Metabolic Control In Women Research Articles

Оценка расстройств пищевого поведения у женщин с осложненным сахарным диабетом 2-го типа

Objective. To analyze the types of eating disorders in women with microvascular complications of type 2 diabetes mellitus (DM2), to identify the predominant type in patients with diabetic retinopathy and nephropathy, to analyze the correlation with clinical characteristics. Patients and methods. 382 women with T2DM from 50 to 80 years with diabetic retinopathy (subgroup IA, n = 121) and diabetic nephropathy (subgroup IB, n = 261) were examined at the endocrinology department of Perm Regional Clinical Hospital. DEBQ questionnaire was used to identify eating disorders. Results. The results of the study showed that one in five women did not have eating disorders. Patients with diabetic retinopathy had all types of eating disorders. In women with diabetic nephropathy, the restrictive and emotiogenic type prevailed. In both groups the eating disorders with high body mass index, glycated hemoglobin levels, and lipid metabolism indicators were established,statistically significant. Conclusion. Established eating disorders showed significant impact on metabolic control in women with complicated T2DM. The detection and prevention of this condition should be considered as a priority in the observation of this category of patients. Key words: diabetic retinopathy, diabetic nephropathy, women, eating disorders, type 2 diabetes mellitus

Особенности нарушений пищевого поведения у больных сахарным диабетом 2 типа

Aim: to establish the features of eating disorders in patients with type 2 diabetes mellitus. Material and methods. Examination of 536 women with complicated T2DM aged 50–80 years was carried out on the basis of the endocrinology department of the State Budgetary Healthcare Institution “PKKB”, Perm. The DEBQ questionnaire was used to identify eating disorders. Results. Emotional type of eating behavior was observed in 2.4% of DM2 patients, external — in 13%, restrictive — in 21%. All three eating disorders were present in 7.1% of patients, emotiogenic in combination with external — in 14.3%, restrictive in combination with emotiogenic — in 6.2%, restrictive in combination with external — in 14.6%. The emotiogenic type of eating behavior correlated with age (r = –0.598; p = 0.006), duration of diabetes (r = –0.536; p = 0.0148), body mass index (r = 0.363; p = 0.008), waist size (r = 0.384; p = 0.0361), total cholesterol (r = 0.741; p = 0.0079). A connection has been established between xternal type of eating behavior and body mass index (r = 0.567; p = 0.009), high-density lipoprotein cholesterol (r = –0.7; p = 0.0014), glycated hemoglobin level (r = 0.780; p = 0.022), triglycerides (r = 0.348; p = 0.0164). The dependence of the restrictive type of eating behavior on age (r = 0.879; p = 0.048), body mass index (r = 0.321; p = 0.021), glycemia level (r = –0.6; p = 0.01) and lipoprotein cholesterol was revealed. low density (r = –0.663; p = 0.013). Conclusion. Established eating disorders have shown an impact on metabolic control in women with type 2 diabetes. Their detection and prevention should be considered as a priority in the dispensary observation of this category of patients. Keywords: eating disorders, type 2 diabetes mellitus, women, metabolic control.

Remote monitoring of gestational diabetes with my Sugr App integrated to diabetology EMR during Covid-19 emergency

The aim of our study was demonstrate how the implementation of a shared management process using innovative tools, such as telemonitoring with a mobile app, has a benefits in term of facilitating the management of women with GD and reducing access to hospitals. Due to COVID-19 emergency in 2020, the integration between the Diabetologist EMR (SDC) and mySugr app for people with diabetes was activated for 4 months; the patient can enter blood sugar and other clinical data in the app for recording and tracking data directly in the EMR. The telemonitoring service was proposed to pregnant patients to avoid further direct access for the visits. The analysis of glycemic control and maternal-fetal outcome was performed on a total of 46 pregnant women (38 Italian and 8 foreign, age 35.4 ± 4.9 years, graduates 73%, pre-pregnancy BMI 24.9 ± 5.4 Kg / m2) enrolled on average at 30 ± 5 weeks. The total blood glucose levels recorded were 8818 (176 ± 98 blood sugar levels per patient), the mean pre- and post-meal blood glucose levels were respectively 96 ± 9.8 mg / dl and 127.8 ± 34.6 mg / dl. Delivery took place at 39 ± 2 weeks, in 65.2% spontaneously (34.8% Caesarean section) in the absence of preterm births or birth trauma. All the women examined showed a high degree of satisfaction. Despite numerical limitation, this experience shows how the use of my- Sugr app integrated with SDC can offer to Diabetologists a secure data flow in electronic format, permitting an immediate consultation and a subsequent benefits on the metabolic control in women with GD. The solutions used are appreciated by all pregnant women and allowed the reduction of access to diabetes Centers. The implementation of this experience of telemedicine management is also desirable outside the period of COVID-19 emergency. KEY WORDS diabetes; telemedicine; pregnancy.

Reproductive Health and Metabolic Parameters in Women with Type 2 Diabetes

Abstract Aim: This study evaluated the correlations between metabolic parameters and reproductive health data in women with type 2 diabetes mellitus (T2DM). Material and methods: In this observational retrospective study, data from the medical records of 324 adult women with T2DM attending their regular diabetes check-ups were collected and analyzed (i.e., anthropometric parameters at first outpatient visit and yearly thereafter, first recorded HbA1c and all HbA1c for the entire follow-up duration, as well as obstetrical/gynecological information). Results: Age at the diagnosis of T2DM correlated positively with age at menarche (r = 0.21, [95% CI: 0.09, 0.31], p = 0.0002) and age at menopause (r = 0.18 [95% CI: 0.07, 0.29], p <0.01). Age at menarche correlated negatively with mean weight (r = –0.21 [95% CI: –0.31, –0.10], p: 0.0002) and mean BMI (–0.22 [–0.32, –0.11], p <0.0001) over the follow-up time. Patients with shorter time difference between age at menarche and age at onset of T2DM (≤45 years) had higher mean weight (83.8 ± 14.5 kg vs. 78.4 ± 16.0 kg, p = 0.0001), BMI (33.2 ± 5.6 kg/m2 vs. 31.8 ± 5.7 kg/m2, p <0.05), and HbA1c over time (6.9 ± 0.8% vs. 6.6 ± 0.9%, p <0.0001). Women with T2DM with earlier menarche (<12 years old), with irregular menses during their reproductive life, and ≥3 pregnancies had higher overall BMI, but mean HbA1c were not significantly different. However, women diagnosed with T2DM before menopause had a higher mean HbA1c over time (7.1 ± 0.8% vs. 6.7 ± 0.9%, p <0.01). Conclusion: The BMI correlated with several indicators of reproductive health (earlier menarche, irregular menses, and higher number of pregnancies), while earlier onset of T2DM influenced metabolic control in women with T2DM.

The complex interplay between clinical and person-centered diabetes outcomes in the two genders

BackgroundNew approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM.MethodsClinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators.ResultsOverall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached HbA1c levels < =7.0% (23.2% vs. 27.8%; p = 0.03), LDL-cholesterol < 100 mg/dl (48.3 vs. 57.8%; p = 0.0005), and BMI <27 Kg/m2 (27.2 vs. 31.6%; p = 0.04) than men. Women had statistically significant poorer scores for physical functioning, psychological well-being, self-care activities dedicated to physical activities, empowerment, diabetes-related distress, satisfaction with treatment, barriers to medication taking, satisfaction with access to chronic care and healthcare communication, and perceived social support than men; 24.8% of women and 8.8% of men had WHO-5 < =28 (likely depression) (p < 0.0001); 67.7% of women and 55.1% of men had PAID-5 > 40 (high levels of diabetes-related distress) (p < 0.0001). At multivariate analysis, factors associated with an increased likelihood of having elevated HbA1c levels (≥8.0%) were different in men and women, e.g. having PAID-5 levels >40 was associated with a higher likelihood of HbA1c ≥8.0% in women (OR = 1.15; 95%CI 1.05–1.25) but not in men (OR = 1.00; 95%CI 0.93–1.08).ConclusionsIn T2DM, women show poorer clinical and person-centered outcomes indicators than men. Diabetes-related distress plays a role as a correlate of metabolic control in women but not in men. The study provides new information about the interplay between clinical and person-centered indicators in men and women which may guide further improvements in diabetes education and support programs.

Gender-Disparities in Adults with Type 1 Diabetes: More Than a Quality of Care Issue. A Cross-Sectional Observational Study from the AMD Annals Initiative.

We evaluated gender-differences in quality of type 1 diabetes (T1DM) care. Starting from electronic medical records of 300 centers, 5 process indicators, 3 favorable and 6 unfavorable intermediate outcomes, 6 treatment intensity/appropriateness measures and an overall quality score were measured. The likelihood of women vs. men (reference class) to be monitored, to reach outcomes, or to be treated has been investigated through multilevel logistic regression analyses; results are expressed as Odd Ratios (ORs) and 95% confidence intervals (95%CIs). The inter-center variability in the achievement of the unfavorable outcomes was also investigated. Overall, 28,802 subjects were analyzed (45.5% women). Women and men had similar age (44.5±16.0 vs. 45.0±17.0 years) and diabetes duration (18.3±13.0 vs. 18.8±13.0 years). No between-gender differences were found in process indicators. As for intermediate outcomes, women showed 33% higher likelihood of having HbA1c ≥8.0% (OR = 1.33; 95%CI: 1.25–1.43), 29% lower risk of blood pressure ≥140/90 mmHg (OR = 0.71; 95%CI: 0.65–0.77) and 27% lower risk of micro/macroalbuminuria (OR = 0.73; 95%CI: 0.65–0.81) than men, while BMI, LDL-c and GFR did not significantly differ; treatment intensity/appropriateness was not systematically different between genders; overall quality score was similar in men and women. Consistently across centers a larger proportion of women than men had HbA1c ≥8.0%, while a smaller proportion had BP ≥140/90 mmHg. No gender-disparities were found in process measures and improvements are required in both genders. The systematic worse metabolic control in women and worse blood pressure in men suggest that pathophysiologic differences rather than the care provided might explain these differences.

Menstrual Cycle and Glycemic Control

Women with type 1 diabetes frequently report problems with blood glucose control around the time of menstruation. Although this issue has been extensively studied, the correlation between the phases of the menstrual cycle and blood glucose control remains to be established. This present study discusses the controversy that exists in the current literature regarding the effect of the menstrual cycle on metabolic control in women with type 1 diabetes. A search was made in the PubMed database in March 2008 of papers published in the last fifteen years that included the terms “menstrual cycle” and “type 1 diabetes”. Six articles were selected. In some women with type 1 diabetes, premenstrual hyperglycemia has been reported as being detrimental to adequate blood glucose control. Many factors have been attributed to this phenomenon. Some studies have reported elevated progesterone levels during premenstrual hyperglycemia. Other studies have suggested that premenstrual symptoms may explain the unsatisfactory blood glucose control found during this period. Despite conflicting reports in the literature, it would appear that premenstrual hyperglycemia does occur in some diabetic women. More studies with larger sample sizes and reliable methodology have been recommended. This review also took into consideration the registration of some recent patents.

Effects of 14-Week Tai Ji Quan Exercise on Metabolic Control in Women with Type 2 Diabetes

The present study investigated the effects of 14 weeks of practicing Tai Ji Quan (TJQ) on metabolic control and lipid metabolism in women with type 2 diabetes. Twenty Beijing female residents (57.4 +/- 6.2 years) were recruited and were randomly assigned to either the TJQ training or the control group. In the TJQ group, the exercise duration was 1 hour per day and 5 days a week for 14 weeks. FPG, GSP, FPI, TC, HDL-C, LDL-C, TG, resting blood pressures and heart rate were measured before and after the 14 weeks in the 2 groups. It was found that after 14 weeks, the TJQ group had significantly lower FPG, GSP, TG and higher FPI concentration, whereas there were no significant differences in TC, HDL-C and LDL-C. It was concluded that TJQ exercise could be used as an intervention tool to improve glycaemic control and serum TG level in the elderly people. Future research with TJQ of different styles and exercise of different intensities were recommended.

Evaluation of Metabolic Control in Women with Gestational Diabetes Mellitus by the Continuous Glucose Monitoring System: A Pilot Study

To evaluate the blood glucose concentrations in a group of women with gestational diabetes mellitus (GDM), by the use of a continuous glucose monitoring system (CGMS). Seven women with diet-controlled GDM (group G1), 5 with diet- and insulin-controlled GDM (group G2), and 7 healthy, pregnant women (group N) were included in the study. The treatment was adjusted on the basis of self-monitoring of blood glucose (SMBG). The self-monitoring was performed 4 times a day, with the goals of fasting blood glucose values of <90 mg/dL and postprandial (2 hours after each meal) values of <120 mg/dL. Then patients were submitted to a 72-hour period of use of the CGMS. In the 3 study groups--N, G1, and G2, respectively--no significant differences were noted in individual study parameters, measured with the CGMS in regard to the following: mean 24-hour glycemia (85, 87, and 91 mg/dL), fasting blood glucose (79, 88, and 82 mg/dL), postprandial glucose (96, 97, and 105 mg/dL), mean glucose level during the night (77, 71, and 75 mg/dL), and area under the glycemia curve (281, 315, and 310). Moreover, no significant difference was found in the total duration of glycemia below 60 mg/dL (317, 300, and 370 minutes) or the duration of glycemia of more than 120 mg/dL (259, 225, and 394 minutes) in group N, G1, and G2, respectively. With use of the CGMS, however, in comparison with SMBG, a wider range of glycemic levels was observed in all 3 study groups: for the healthy, pregnant women, 41 to 194 mg/dL versus 61 to 151 mg/dL; for G1, 40 to 244 mg/dL versus 40 to 180 mg/dL; and for G2, 40 to 173 mg/dL versus 50 to 157 mg/dL. The therapy, based on SMBG levels, when applied to the group of women with GDM, brought the glucose levels under effective control, with mean outcome values similar to those observed in the group of normal pregnant women. Nevertheless, using the CGMS, we detected long, asymptomatic periods of high and low blood glucose levels, both in the patients with GDM and in the unaffected pregnant women. The use of the CGMS for monitoring blood glucose profiles might be beneficial in this group of pregnant women.

Large-for-gestational-age newborns in women with insulin-treated gestational diabetes under strict metabolic control

To assess the influence of strict metabolic control in women with insulin-treated gestational diabetes on the risk of large-for-gestational-age (LGA) newborns, the frequency of obstetrical complications and fetal outcome. In this prospective cohort study, 875 women were screened for gestational diabetes mellitus with a 75 g oral glucose tolerance test (OGTT) between weeks 24 and 28 of gestation. The study group (n = 162) consisted of women with insulin-treated gestational diabetes mellitus (GDM) and the control group (n = 713) of women with normal glucose tolerance (NGT). In the women with diabetes, strict adjustments of fasting glucose levels to 90 mg/dl and 130 mg/dl postprandially were achieved with insulin administration. No increased risk for LGA newborns was observed in women with GDM and good metabolic control (16.7% vs. 12.3%; p = 0.1). In women with NGT, maternal prepregnancy BMI was significantly higher in those who delivered LGA newborns than in those who gave birth to newborns below the 90th percentile [27.2 kg/m(2) (5.0) vs. 24.4 kg/m(2) (5.6); p = 0.006], whereas there was no influence of maternal BMI on birth weight of newborns in women with GDM. There was no difference between the two groups with respect to maternal birth traumata and fetal outcome, except for plexus palsy which occurred in three GDM women with macrosomic newborns. Strict metabolic control and surveillance in women with insulin-treated GDM seems to attenuate the risk for LGA newborns, diabetic fetopathia, and the influence of maternal BMI on fetal growth.

HbA1c levels are significantly lower in early and late pregnancy.

Strict glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by diabetes (1–3). In addition to home blood glucose measurement, which may not always reflect the true average blood glucose level (4), HbA1c is a useful parameter in metabolic regulation (5–8). Thus, supplementation with HbA1c, as is common outside pregnancy, seems appropriate. Before pregnancy, the target for metabolic control in women with diabetes is HbA1c values near the normal range (9). However, the upper normal range of HbA1c during normal pregnancy is only sparsely investigated with different methods (10), mainly in late pregnancy (5,6,11,12), and reference ranges are generally established from the nonpregnant state (4). Increased third-trimester HbA1c levels are associated with an increased risk of preeclampsia (3,13), macrosomia (1), and stillbirth (2), leading to speculations that the target for HbA1c in pregnancy should be even lower than outside pregnancy to prevent adverse events. There is a need to establish the reference range of HbA1c during normal pregnancy with an internationally recognized Diabetes Control and Complications Trial (DCCT)-aligned method. In this study, we evaluated the normal upper range of HbA …

Metabolic control in women with type 1 diabetes during and after pregnancy

Metabolic control in women with type 1 diabetes during and after pregnancy

Insulin antibodies do not preclude optimization of metabolic control in women with IDDM during pregnancy.

To evaluate whether the presence of insulin antibodies (IAs) may preclude the optimization of metabolic control during pregnancy and affect outcome in women with IDDM. IAs were measured by radiobinding assay in 44 women with IDDM referred to the Diabetes and Pregnancy Outpatients' Clinic during 46 pregnancies. Age, duration of IDDM, metabolic control (HbA1c, mean pre- and postprandial capillary blood glucose, frequency of hypo- or hyperglycemia), insulin requirement at 1st and 3rd trimester of pregnancy, BM1, and weight gain were recorded. Neonatal variables such as gestational age, weight, length, and the presence at birth of either hypoglycemia, hypocalcemia, or jaundice requiring phototherapy were also considered. IAs correlated positively with insulin requirement (P < 0.05) and negatively with HbA1c at term (P < 0.01). Patients with IA levels > or = 40% insulin binding (8 of 46) had a higher insulin requirement and lower preprandial capillary blood glucose at the beginning of pregnancy but not at term (P < 0.005), whereas they had lower HbA1c at term than did patients with low IA levels (P < 0.01). IA levels decreased slightly at term (P = 0.007). IA levels > or = 40% were not associated with a higher rate of hypo- or hyperglycemic episodes or with diabetic complications or thyreopathy. No correlation was found between 1A levels and any of the neonatal variables considered. The presence of IAs does not preclude optimization of metabolic control during pregnancy and is compatible with a favourable outcome.