another class of antihypertensive converting enzyme) inhibitors or ARB (Angiotensin receptor blockers). Patients with Hb AIC levels of less than 7 are at a lower risk of nephropathy.

What can we learn from variation of red cell size distribution?

What can we learn from variation of red cell size distribution?

Effects of soy protein and genistein on blood glucose, antioxidant enzyme activities, and lipid profile in streptozotocin-induced diabetic rats

In the current study, the effect of soy protein and genistein, one of the main isoflavones in soybeans, on blood glucose, lipid profile, and antioxidant enzyme activities in streptozotocin (STZ)-induced diabetic rats was investigated. Male Sprague–Dawley rats were divided into nondiabetic control, STZ, STZ-genistein supplemented group (STZ-G; 600 mg/kg diet), and STZ-isolated soy protein supplemented group (STZ-ISP; 200 g/kg diet). Diabetes was induced by a single injection of STZ (50 mg/kg BW) freshly dissolved in 0.1 mol/L citrate buffer (pH 4.5) into the intraperitonium. Diabetes was confirmed by measuring the fasting blood glucose concentration 48-h post-injection. The rats with blood glucose level above 350 mg/dL were considered to be diabetic. Genistein and ISP were supplemented in the diet for 3 weeks. The supplementation of genistein and ISP increased the plasma insulin level but decreased the HbA IC level of the STZ-induced diabetic rats. The supplementation of genistein and ISP increased the glucokinase level of the STZ-induced diabetic rats. A significant reduction in glucose-6-phosphatase was observed in the groups treated with genistein and ISP in comparison with the diabetic control group. Hepatic superoxide dismutase, catalase, and glutathione peroxidase activities of the STZ-induced diabetic rats were significantly decreased in comparison with the control rats. Administering genistein and ISP to the STZ-induced diabetic rats significantly increased those enzyme activities. The concentration of thiobarbituric acid reactive substances in the STZ-induced diabetic rats was significantly elevated, while the genistein and ISP supplement decreased it to the control concentration. Genistein and ISP supplements seem to be beneficial for correcting the hyperglycemia and preventing diabetic complications.

Properties of normal and glycated human hemoglobin in presence and absence of antioxidant

We present a novel approach to study properties of normal (HbA) and nonenzymatically glycated (HbA Ic, HbA Ia+b) human hemoglobin using absorption spectroscopy and differential scanning calorimetry. The effect of the presence of the antioxidant fisetin on glycation of HbA is studied. Here, absorption spectroscopy has been fruitfully exploited to observe the formation of the glycated hemoglobin. With the differential scanning calorimetry, we studied the thermal unfolding of the protein hemoglobin at various conditions. The thermogram of the pure HbA showed two transition regions, with the occurrence of a partially unfolded intermediate state (the formation of which is mainly reversible) prior to complete denaturation (irreversible process). The denaturation temperature of HbA was found to be strongly dependent on the heating rate. Furthermore, there is a significant cooperativity between the two transition regions in pure HbA. The overall denaturation for the glycated hemoglobin takes place at a lower temperature, suggesting a decrease in the stability of the protein when it is glycated. In presence of fisetin, glycation is inhibited to a certain extent and the thermograms match well with that of normal HbA. Implications of the results are discussed.

Social and psychological characteristics of Kuwaiti children and adolescents with type 1 diabetes

Type 1 diabetes mellitus is a chronic disease that may have an impact on children's psychosocial adjustment. This study aimed to investigate the psychosocial characteristics of Kuwaiti children with type 1 diabetes as compared to healthy children without diabetes, and assess the impact of glycaemic control on psychosocial variables. A total of 349 school children aged 6–18 years with type 1 diabetes, and 409 children without diabetes having comparable age, gender, and social class were included in the study. Data were obtained by interviewing children and parents using a questionnaire. Psychological distress was measured by the Hopkins symptoms checklist-25 scale including anxiety and depression. Glycaemic control was assessed by glycosylated haemoglobin, HbA IC level. Glycaemic control was considered ‘good to excellent’ at HbA IC<8.0%, ‘fair’ at HbA IC 8.1 to 10.0%, and ‘poor’ at HbA IC>10.0%. Median scores of anxiety, depression, and total distress were significantly higher in children with diabetes indicating worse psychological adjustment. There was also significant difference between children with diabetes and those without diabetes in social aspects and school absence days. There was significant positive correlation between HbA IC concentration and scores of the psychological functioning indices. Children with poor glycaemic control had worse psychological adjustment. After controlling the variance accounted by gender and age, stepwise multiple regression analysis showed that girls, older children, children in need of emotional support, and those with higher HbA IC were at higher risk for psychological maladjustment. These variables explained 47.9% of the variation in total distress. In conclusion, the study supported our hypotheses. Children with diabetes had worse psychological adjustment, and distress was related to glycaemic control. Since psychological distress increases the risk for future complications due to its relation with glycaemic control, longitudinal studies are recommended to identify children with diabetes having distress at an early stage when preventive interventions are effective.

The effects of dietary caloric restriction on antioxidant status and lipid peroxidation in mild and severe streptozotocin-induced diabetic rats

Background: Dietary caloric restriction (CR) without malnutrition is effective in the control of diabetes mellitus by stabilizing glucose homeostasis and enhancing glycemic control. Mild and severe streptozotocin-induced diabetic and non-diabetic rats were subjected to caloric restriction and ad libitum feeding to evaluate their effects on oxidative stress and lipid profile in the plasma of experimental animals. Methods: Mild and severe diabetes were induced in Male Wistar rats by intraperitoneal injection of 35 and 65 mg/kg streptozotocin respectively. The experimental animals were subjected to 40% caloric restriction and ad libitum feeding for 9 weeks. Results: CR was effective in significantly reducing body weight, blood glucose, HbA IC and TG concentrations (all p<0.001) in mild diabetic rats and non-significantly improving the plasma HDL-cholesterol concentrations. However, CR did not produce any significant effect on the antioxidant enzyme activities and MDA concentrations in all the groups nor in any of the parameters measured in non-diabetic rats except their overall weight change. There were significant ( p<0.001) decreases in body weight and non-significant fluctuating results in HbA IC and HDL-cholesterol in severe diabetic animals. Conclusions: These results demonstrate that caloric restriction is most effective in mild than in non-diabetic or severe diabetic animals.

Gender-specific association of vitamin D receptor polymorphism combinations with type 1 diabetes mellitus

Recent data have indicated the significance of vitamin D receptor (VDR) polymorphisms in type 1 diabetes mellitus (T1DM). We have studied the association of five known restriction enzyme polymorphisms of the VDR gene in patients with T1DM. One hundred and seven children with T1DM (T1DM for 5 Years; age, 1-14 Years; boys/girls, 57/50; body mass index, 17.0+/-2.3 kg/m(2); haemoglobin A(Ic) (HbA(Ic)), 7.87+/-1.05) and 103 healthy subjects were enrolled. The VDR polymorphisms ApaI, BsmI, FokI, TaqI and Tru9I ("a", "b", "f", "t" and "u" alleles respectively) were investigated. The "t" and "T" alleles miss the Hardy-Weinberg equilibrium (P<0.01) in control and diabetic populations; we therefore excluded this polymorphism from further analysis. We did not find a difference in the allele prevalence in T1DM patients and controls of any of the five polymorphisms. However, when the "b", "a" and "u" alleles were simultaneously compared in girls, there was a significantly higher prevalence in patients with diabetes compared with controls ("b"+"a"+"u" present/absent: healthy, 0/53; diabetic, 13/37; P<0.005). In boys the prevalence of "b"+"a"+"u" genotype was similar in T1DM and controls. The impact of the "t" allele cannot be investigated in this study population. Not a single VDR polymorphism increases the susceptibility to T1DM. The common presence of the "b", "a" and "u" alleles greatly increases the probability of T1DM in girls.

Factors affecting visual outcomes after small-incision phacoemulsification in diabetic patients

Purpose To examine the factors affecting visual outcome after phacoemulsification and evaluate the use of preoperative visual potential in assessing the visual prognosis in diabetic patients. Setting Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA. Methods In a retrospective chart review of 1345 consecutive patients who had uneventful small-incision phacoemulsification, operated eyes from 106 diabetic and 55 nondiabetic control patients were selected. Data on demographics, level of retinopathy, perioperative glycosylated hemoglobin (HbA Ic), surgical duration, preoperative best corrected visual acuity (BCVA), and visual potential were collected. Results The age, sex, preoperative BCVA, and visual potential in the diabetic and control eyes were comparable. Throughout the postoperative period, BCVA was worse of the diabetic group. At 1 year, BCVA was 20/40 in 82.1% of the diabetic group and 94.7% of the control group ( P = .01). The most important factors affecting postoperative BCVA included coexisting diabetes and preoperative level of retinopathy. No correlation was found between perioperative and postoperative BCVA. Diabetic patients were less likely than control patients to achieve a BCVA better than or equal to the preoperative visual potential at 4 years (hazard ratio 0.6; 95% confidence interval, 0.4-0.9; P = .011). Patients with nonproliferative diabetic retinopathy were nearly 5 times less likely ( P = .023) and patients with proliferative diabetic retinopathy 30 times less likely ( P < .0001) to achieve a postoperative BCVA of 20/40 than diabetic patients without retinopathy. Conclusions Although uneventful small-incision phacoemulsification improved visual acuity in diabetic patients, this group had an overall worse visual outcome than nondiabetic patients. The most important predictors of visual outcome were coexisting diabetes and the extent of preoperative retinopathy. Methods used to assess preoperative visual potential provided a reasonable estimate of postoperative BCVA in diabetic patients. Given the inverse association between the level of retinopathy and visual outcome, it may be better to perform cataract extraction in diabetic patients during earlier stages of retinopathy.

Renal resistance to vasopressin in poorly controlled type 1 diabetes mellitus.

To investigate the hypothesis that diabetes induces nephrogenic diabetes insipidus, we studied the urine-concentrating ability in response to vasopressin (AVP) in 12 patients with insulin-dependent diabetes mellitus (IDDM) and 12 nondiabetic controls. Subjects were euglycemic-clamped, and after oral water loading, AVP was infused intravenously for 150 min. AVP induced a greater (P<0.001) rise in urine osmolality in controls (67.6+/-10.7 to 720+/-31.1 mosmol/kg, P<0.001) than in IDDM patients (64.3+/-21.6 to 516.7+/-89.3 mosmol/kg, P<0.001). Urinary aquaporin-2 concentrations after AVP infusion were higher in controls (611.8+/-105.6 fmol/mg creatinine) than in IDDM (462.0+/-94.9 fmol/mg creatinine, P = 0. 003). Maximum urine osmolality in IDDM was inversely related to chronic blood glucose control, as indicated by Hb A(Ic) (r = -0.87, P = 0.002). To test the hypothesis that improved glycemic control could reverse resistance to AVP, 10 IDDM subjects with poor glycemic control (Hb A(Ic) >9%) were studied before (B) and after (A) intensified glycemic control. Maximum urine osmolality in response to AVP increased with improved glycemic control (B, 443.8+/-49.0; A, 640.0+/-137.2 mosmol/kg, P<0.001), and urinary aquaporin-2 concentrations after AVP increased from 112.7 +/-69 to 375+/-280 fmol/mg creatinine (P = 0.006), with improved glycemic control. Poorly controlled IDDM is associated with reversible renal resistance to AVP.

Hepatocyte growth factor as a potential index of complication in diabetes mellitus.

Diabetes mellitus (DM), characterized by the premature development of microvascular and macrovascular disease, shows a loss of vasodilatory properties of resistance vessels. However, the mechanisms of endothelial dysfunction in diabetes have not yet been clarified. Hepatocyte growth factor (HGF) in vascular cells was down-regulated by high glucose levels, potentially accelerating the endothelial dysfunction in DM. In this study, the serum HGF level was measured to investigate further the role of HGF in DM. Tissue and circulating HGF levels were measured in the KKAy mouse, a rodent model of non-insulin-dependent diabetes mellitus (NIDDM), and lean C57 BL control mice. Then, serum HGF concentrations were measured in NIDDM patients without liver, kidney or lung damage. For the study of serum HGF concentration, 30 normotensive and age-matched 58 DM patients were studied. The 58 DM patients were divided into 26 patients without hypertension and 32 patients with hypertension [22 patients without hypertensive complications (WHO I) and 10 patients with hypertensive complications (WHO II + III)]. The serum HGF concentration in KKAy mice was significantly lower than that in control mice (P < 0.01), at 14 weeks of age when they exhibit features of diabetes. Similarly, tissue HGF concentrations in the heart and kidney were decreased significantly in KKAy mice compared with control C57 BL mice (P< 0.05). The serum HGF concentration showed a significant negative correlation with hemoglobin (Hb) A(Ic) concentration (P< 0.01, r= -0.41). Since the serum HGF concentration is a potential index of the severity of hypertension, the serum levels of HGF in DM patients without and with hypertension were examined. The serum HGF concentration in DM patients without hypertension was significantly lower than that in normal subjects (P< 0.05), whereas that in DM patients with hypertension was significantly higher than that in normal subjects (P < 0.01). Moreover, the serum HGF concentration in DM patients with hypertensive complications was further higher than that in others (P < 0.01). The present data showed that serum, cardiac and renal HGF concentrations in KKAy mice were significantly decreased compared with control mice. Therefore, a decrease in local HGF may be a trigger of endothelial dysfunction in DM. Clinical data also demonstrated a significant negative correlation between serum HGF and HbA(Ic) concentrations in diabetic patients without complications. In contrast, the serum concentration of HGF was significantly elevated depending on the severity of hypertension. These results suggest that HGF may be a new index of complications such as hypertension in DM.

Age at onset and long-term metabolic control affect height in type-1 diabetes mellitus.

Reduced height as a consequence of type-I-diabetes mellitus in childhood has been reported in many studies. However, it is still debated whether good metabolic control can normalize the growth rate. A total of 436 children (204 boys, 232 girls, mean age at diagnosis of diabetes 8.2+/-0.2 years) were followed at our outpatient diabetes centre. Z-scores for height were evaluated in relation to duration of diabetes, age at onset and long-term metabolic control. At diagnosis, height in children with diabetes was significantly above the reference population (+0.43+/-0.09). Standardized height decreased during the subsequent course of diabetes. This likely represents a delay of growth, as the final height (chronological age > 18 years, n = 144) was +0.27+/-0.09. Growth reduction was more pronounced in patients diagnosed before the onset of puberty and final height in patients with a prepubertal onset of diabetes was significantly lower (+0.10+/-0.13) compared to patients with a pubertal/postpubertal onset (+0.52+/-0.14). Among patients with a prepubertal onset, the subgroup with "poor" metabolic control (long-term median HbA(Ic) >7%) lost significantly more height compared to patients with "good" metabolic control. Despite modern treatment regimens, reduced longitudinal growth can still be demonstrated in type-I diabetes. This parameter therefore provides a valuable endpoint for quality control in paediatric diabetology.

An examination of DNA strand breakage in the comet assay and antioxidant capacity in diabetic patients

There are two forms of diabetes, insulin-dependent Diabetes mellitus (IDDM) and non-insulin dependent Diabetes mellitus (NIDDM). There is evidence to suggest that reactive oxygen is involved in the pathogenicity and complications arising from IDDM, but there is little to suggest a role of oxidative stress in the pathogenesis of NIDDM. In order to investigate this hypothesis further, peripheral blood samples were taken from control individuals and IDDM and NIDDM patients and examined for antioxidant capacity and in the Comet assay for DNA strand breakage. The individuals answered a questionnaire to provide information relating to lifestyle factors in case such factors might have a confounding effect. There were 20 controls, 22 IDDM patients and 23 NIDDM patients. No differences could be detected in control and diabetic patient groups in terms of creatinine levels and antioxidant capacity. DNA damage in the Comet assay was at a lower level than in the control in the IDDM patients and a slightly lower level in the NIDDM patients, which might indicate that these cells are handling more oxidative damage on a regular basis. As expected, there were differences in glycosylated haemoglobin (HbA IC) levels. The confounding factors (smoking, drinking and vitamin intakes, etc.) appeared to have no effect.

Assessment of radioisotopic micturating cystography of the diagnosis of vesicouretic reflux in renal transplant recipients with acute pyelonephritis

The gold standard for documenting vesicoureteric reflux is direct (retrograde) micturating cystography (MC). In children, radioisotopic MC has been advocated for increased sensitivity and lesser radiation exposure. In renal transplant recipients, where reflux can induce acute pyelonephritis, this technique has not been evaluated. The aim of this study was to assess the radioisotopic technique in these patients. Seventeen renal transplant recipients had developed acute pyelonephritis following the surgical grafting procedure. They were investigated using both MC techniques. Radioisotopic MC was performed using 99mTc-pertechnetate. Reflux was documented in nine patients by radioisotopic MC but in only seven with the conventional technique. All negative patients remained symptom free after the pyelonephritis was cured and it was assumed that they had no reflux. Consequently, using the radioisotopic MC as gold standard, the conventional X-ray technique had a sensitivity of 78% and a specificity of 100%. Direct radioisotopic MC allowing continuous cystogram recording is more accurate than conventional X-ray MC for the diagnosis of vesicoureteric reflux in transplanted patients with acute pyelonephritis.

Psychological reactions at the onset of insulin-dependent diabetes mellitus in children and later adjustment and metabolic control.

The initial psychological reactions at the onset of insulin-dependent diabetes mellitus (IDDM) in a population-based sample of 76 children were studied with staff observations and a self-report questionnaire for children 12 years of age and more. Younger children reacted with more anger and less distress than the older children. High initial self-reported distress was associated with poorer subjective psychological IDDM adjustment at a follow-up 10 months later for the older children. The children's initial reactions as well as later adjustment were intimately associated with maternal initial reactions in the total group. The metabolic control, estimated as the mean level of the major fraction of glycosylated haemoglobin (Hb AIc) during the first 2 years, was poorer in the adolescent group. Initial anxiety over injections and protest but low general distress in mothers and children were associated with better metabolic control.

Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus.

The relations between age, metabolic control, disease adjustment, and psychological factors in boys and girls with recently diagnosed insulin-dependent diabetes mellitus (IDDM) were studied. Older girls had significant higher postremission glycosylated haemoglobin A (Hb AIc) levels (p = 0.008). Girls with more hospitalizations had a lower developmental level (p = 0.05), and had significantly more problems in the behavioural rating (p = 0.05). Boys with more hospitalizations had a more external locus of control (p = 0.01), more difficulties with disease adjustment, more emotional problems, and were also clinically assessed as having more behavioural problems. Boys showing more difficulties in psychological adjustment to the disease also had higher postremission Hb AIc levels (p = 0.02). Although Swedish children with IDDM of short disease duration do not differ from healthy children in important psychological aspects, older girls and a small group of problematic younger boys are at risk of developing metabolic imbalance after a short disease duration.

Fluorophotometric study of lens autofluorescence and the blood-retinal barrier in 56 diabetic patients.

We examined lens autofluorescence and the permeability of the blood-retinal barrier in 56 diabetic patients (34 insulin-dependent and 22 non-insulin-dependent), using the Fluorotron Master (R), a commercially available fluorophotometer. Significant relationships were found between age and lens autofluorescence (p < 0.01), between duration of diabetes and lens autofluorescence in insulin-dependent diabetics (p < 0.01), and between duration of diabetes and blood-retinal barrier permeability in all diabetics (p < 0.05). The relationships between lens autofluorescence and duration of diabetes in non-insulin dependent patients (p > 0.05), and between lens autofluorescence or the penetration ratio and HBA Ic during the five preceding years (p > 0.05) were not significant. Fluorophotometry provides an objective and reproducible method for in vivo investigation of the ocular complications of diabetes and of the factors influencing them.

Strict glycemic control in women with pregestational insulin-dependent diabetes mellitus

Objective: To determine the efficacy of strict glycemic control in women with pregestational insulin-dependent diabetes mellitus (IDDM). Methods: The records of 62 pregnant women with pregestational IDDM who had attended the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Virgen de las Nieves General Hospital, Granada, Spain, between 1982 and 1992, were reviewed. The women had received several daily doses of a mixture of rapid action (regular) and intermediate action insulin with the aim of keeping preprandial glucose levels lower than 95 mg/dl and postprandial glucose levels lower than 120 mg/dl. Perinatal outcomes were compared with those of a control group consisting of 96 randomly selected, normal, pregnant women who gave birth at approximately the same time. Results: Mean glycemic profile in the first assay at an insulin dose of 33.1 ± 15.9 IU/day was 153.7 ± 52.3 mg/dl and the HbA Ic was 7.7 ± 2.3%. In the last assay before delivery patients received an insulin dose of 68.2 ± 30.7 IU/day and had a mean glycemic profile of 94.4 ± 18.1 mg/dl and an HbA Ic of 5.9 ± 1.4% ( P < 0.001 for all parameters). The perinatal mortality of newborn infants of the diabetic mothers was 48 per 1000, and 11.3 per 1000 had some congenital malformations. Conclusions: Our results verify that strict glycemic control decreases the elevated perinatal mortality normally suffered by IDDM patients. However, if it is to reduce the number of congenital malformations, it must be initiated before the early gestational stages.

Effects of supine blood pressure on interpretation of standing up test in 500 patients with diabetes mellitus

The relationship between fall in blood pressure (BP) on standing and supine BP before standing up was studied in 75 healthy controls and in 500 patients with diabetes mellitus (DM) using conventional BP measurements. The influences of physiological (sex, age, height) and DM-related factors (type, duration, HbA 1c-level, use of insulin, oral antidiabetic and anti-hypertensive medication) on BP-fall were assessed. The effects of using a fixed abnormality threshold and a new supine BP-related abnormality definition on interpretation of the test were determined. Highly significant relationships of BP-fall with supine BP were found in control and DM subjects. Slopes did not differ between these groups. Slopes for systolic BP-fall were steeper in type 1 than in type 2 DM patients. A forward stepwise regression procedure revealed that supine BP (explaining 24% of variance) and HbA Ic (explaining 1%) had significant influences on systolic BP-fall. Diastolic supine BP explained 14% of diastolic BP-fall, age 3%, and sex 2%. Only supine BP was thus of practical relevance in explaining BP-fall. Taking supine BP into consideration affected test results: of 74 subjects with an abnormal conventional systolic BP-fall, 10 (13.5%) had been misclassified according to the new method, and 4 additional patients had been misclassified as normal. Classification changes were much larger for diastolic BP-fall (63% of conventionally abnormal results were reclassified as normal), but the range of diastolic BP is smaller than for systolic BP, meaning that the measurement error interferes with its clinical utility. BP-fall was higher in type 2 than in type 1 diabetics, and higher in those using anti-hypertensives than in those who did not. These effects were due to differing supine BPs, showing that taking supine BP into account can prevent incorrect conclusions regarding abnormality of the standing up test in DM. The validity of this test can be improved by accounting for supine BP.

Fructosamine as a screening-test for gestational diabetes mellitus: a reappraisal

Fructosamine, glycosylated hemoglobin (HbA Ic) and serum total proteins were measured in normal nondiabetic pregnant women (n = 170) at three stages of pregnancy (14–18, 24–28, and 32–40 weeks of gestation). No significant correlation was found between fructosamine and either HbA Ic or total plasma proteins. Only early in pregnancy (< 20 weeks of gestation) was a correlation found between fructosamine and fasting blood glucose (r = 0.40, P < 0.05). There was also no correlation between either tests (i.e. fructosamine and HbA Ic) and fetal birthweight. The value of fructosamine measurement in the detection of diabetes in pregnancy was further tested in a group of high-risk patients (n = 98) for developing carbohydrate intolerance. It is concluded that fructosamine has limited value as a screening test for gestational diabetes mellitus, particularly for the mild form of the glucose intolerance.