OGTT Results Research Articles

Qinlian Hongqu Decoction Modulates FXR/TGR5/GLP-1 Pathway to Improve Insulin Resistance in NAFLD Mice: Bioinformatics and Experimental Study.

Background: Qinglian Hongqu decoction (QLHQD), a traditional Chinese herbal remedy, shows potential in alleviating metabolic issues related to nonalcoholic fatty liver disease (NAFLD). However, its precise mode of action remains uncertain. Objective: This study aims to evaluate the efficacy and mechanisms of QLHQD in treating NAFLD. Methods: This study utilized a NAFLD mouse model to assess the effects of QLHQD on lipid metabolism, including blood lipids and hepatic steatosis, as well as glucose metabolism, including blood glucose levels, OGTT results, and serum insulin. Network pharmacology, bioinformatics, and molecular docking were used to explore how QLHQD may improve NAFLD treatment. Key proteins involved in these mechanisms were validated via WB and immunohistochemistry. Additionally, the expression of downstream pathway targets was examined to further validate the insulin resistance mechanism by which QLHQD improves NAFLD. Results: Animal studies demonstrated that QLHQD alleviated lipid abnormalities, hepatic steatosis, blood glucose levels, the insulin resistance index, and the OGTT results in NAFLD mice (P < 0.05 or 0.01). Network pharmacology and bioinformatics analyses indicated that the effects of QLHQD on NAFLD might involve bile acid secretion pathways. Subsequent validation through Western blotting, immunohistochemistry, and qPCR demonstrated that QLHQD may influence fat metabolism and insulin sensitivity in NAFLD mice via the FXR/TGR5/GLP-1 signaling pathway. Conclusion: QLHQD significantly alleviates glucose and lipid metabolism disorders in a high-fat diet-induced NAFLD mouse model. Its mechanism of action may involve the activation of the FXR/TGR5/GLP-1 signaling pathway in the gut, which reduces lipid accumulation and insulin resistance.

Changes in Oxidative Stress Markers in Pregnant Women of Advanced Maternal Age with Gestational Diabetes and Their Predictive Value for Neurodevelopmental Impact.

To explore the relationship between changes in oxidative stress markers in pregnant women of advanced maternal age with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes and neonatal neurodevelopment, as well as their predictive value. Two hundred pregnant women of advanced maternal age were selected and divided into Group A (normal blood sugar) and Group B (GDM) based on the 75 g (Oral Glucose Tolerance Test) OGTT results. Oxidative stress markers were measured, and pregnancy outcomes and neonatal Neonatal Behavioral Assessment Scale (NABA) scores were recorded. Malondialdehyde (MDA) levels in Group B were higher than those in Group A, while Glutathione (GSH) and Superoxide Dismutase (SOD) levels were lower. Group B had higher rates of adverse pregnancy outcomes and neurological abnormalities than Group A. The Area Under the Curve (AUC) values for serum MDA, GSH, and SOD levels combined prediction were higher than those for individual predictions (P<0.05). Oxidative stress markers in pregnant women of advanced maternal age with GDM are associated with adverse pregnancy outcomes and neonatal abnormalities, and combined prediction has good predictive efficiency (AUC>0.7).

Prediction of Gestational Diabetes by Second Trimester Complete Blood Count Derived Inflammatory Markers

Abstract Aim: To investigate the predictive ability of routine complete blood count (CBC) derived inflammatory markers on gestational diabetes mellitus (GDM) in the second trimester. Methods: A total of 181 patients, whose routine complete blood count (CBC) was measured between 14 and 24 weeks of gestation, were divided into two groups according to a 75 g OGTT results. 99 women were GDM and 82 women had normal glucose tolerance (NGT). The groups were compared regarding mean platelet volume (MPV), platelet distribution width (PDW), plateletocrit (PCT), immature granulocyte count, delta neutrophil index (DNI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and Systemic Immune-Inflammation Index (SII). Results: PDW, immature granulocyte count, NLR, PLR and SII were higher in the GDM group, but no statistically significant difference was observed. Mean values of DNI were lower in women with GDM than NGT, although not statistically significant (0.84 versus 0.99, p =0.742). Conclusion: Our findings revealed that using second trimester inflammatory CBC parameters prior to screening test is not an accurate method to predict GDM.

Non-Targeted Metabolomics Analysis of Mother and Infant in Gestational Diabetes Mellitus and Neonatal Clinical Characterization.

The goal was to analyze serums of GDM patients and healthy pregnant women using HPLC-MS and preliminarily screen differential metabolites by metabolomics. Sixty pregnant women who underwent elective cesarean section at term in Dongguan Dalang Hospital from January 2023 to April 2023 were selected and divided into the GDM group and healthy pregnancy group. Pre-pregnancy and pregnancy examination information, such as age, BMI, OGTT results, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and other clinical data were col-lected for statistical analysis. Non-targeted metabolomics of serum from 30 GDM patients and 30 healthy pregnant women were studied by HPLC-MS, and different ions were searched. The structures of differential metabolites were identified by HMDB database. The metabolic pathways of differential metabolites were analyzed by KEGG database. The OGTT result, pCO2, pO2, HCO3, BE, Apgar score, and bilirubin levels in the GDM group were higher than those in the healthy pregnancy group (p < 0.05). However, there were no significant differences in age, triglyceride, total cholesterol, newborn birth weight, newborn birth blood glucose, and blood gas pH between the two groups (all p > 0.05). Using p < 0.05 as the screening standard, 55 differential metabolites were identified in serum, mainly including fatty acyl, carboxylic acids and their derivatives, steroids and their derivatives, ketoacids and their derivatives, and pyrimidine nucleosides, etc., all of which were up-regulated or down-regulated to varying degrees. The 55 metabolites were mainly involved in the metabolism of pyrimidine, pyruvate, alanine, aspartic acid, glutamic acid, and arachidonic acid, glycolysis, and biosynthesis of unsaturated fatty acids. The discovery of these metabolites provides a theoretical basis for an indepth understanding of GDM pathogenesis. Non-targeted metabonomics analysis of blood metabonomics research technology has shown great potential value in the early diagnosis of obstetric diseases and the study of disease mechanisms.

Investigation of Serum Cartonectin Concentrations in Pregnant Women with Gestational Diabetes Mellitus; a Prospective Non-Interventional Cohort Study

OBJECTIVE: To investigate serum cartonectin concentrations in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). STUDY DESIGN: This prospective non-interventional cohort study was conducted on 176 pregnant women. The study group consisted of 88 pregnant women diagnosed with GDM, and the control group consisted of 88 pregnant women with normal 75-g OGTT results. First, the study and control groups, and then the subgroups were compared in terms of serum cartonectin concentrations. RESULTS: The study and control groups were similar in terms of BMI and gestational age at blood sampling (p=0.599, p=0.854). The study and control groups were similar in terms of median serum cartonectin concentrations (6.28 ng/ml and 7.13 ng/ml, respectively, p=0.165). In the subgroup analysis, the normal weight control group, overweight control group, normal weight study group, and overweight study group were compared in terms of serum cartonectin concentrations. The lowest median cartonectin concentration was detected in the overweight study group, followed by the overweight control group, normal weight study group, and normal weight control group (5.8 ng/ml, 6.5 ng/ml, 6.9 ng/ml, and 8.2 ng/ml, respectively, p=0.235). CONCLUSION: Serum cartonectin concentrations were found to be similar in the GDM and control groups. However, the number of participants in this study is limited to draw a definitive conclusion. Many studies with larger series are needed to reveal whether serum cartonectin is involved in the pathophysiology of GDM.

Antidiabetic Properties of Stingless Bee Pollen in High-Fat Diet FED-Low Dose STZ Induced Experimental T2DM Rats

Diabetes mellitus (DM) is a multisystem metabolic disease because of either insulin insufficiency or ineffectiveness. Individuals with DM continuously measure their blood glucose levels during fasting and after eating in order to manage their condition effectively. glucose levels during fasting and after eating in order to manage their condition effectively. Despite the availability of several drugs, there is no treatment proven to be perfect due to adverse side impacts as well as reduced long-term efficacy. Moreover, the excessive formation of free radicals has been linked to diabetes progression, development, as well as complications. As a result, there is a need to explore new medicines without side effects, preferably derived from natural products. Therefore, this study analyzes the antidiabetic properties of stingless bee pollen scientifically. This natural product was fed a high-fat diet and low streptozotocin doses in experimental rats with T2DM. An oral glucose tolerance test aimed investigate stingless bee pollen effect on glucose homeostasis. An insulin toleration test was executed to obtain stingless pollen influence on insulin sensitivity. This study measures Insulin resistance with HOMA-IR. Oral administration of stingless bee pollen for 30 days raised glucose homeostasis in T2DM rats, as shown by the OGTT, ITT, and HOMA-IR results. In addition, this treatment significantly improved changes in glycated hemoglobin, fasting blood glucose, protein, uric acid, urea, as well as creatinine levels. The activity changes of ALP, AST, and ALT liver enzyme markers in T2DM rats were nearly normalized after given with stingless bee pollen. The activity of carbohydrate metabolism enzymes includes pyruvate kinase, glucokinase, glucose-6-phosphatase, glucose-6-phosphate dehydrogenase, fructose-1,6-bisphosphatase and lactate dehydrogenase in T2DM rats’ liver tissue. This change was significantly restored to near-normal levels after stingless bee pollen treatment.&#x0D; Keywords: Diabetes Mellitus, High Fat Diet, Metformin, Stingless Bee Pollen

Continuous Glucose Monitoring as an Additional Tool in Early Cystic Fibrosis-Related Diabetes Monitoring and in Evaluation of Short-Term Sitagliptin Response.

We studied 25 CF patients with abnormal OGTT results and compared glucose and insulin levels during the OGTTs with CGM results as a tool for early CFRD diagnosis. In addition, we evaluated glycaemic control with CGM before and after treatment with sitagliptin. A correlation was found between lower plasma insulin levels during the OGTTs and higher average sensor glucose (p = 0.009) and hyperglycaemic excursions (p = 0.017). The CGM data on sitagliptin treatment (n = 25) showed an average glycaemic improvement from 124.2 to 117.2 mg/dL (p = 0.002) with a 5.6-point standard deviation of glucose decrease (p < 0.001). Hyperglycaemic excursions ≥200 mg/dL diminished 57.1% (p = 0.021). Both time in range and time above 180 mg/dL improved during treatment (p = 0.036 and p = 0.006, respectively). CGM is a useful tool that offers valuable information for both the diagnosis and the management of CFRD. Lower plasma insulin levels during OGTTs are associated with a poor ambulatory glucose profile in CGM. Sitagliptin could play an important role in the treatment of the early stages of CFRD.

Inositol supplementation for the prevention and treatment of gestational diabetes mellitus: a meta-analysis of randomized controlled trials.

Inositol is a potential new therapeutic agent for gestational diabetes mellitus (GDM), but its effectiveness is still controversial. The aim of the report was to evaluate the effectiveness of inositol to preventing or reducing the severity of GDM. We searched PubMed, EmBase, Web of science, Cochrane library databases, Clinicaltrials.gov, and International Clinical Trials Registry Platform for randomized controlled trials (RCTs) assessing the effectiveness of inositol supplementation to prevent and treat GDM. This meta-analysis was performed using the random-effects model. A total of 7 RCTs (1319 pregnant women at high risk of GDM) were included in the meta-analysis. The meta-analysis found that inositol supplementation resulted in a significantly lower incidence of GDM in the inositol versus the control group (odds ratio [OR] 0.40; 95% confidence interval [CI] 0.24-0.67; P = 0.0005). The inositol group had improved fasting glucose oral glucose tolerance test (FG OGTT; mean difference [MD] = -3.20; 95% CI -4.45 to -1.95; P < 0.00001), 1-h OGTT (MD = -7.24; 95% CI -12.23 to -2.25; P = 0.004), and 2-h OGTT (MD = -7.15; 95% CI -12.86 to -1.44; P = 0.01) results. Inositol also reduced the risk of pregnancy-induced hypertension (OR 0.37; 95% CI 0.18-0.75; P = 0.006) and preterm birth (OR 0.35; 95% CI 0.18-0.69; P = 0.003). A meta-analysis of 4 RCTs including 320 GDM patients showed that the patients' insulin resistance (P < 0.05) and neonatal hypoglycemia risk (OR 0.10, 95% CI 0.01-0.88; P = 0.04) were lower in the inositol than in the control group. Inositol supplementation during pregnancy has the potential to prevent GDM, improve glycemic control, and reduce preterm birth rates.

Outcomes of Pancreas Transplantation for Lower-Ranked Candidates

To perform more pancreas transplantation (PTx), our center sometimes performs pancreas transplantation for candidates ranked sixth place or lower. In this study, we analyzed the outcomes of PTx performed in our center to compare the outcomes of higher- and lower-ranked candidates. Seventy-two cases in which PTx was performed at our center were divided into 2 groups according to the candidate's rank. Cases in which PTx was performed for candidates up to fifth place were classified into the higher rank candidate group (HRC group; n=48), whereas PTx for candidates who were ranked sixth place or lower were classified into the lower rank candidate group (LRC group; n=24). The outcomes of PTx were retrospectively compared. Although the LRC group included a greater number of older donors (age ≥60 years), a greater number of donors with deteriorated renal function, and a greater number of HLA mismatches, the 1- and 5-year patient survival rates in the HRC group were 91.6% and 91.6%, respectively, compared with 95.8% and 87.0%, respectively, in the LRC group (P=.755). In terms of both pancreas and kidney graft survival, there were no significant differences between the 2 groups. Additionally, there were no significant differences between the 2 groups regarding the glucagon stimulation test and 75 g OGTT results, insulin independence rate, HbA1c, or serum creatinine level after transplantation. In Japan, where there is a severe donor shortage, the performance of transplantation for lower-ranked candidates would increase the number of opportunities for patients to receive PTx.

Fetal Epicardial Fat Thickness: Its Role as Marker for Gestational Diabetic Mellitus.

Background There are very few studies on the association between fetal epicardial fat thickness (EFT) and gestational diabetes mellitus (GDM). Aims To evaluate the role of fetal epicardial fat thickness as a marker and use it in pregnancies to screen for GDM. Settings and Design A cross-sectional analytical study was conducted in the Department of Radiodiagnosis and Imaging at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, after the due clearance from the institutional research and ethics committee. Materials and Methods The study included pregnant patients at 24 + 0/6 to 28 + 0/6 weeks of gestation scheduled for a 75 g oral glucose tolerance test from December 1, 2020 to March 30, 2022. Antenatal ultrasound was performed on Voluson E8 Expert BT12 (Wipro GE) ultrasound machine. Out of 180 patients, 60 patients were selected, that is, 30 patients with raised 75 g OGTT results (cases of GDM) and 30 patients with normal 75 g OGTT results. Statistical Analysis The collected data were transformed into variables, coded, and entered into Microsoft Excel. Data were analyzed using the Shapiro-Wilk normality test, student's t -test or Mann-Whiney U test, chi-square test, or Fisher's exact test and statistically evaluated using the SPSS-PC-25 version. Results Fetal EFT was found to be significantly more in the GDM group in comparison to controls without GDM, and the increased fetal EFT was positively associated with 2-hour OGTT serum glucose values. The mean fetal epicardial fat thickness (EFT) in mothers with GDM was significantly larger, i.e., 0.17 ± 0.02 cm than in mothers without GDM, i.e., 0.12 ± 0.01 cm ( p < 0.001). The receiver operating characteristic (ROC) curve plotted from values calculated from our results shows high sensitivity (i.e., 96.67%) and specificity (i.e., 90%) of fetal EFT as a predictor for GDM with an AUROC value of 0.96 and 95% confidence interval of 0.92 to 1.0. Conclusions EFT was significantly higher in fetuses of diabetic versus nondiabetic mothers. The mean difference in EFT of GDM cases and controls was relatively small but was statistically significant. The study concluded that measuring the epicardial fat thickness in fetuses can serve as a novel marker in GDM.

Evaluation of First Trimester Fasting Blood Glucose, HOMA-IR and HbA1c in Prediction of Gestational Diabetes Mellitus in Non-Obese Pregnant Women: A Retrospective Study

Aim: Gestational Diabetes Mellitus (GDM) is the most common endocrine complication in pregnancy with fetomaternal comorbidities. It is aimed to evaluate fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), and hemoglobin A1c (HbA1c) values in the first trimester in non-obese pregnant women for early detection of GDM.&#x0D; Material and Methods: Pregnant women with first-trimester FBG, HOMA-IR, HbA1c values, and second-trimester OGTT results were scanned from the hospital database. First-trimester height, weight, age and gestational weeks were also recorded. The presence of Body Mass Index (BMI) over 30 kg/m2, chronic and systemic disease and history of G(DM) were not included in the study. ROC analysis was performed on FBG, HOMA-IR, and HbA1c.&#x0D; Results: This retrospective study was conducted between 01/01/2021, and 01/01/2022 in Tuzla State Hospital Gynecology and Obstetrics Clinic. 131 pregnant women who met the inclusion criteria were reached. Twenty of pregnant women were evaluated as GDM positive(+). Age, height, weight, BMI, gestational week, and nulliparity were observed to be similar between the groups. FBG, insulin, HOMA-IR, and HbA1c values were higher in the group with GDM. As a result of ROC analysis, those with an FBG value of 88,5 mg/dl (sensitivity 68.2%, specificity 68.2%), a HOMA-IR value of 2.24 (sensitivity 63.6%, specificity 64.5%), and a HbA1c (sensitivity 68.2%, specificity 66.7%) value of over 5.25% were observed to be at risk for GDM.&#x0D; Conclusion: It has shown that pregnant women with high first trimester FBG, HOMA-IR and HbA1c have a high risk for GDM and can be used as a predictor of GDM.

Importance of Blood Glucose Monitoring in Pregnant Females

Objective: To determine the frequency of gestational diabetes mellitus (GDM) among pregnant females. Study Design: Cross-sectional study. Place and Duration: Department of Gynecology and Obstetrics, and department of Pathology, Dow University of health sciences, From February 2021 to January 2022. Methodology: Five hundred pregnant ladies with gestational age between 24-28 weeks with any parity were included. These women were challenged with 75 grams of oral glucose solution and blood glucose levels were estimated at one-hour post-prandial. The cut-off limit was set to 140 mg/dl and women with more than this value were subjected to a 2 hr 75 grams oral glucose tolerance test to confirm the diagnosis of GDM. Results: Out of a total of 500 pregnant women, the mean age, gestational age and BMI were 26.4±4.3 years, 27.0±10.2 weeks and 27.6±4.3 kg/m2. There were 59 (11.8%) women who were found to have a positive glucose challenge test (GCT) while the remaining 441 (88.2%) had plasma glucose below 140 mg/dl. Furthermore, 59 OGTT results showed that 43 (8.6%) women had GDM. Women with GDM had significantly higher age (p&lt;0.0001), higher BMI (p=0.0064) and multigravidity (0.0191) Practical Implications: Oral glucose challenge test can be administered in all pregnant women particularly in high risk individuals. Conclusion: The frequency of GDM was high. Pregnant ladies should be screened for GDM in time to prevent further complications during and after pregnancy. Keywords: Blood glucose, gestational diabetes mellitus, post-prandial.

Most Appropriate Gestational Age for OGTT amongst High-Risk Pregnant Patients? Need for RCT

High risk for gestational diabetes mellitus includes mothers with certain ethnicities, increasing maternal age, mothers with history of high or low birth weights, rising parity, previous macrosomic baby, stillborn baby, a family history or first degree relative with gestational diabetes (GDM) and type 2 diabetes mellitus, history of glucose intolerance or GDM, polycystic ovarian syndrome and maternal obesity. Timely screening, hence intervention can prevent complications of GDM to fetus and mother. Studies investigating, when during pregnancy should this high-risk group be screened, have established that 24-28 weeks OGTT have missed a few early onset GDM cases and booking visit OGTT/12 weeks gestational age OGTT may miss late onset GDM cases. All these studies have either been retrospective or comparison groups have been mis-matched. To date there is no prospective direct comparisons, comparing early OGTT results (12 weeks gestation) and late OGTT results (24—28weeks gestations). Physiologically speaking, stress of pregnancy is higher with advancing age of gestation and 24-28 weeks gestational age OGTT seems appropriate however evidence suggests that a few early onset GDM cases are missed. There is a need for prospective comparison at two different time intervals in same group of these high risk patients to answer this question.

Can Thyroid Screening in the First Trimester Improve the Prediction of Gestational Diabetes Mellitus?

This study aimed to evaluate the clinical utility of the subclinical hypothyroidism (SCH) marker, elevated thyroid-stimulating hormone (TSH) and thyroid antibodies in their ability to predict subsequent gestational diabetes mellitus (GDM). In a prospective clinical trial, 230 pregnant women were screened for thyroid function during the first trimester of pregnancy. Increased TSH levels with normal free thyroxine (fT4) were considered SCH. The titers of thyroid peroxidase antibody (anti TPO Ab) at >35 IU/mL and thyroglobulin antibody (anti Tg Ab) at >115 IU/mL were considered as antibodies present. According to the OGTT results, the number of pregnant women with GDM showed the expected growth trend, which was 19%. Two groups of pregnant women were compared, one with GDM and the other without. Increased TSH levels and the presence of thyroid antibodies showed a positive correlation with the risk of GDM. TSH levels were significantly higher in pregnant women with GDM, p = 0.027. In this study, 25.6% of pregnant women met the diagnostic criteria for autoimmune thyroiditis. Hashimoto’s thyroiditis was significantly more common in GDM patients, p < 0.001. Through multivariate logistic regression, it was demonstrated that patient age, TSH 4 IU/mL, and anti TPO Ab > 35 IU/mL are significant predictors of gestational diabetes mellitus that may improve first-trimester pregnancy screening performance, AUC: 0.711; 95% CI: 0.629–0.793.

А PREVALENCE AND RISK FACTORS FOR INSULIN RESISTANCE AND DYSGLYCEMIA AFTER KIDNEY TRANSPLANTATION IN PATIENTS ON CYCLOSPORINE-A BASED IMMUNOSUPPRESSION

Posttransplantation disturbances in glucose metabolism and increased insulin resistance &nbsp;are major factors affecting overall cardiovascular morbidity, reduced graft function, and survival after renal transplantation. We analyzed the prevalence of increased insulin resistance simultaneously with the prevalence of pre-diabetes in kidney transplant patients receiving a Cyclosporine-A based immunosuppression, and analyzed the risk factors for its occurrence, as well as the consequences on graft function. Fifty-nine&nbsp; recipients of a living donor kidney, without previously diagnosed diabetes, were included in this cross-sectional and prospective study. All patients were on the same triple calcineurin inhibitor based immunosuppressive therapy at maintenance doses. In all of them, OGTT was performed at least 6 months after transplantation in order to determine the prevalence of glucose disorders, as well as to determine the indices for insulin resistance and insulin secretion. We also analyzed potential risk factors for their occurrence. According to the OGTT results, patients were divided into two groups: a group with dysglycemia and a group of normoglycemic patients. Graft function was also monitored after a certain follow-up period in both groups. The overall prevalence of glucose disturbances and insulin resistance was 33.9% (20/59) and 86.44% (51/59), respectively. In the group with dysglycemia, the prevalence of insulin resistance was 95% (19/20), while the beta -function index was decreased in 40% (8/20). The mean value of the insulin resistance index in the dysglycemic group was significantly higher (3.139 ± 1.11) compared to the normoglycemic group (2.264±1.00),p ˂0.01. The most significant risk factors for increased insulin resistance in the group with dysglycemia were: shorter transplant period, higher doses of Cyclosporine-A, post-load insulin and the the insulin secretion index. In this group of patients, a significant decrease in e-GFR was observed after an average of 18 months of follow-up. The prevalence of IR after renal transplantation is high in all patients, and especially in patients with disorders of glucose metabolism. The routine application of OGTT as a diagnostic tool for occult diabetes and pre-diabetes and the determination of insulin resistance can contribute to reducing their prevalence, since most of the risk factors for their occurrence are potentially modifiable. Keywords:&nbsp;kidney transplantation, pre-diabetes, insulin resistance, immunosuppression

Gestational Diabetes Mellitus: Clinical Characteristics and Perinatal Outcomes in a Multiethnic Population of North Italy.

Aim To evaluate clinical characteristics and perinatal outcomes in a heterogeneous population of Caucasians born in Italy and High Migration Pressure Countries (HMPC) women with GDM living in Piedmont, North Italy. Methods We retrospectively analyzed data from 586 women referring to our unit (2015–2020). Epidemiological (age and country of origin) and clinical-metabolic features (height, weight, family history of DM, parity, previous history of GDM, OGTT results, and GDM treatment) were collected. The database of certificates of care at delivery was consulted in relation to neonatal/maternal complications (rates of caesarean sections, APGAR score, fetal malformations, and neonatal anthropometry). Results 43.2% of women came from HMPC; they were younger (p < 0.0001) and required insulin treatment more frequently than Caucasian women born in Italy (χ2 = 17.8, p=0.007). Higher fasting and 120-minute OGTT levels and gestational BMI increased the risk of insulin treatment (OGTT T0: OR = 1.04, CI 95% 1.016–1.060, p=0.005; OGTT T120: OR = 1.01, CI 95% 1.002–1.020, p=0.02; BMI: OR = 1.089, CI 95% 1.051–1.129, p < 0.0001). Moreover, two or more diagnostic OGTT glucose levels doubled the risk of insulin therapy (OR = 2.03, IC 95% 1.145–3.612, p=0.016). We did not find any association between ethnicities and neonatal/maternal complications. Conclusions In our multiethnic GDM population, the need for intensive care and insulin treatment is high in HPMC women although the frequency of adverse peripartum and newborn outcomes does not vary among ethnic groups. The need for insulin therapy should be related to different genetic backgrounds, dietary habits, and Nutrition Transition phenomena. Thus, nutritional intervention and insulin treatment need to be tailored.

498 Oxidative stress and left ventricular performance in patients according to different glycometabolic phenotypes

Abstract Recent studies demonstrated that in normoglucose-tolerant subjects (NGT), 1-h post load plasma glucose value ≥155 mg/dL, during OGTT, identifies a worse cardio-metabolic risk profile with increased risk for Type 2 Diabetes Mellitus (T2DM). T2DM patients present increased oxidative stress, due to high blood glucose levels, which plays a central role in the development of CV events. The aim of our study was to evaluate the correlation between oxidative stress and subclinical myocardial damage, assessed with speckle tracking echocardiography, in NGT patients with 1-h post load ≥155 mg/dL vs. NGT &amp;lt; 155 subjects, impaired glucose tolerance (IGT) and T2DM patients. We enrolled 100 Caucasian patients (61 M, 39 W, mean age 61.4 ± 10.7) afferent to CATAMERI study. Main exclusion criteria were CV complications, history of malignant or chronic respiratory disease, alcohol, drug influencing glucose metabolism or smoking abuse. All subjects underwent clinical and laboratory evaluation, OGTT and HOMA-IR. The serum values of the markers of oxidative stress (8-isoprostane and NOX-2) were assessed with ELISA sandwich. Statistical analysis was performed with ANOVA test, linear correlation analysis and stepwise multivariate linear regression model. According to OGTT results, subjects were divided into 4 groups: NGT &amp;lt; 155 (n = 30), NGT ≥ 155 (n = 24), IGT (n = 28), T2DM (n = 18). Serum levels of 8-isoprostane and NOX-2 were significantly increased (P &amp;lt; 0.0001) in NGT ≥ 155 compared to NGT &amp;lt; 155 group, but similar with IGT, indicating an increase in oxidative stress with the worsening of the metabolic status. The left global systolic function, evaluated as myocardial deformation and global longitudinal strain (GLS), appeared progressively lower proceeding from the NGT &amp;lt; 155 group to the T2DM group (P &amp;lt; 0.0001). Moreover, for similar values of ejection fraction (EF), NGT ≥ 155 subjects presented reduced GLS compared to NGT &amp;lt; 155 (P = 0.001), but similar to IGT patients. The linear correlation analysis showed that endo/epi ratio was significantly and inversely correlated with 1 h post load glycaemia (r = −0.632, P &amp;lt; 0.0001), NOX-2 (r = −0.638, P &amp;lt; 0.0001), 8-isoprostane (r = −0.508, P &amp;lt; 0.0001); GLS was inversely correlated with 1 h post load glycaemia (r = −0.734, P &amp;lt; 0.0001) and directly and significantly correlated with 8-isoprostane (r = 0.564, P &amp;lt; 0.0001), NOX-2 (r = 0.625, P &amp;lt; 0.0001). From stepwise multivariate linear regression model, NOX-2 resulted the major predictor of endo/epi ratio, justifying 40.7% of its variation. 1-h post load glycaemia was the second predictor of endo/epi ratio justifying another 9.2% of its variation. Similarly 1-h post load glycaemia was the strongest predictor of the GLS, explaining 53.9% of its variation. Our study demonstrated that NGT ≥ 155 subjects present functional alterations of myocardial contractile fibres, compared to NGT &amp;lt; 155 subjects, but similar to IGT, and these alterations are correlated with oxidative stress. Moreover, GLS is able to identify early alterations in the contractility of subendocardial longitudinal fibres long before the alteration of EF. This data have a central role in ongoing research on the association between hyperglycaemia at 1-h post load and CV risk.

16 Impaired glucose tolerance and cardiovascular outcomes after an acute coronary syndrome—the important role of 1-h plasma glucose at the oral glucose tolerance test

Abstract Aims 2-h plasma glucose (PG) ≥140 mg/dl but &amp;lt;200 mg/dl at the oral glucose tolerance test (OGT), defined as impaired glucose tolerance (IGT), has been reported as related to adverse cardiovascular outcomes in non-diabetic patients. The added value of 1-h plasma glucose (PG) ≥155 mg/dl at the OGTT is unknown. We investigated the value of 1-h PG in IGT patients admitted for an acute coronary syndrome (ACS) in relation to in hospital outcome. Methods and results Among 109 patients admitted to Coronary Care Unit for an ACS, with both no previous diagnosis of diabetes and first-line in-hospital screening with glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) negative for either diabetes and prediabetes, OGTT was performed. On the basis of the OGTT results, 21 patients (19.3%) were newly diagnosed diabetes. The remaining 88 patients were divided into: Group A: ‘fully glucose tolerant’, with 1 h PG-OGTT &amp;lt;155 mg/dl and 2 h PG-OGTT &amp;lt;140 mg/dl; Group B: ‘early-impaired IGT’ with 1 h-PG at OGTT ≥155 mg/dl and 2 h-PG &amp;lt;140 mg/dl; Group C: ‘late impaired-IGT’, with 1 h-PG at OGTT &amp;lt;155 mg/dl and 2 h PG-OGTT ≥140 mg/dl; and Group D: ‘fully impaired IGT’, with 1 h-PG at OGTT ≥155 mg/dl and 2 h PG-OGTT ≥140 mg/dl. In this analysis we compared the four groups as to cardiac markers and days of hospitalization by the Kruskal–Wallis test and correcting multiple comparisons with the Bonferroni’s adjustment. On the basis of the OGTT results, 12 patients (13.5%) belonged to Group A, 32 (39%) to Group B, 8 (9%) to Group C, and 35 (39%) patients to Group D. Group D patients had significant higher Hs-TnT at admission compared to Group A (P = 0.013), Group B (P = 0.023), and Group C (P = 0.005). Group D patients featured significant higher Hs-TnT peak compared to Group A (P = 0.016) and Group B (P = 0.005). Patients in Group D had a longer hospitalization compared to Group A (P = 0.005). Conclusions In the setting of ACS, compared to non-diabetic patients with a normal OGTT, only IGT patients characterized by both 1 h-PG ≥155 mg/dl and 2 h PG ≥ 140 mg/dl had more severe myocardial injury and longer hospitalization. These results suggest that, within currently defined IGT patients, 1 h-PG importantly contributes to assessing cardiac risk.

Novel metabolic marker Afamin: A predictive factor for Large-for-Gestational-Age (LGA) fetus estimation in pregnancies with gestational diabetes mellitus?

Gestational diabetes mellitus (GDM) affects both maternal and fetal/infant outcomes during and after pregnancy. The reason for the high incidence of large-for-gestational-age (LGA) infants in GDM patients despite close monitorization of glucose levels with early detection of the disease remains unclear to date. Our study aims to investigate the levels of the third-trimester novel marker afamin in GDM versus non-GDM pregnancies in terms of glycemic control status and their utility in the prediction of LGA fetuses. This prospective case-control study analysis involved 49 pregnant women with GDM diagnosed using the 75-g oral glucose tolerance test (75-g OGTT) and 40 randomly selected women with a similar body mass index (BMI) and gestational age (GA). Blood samples were collected in the third trimester of pregnancy. The afamin level was determined using a human afamin ELISA kit according to the manufacturer's procedure. There was no significant difference found in BMI or GA of patients. Third-trimester afamin levels were 93.91 mg/L and 83.87 mg/L in the GDM and non-GDM groups, respectively (p=0.625). Afamin values of patients were not correlated with age, BMI, GA, HgA1c, 75-g OGTT fasting and 75-g OGTT 1-hour, or 75-g OGTT 2-hour values (p>0.05). GDM patients with LGA fetuses had significantly higher afamin values than patients with appropriate-for-gestational-age (AGA) fetuses (120.8 mg/L versus 91.26 mg/L, respectively). Between GDM patients with either LGA or AGA fetuses, there was no statistically significant difference found for age, BMI, GAs, insulin dose, 75-g OGTT results, or HgA1c values. Our findings conclude that novel marker afamin levels could predict the risk of LGA infants independently of glycemic control status and provide insight into the pathogenesis of LGA fetuses, thus helping to reduce the risk of associated complications.

Improved Survival and Retinal Function of Aging ZDF Rats in Long-Term, Uncontrolled Diabetes by BGP-15 Treatment.

Retinal complications of diabetes often lead to deterioration or even loss of vision. This hastens discovery of pharmacological agents able to counterbalance diabetic retinopathy. BGP-15, an emerging small molecule agent, was formerly proven by our workgroup to be retinoprotective on nonobese diabetic animals, Goto-Kakizaki rats. In the present study, we aimed to examine its long-term tolerability or incidental side effects on obese-prone Zucker diabetic fatty (ZDF) rats to further increase the rationale for a future human translation. To make terminal visual status comparable with our other investigations, we also carried out electroretinography (ERG) at the end of the experiment. Our study was started on 16-week-old ZDF rats and lasted for 52 weeks, while BGP was administered daily by gavage. During the 12 months of treatment, 100% of BGP-treated animals survived compared to the non-treated ZDF group, where 60% of the animals died, which was a statistically significant difference. Based on ERG results, BGP-15 was able to counterbalance visual deterioration of ZDF rats caused by long-term diabetes. Some moderate but significant changes were seen in OGTT results and some relationship to oxidative stress by the western blot method: BGP-15 was able to increase expression of HSP70 and decrease that of NFkB in eyes of rats. These were in concert with our previous observations of SIRT1 increment and MMP9 decrement in diabetic eyes by BGP. In summary, not only is BGP-15 not harmful in the long run but it is even able to reduce the related mortality and the serious consequences of diabetes. BGP-15 is an excellent candidate for future drug development against diabetic retinopathy.