On Oral Glucose Tolerance Test Research Articles

Diagnostic significance of individual glucose values in oral glucose tolerance test and the associated risk factors for gestational diabetes mellitus in pregnant mothers: A cross-sectional study

Background: The diagnosis of gestational diabetes mellitus (GDM) is mainly based on oral glucose tolerance test (OGTT) in Sri Lankan clinical setting. The present study was to assess the diagnostic significance of individual glucose values in 75g OGTT in a group of pregnant mothers, to modify the test procedure to make it more convenient and cost-effective and to identify the associated risk factors for GDM.Methods: A total of 150 pregnant women within the second trimester and attending the antenatal clinics at Teaching Hospital Mahamodara were recruited for the study. Data collection was carried out via an interviewer-administered questionnaire followed by retrieval of laboratory data on OGTT.Results: Seventeen pregnant women (11.33%) were diagnosed with GDM by OGTT based on the WHO criteria. Diagnosis was based on either fasting or 2-hour glucose values alone or by increased levels in more than one of those parameters. None of them were diagnosed based on the 1-hour glucose value alone. The AUC values were 0.951 (0.884, 1.000), 0.829 (0.715, 0.942) and 0.859 (0.776, 0.943) respectively for fasting, 1-hour and 2-hour glucose concentrations (CI 95%). GDM was associated with uncontrolled sweet consumption (X2=5.86, p=0.015) and no association was observed with reference to maternal age, parity, BMI, positive family history of diabetes, and prior history of GDM or diabetes mellitus.Conclusion: Fasting and 2-hour plasma glucose values have higher diagnostic accuracy over 1-hour glucose values and the findings suggest the performance of fasting and 2-hour samples alone in the standard 75g OGTT procedure for the diagnosis of GDM.

Acute and Subchronic Treatment of Roasted and Unroasted Argan Oil on Postprandial Glycemia and Its Effect on Glucose Uptake by Isolated Rat Hemidiaphragm

Background: Argan oil is one of the products used for antidiabetic purposes in Morocco. Objective: This work aims to study the acute and subchronic effect treatment of the roasted (Roil) and unroasted (UnRoil) Argan oils on oral glucose tolerance test (OGTT) and body weight in normal and diabetic rats, evaluate the effect of these oils on glucose absorption by the diaphragm and determine total polyphenol, flavonoids, tannins, chlorophyll and carotenoids amounts. Methods: The anti-hyperglycemic effect of Roil and UnRoil was investigated in normal and alloxanediabetic rats by treating the animals orally with 2 mLKg-1/day of oils for 1 day (Acute treatment) and 4 weeks (Subchronic treatment). Then, OGTT was carried out at the end of each treatment, and the body weight was checked for each week. Besides, these oils (1 gL-1) were tested on glucose absorption by the diaphragm isolated from Wistar rats in vitro. Results: This work shows that Roil and UnRoil significantly decrease the postprandial glycemic level in acute and subchronic treatments in normal and diabetic rats. Besides, the intake of these oils in diabetic rats significantly attenuates the postprandial glycemia compared to the acute-treated group. In vitro glucose uptake by the hemidiaphragm study shows that Argan oils promote glucose consumption by the muscles. Conclusion: Argan oils showed a very important anti-hyperglycemic effect, which could be explained by promoting peripheral glucose uptake. UnRoil shows a better effect than Roil on glucose consumption, meaning that the roasting process influences the phytoconstituent responsible for this activity.

Combining Celiac and Hepatic Vagus Nerve Neuromodulation Reverses Glucose Intolerance and Improves Glycemic Control in Pre- and Overt-Type 2 Diabetes Mellitus.

Neurological disorders and type 2 diabetes mellitus (T2DM) are deeply intertwined. For example, autonomic neuropathy contributes to the development of T2DM and continued unmanaged T2DM causes further progression of nerve damage. Increasing glycemic control has been shown to prevent the onset and progression of diabetic autonomic neuropathies. Neuromodulation consisting of combined stimulation of celiac vagal fibers innervating the pancreas with concurrent electrical blockade of neuronal hepatic vagal fibers innervating the liver has been shown to increase glycemic control in animal models of T2DM. The present study demonstrated that the neuromodulation reversed glucose intolerance in alloxan-treated swine in both pre- and overt stages of T2DM. This was demonstrated by improved performance on oral glucose tolerance tests (OGTTs), as assessed by area under the curve (AUC). In prediabetic swine (fasting plasma glucose (FPG) range: 101-119 mg/dL) the median AUC decreased from 31.9 AUs (IQR = 28.6, 35.5) to 15.9 AUs (IQR = 15.1, 18.3) p = 0.004. In diabetic swine (FPG range: 133-207 mg/dL) the median AUC decreased from 54.2 AUs (IQR = 41.5, 56.6) to 16.0 AUs (IQR = 15.4, 21.5) p = 0.003. This neuromodulation technique may offer a new treatment for T2DM and reverse glycemic dysregulation at multiple states of T2DM involved in diabetic neuropathy including at its development and during progression.

3-LB: Effects of Sustained Somatostatin Receptor 2 Antagonism (SSTR2a) on Glycemia in Type 2 Diabetic (T2D) Male Rats—A Pilot Study

Introduction: Somatostatin may be elevated in diabetes, which can reduce glucagon secretion at mealtimes and during hypoglycemia. In this pilot study, we investigated the effect of a sustained low-dose delivery of a novel SSTR2a (ZT-01), using a mini-osmotic pump, on oral glucose tolerance (OGT) and response to an insulin-induced hypoglycemia challenge in a T2D rat model. Methods: Male Sprague Dawley rats (n=4/5 per group) were placed on a high-fat diet (3 weeks) then injected with low-dose streptozotocin (35 mg/kg), inducing T2D. Basal bolus insulin was administered for 7 days (2-3 units/day) to maintain fed-state glycemia targeting 12-25 mmol/L, after which the rats were treated with ZT-01 (0.18 mg/day) or vehicle using implanted mini-osmotic pumps (Alzet). An OGT test on day 3 was followed by a hypoglycemic challenge (12U regular insulin) on day 5. Results: Drug and vehicle groups displayed similar glycemic levels in the fasted state and post oral glucose ingestion. Glycemia was also similar prior to insulin challenge and there was no difference in basal glucagon between groups, but SSTR2a treatment attenuated the drop in blood glucose after bolus insulin. Conclusion: Sustained exposure to low-dose SSTR2a does not appear to affect basal glucose or glucagon levels, nor affect the response to OGT but may improve the glucose response to insulin-induced hypoglycemia in this T2D model. Disclosure N. Aleali: None. N. C. D'souza: None. D. Shakeri: None. E. Simonson: None. R. Liggins: Employee; Zucara Therapeutics, Stock/Shareholder; Zucara Therapeutics. O. Chan: None. M. C. Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Indigo Diabetes, Consultant; Lilly Diabetes, Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi, Stock/Shareholder; Supersapiens, Zucara Therapeutics. Funding GlycoNet (CD-85); Zucara Therapeutics Inc.

Impact of Pre-Pregnancy Hemoglobin Level on the Association Between Pre-Pregnancy Body Mass Index and Gestational Diabetes Mellitus: A Retrospective Cohort Study in a Single Center in China.

To assess the impact of maternal pre-pregnancy body mass index (BMI) on gestational diabetes mellitus (GDM) based on different pre-pregnancy hemoglobin levels. This retrospective cohort study included 1289 pregnant women between June 2020 and January 2022. Clinical data were collected by reviewing their medical and antepartum screening records between 24 and 28 gestational weeks, including pre-pregnancy BMI and pre-pregnancy hemoglobin (Hb) levels. The diagnosis of GDM mainly depended on oral glucose tolerance test (OGTT) during 24-28 weeks. Restricted cubic spline (RCS) was used to investigate the association between the pre-pregnancy Hb level and the risk of GDM. Univariate and multivariate logistic regression analyses were applied to evaluate the relative risk of GDM. Of the 1289 included pregnant women, 187 (14.5%) women were diagnosed with GDM in this study. The pre-pregnancy Hb level was significantly associated with GDM risk, and the pre-pregnancy Hb level of 123 g/L was identified as the threshold to stratify and assess the association between the GDM risk and the pre-pregnancy BMI. For women with a pre-pregnancy Hb level ≥123 g/L, the pre-pregnancy BMI showed a significant association with GDM risk, and the estimated incidence rate of GDM was 7.7%, 14.8%, 36.3% and 44% for underweight, normal-weight, overweight and obese pregnant women, respectively. After adjusting for potential influencing factors of GDM, the respective relative risk was 1.0 (reference), 2.04 (95% CI 0.84, 4.99), 7.06 (2.66, 18.61), and 10.77 (2.85, 40.63) (P for trend < 0.001). In pregnant women with a pre-pregnancy Hb level ≥123 g/L, pre-pregnancy BMI showed a more significant association with GDM risk as compared with those with a pre-pregnancy Hb level <123 g/L.

The utility of glucose area under the curve from the oral glucose tolerance test as a screening tool for cystic fibrosis-related diabetes.

Consistently abnormal glucose levels on oral glucose tolerance test (OGTT) are the most effective screening tool for cystic fibrosis-related diabetes (CFRD). However, some cystic fibrosis (CF) patients demonstrate abnormal glucose profiles not reaching levels required for CFRD diagnosis and are, therefore, left untreated. Since CFRD is associated with disease deterioration, early diagnosis and treatment are desirable. To explore the association between the area under the curve of glucose (G-AUC) obtained during a five-point2-hstandard OGTT and CF disease severity parameters. All CF patients referred for an annual routine OGTT at the Hadassah CF Center between 2002 and 2018, were included. Disease severity parameters were correlated with the G-AUC. Two hundred forty-twoOGTTs were performed in 81 patients (mean age 19.7 ± 9.0 years); 54% were normal, 14% showed impaired glucose tolerance (IGT), 5% had values in the indeterminate range (INDET), 11% had both IGT and INDET and 16% were diagnosed with CFRD. A gradual increase in mean G-AUC was observed among the groups. In multivariate regression models, G-AUC ≥ 295 mg h/dl was independently associated with an increased number of pulmonary exacerbations (PEx). Not all the patients having this value met the CFRD definition. Patients who do not fulfill the criteria for CFRD may have abnormal glucose metabolism identifiable by abnormally high G-AUC values, which may be associated with more PEx. The potential advantage of treating these patients with insulin and the subsequent reduction in PEx needs further investigation.

Comprehensive validation of fasting-based and oral glucose tolerance test–based indices of insulin secretion against gold standard measures

IntroductionWith pre-diabetes and diabetes increasingly recognized as heterogeneous conditions, assessment of beta-cell function is gaining clinical importance to identify disease subphenotypes. Our study aims to comprehensively validate all types of...

Rs864745 in JAZF1, an Islet Function Associated Variant, Correlates With Plasma Lipid Levels in Both Type 1 and Type 2 Diabetes Status, but Not Healthy Subjects.

ObjectiveThis study aims to reveal the association between JAZF1 rs864745 A>G variant and type 2 diabetes (T2D), type 1 diabetes (T1D) risk, and their correlation with clinical features, including islet function, islet autoimmunity, and plasma lipid levels.MethodsWe included 2505 healthy controls based on oral glucose tolerance test (OGTT), 1736 unrelated T2D, and 1003 unrelated autoantibody-positive T1D individuals. Binary logistic regression was performed to evaluate the relationships between rs864745 in JAZF1 and T2D, T1D, and islet-specific autoantibody status under the additive model, while multiple linear regression was used to assess its effect on glycemic-related quantitative traits and plasma lipid levels.ResultsWe did not find any association between rs864745 in JAZF1 and T2D, T1D, or their subgroups (All P > 0.05). For glycemic traits, we found that the G allele of this variant was significantly associated with higher 120 min insulin level, insulinogenic index (IGI), corrected insulin response (CIR), and acute insulin response (BIGTT-AIR) (P = 0.033, 0.006, 0.009, and 0.016, respectively) in healthy individuals. Similar associations were observed in newly diagnosed T2D but not T1D individuals. Although this variant had no impact on islet autoimmunity (All P > 0.05), significant associations with plasma total cholesterol (TC) and low-density lipoprotein (LDL) level stratified by JAZF1 rs864745 variant were observed in the disease status of T2D (P = 0.002 and 0.003) and T1D (P = 0.024 and 0.009), with significant heterogeneity to healthy individuals.ConclusionsThe common JAZF1 rs864745 variant contributes to islet function and lipid metabolism, which might be put into genetic risk scores to assess the risk of related clinical features.

Development and validation of a diabetes mellitus and prediabetes risk prediction function for case finding in primary care in Hong Kong: a cross-sectional study and a prospective study protocol paper

IntroductionDiabetes mellitus (DM) is a major non-communicable disease with an increasing prevalence. Undiagnosed DM is not uncommon and can lead to severe complications and mortality. Identifying high-risk individuals at an...

Prevalence and risk factors for diabetic retinopathy in prediabetes in Asian Indians

AimTo assess the prevalence of diabetic retinopathy (DR) and associated risk factors in Asian Indians with prediabetes. MethodsIn a cross-sectional study conducted at two tertiary care diabetes centres in Chennai, India, clinical and biochemical assessment and nonmydriatic ultra-wide field fundus photography was performed in individuals with prediabetes (impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]) based on oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c) between 5.7% and 6.4% in 2019. The retinal photographs were graded by certified ophthalmologists. Systemic risk factors associated with DR in prediabetes were assessed. ResultsThe mean age of the 192 individuals with prediabetes was 48 ± 13 years (55.2% were males). DR was present in 12 (6.3%) individuals of which nine (4.7%) had mild non-proliferative DR (NPDR) and three (1.6%) had moderate NPDR. None had severe sight-threatening DR. The Poisson multiple regression analysis showed that after adjusting for other systemic covariates, HbA1c values ≥ 6% (6–6.4%) was associated with 2 times higher relative risk of DR (Risk ratio 1.95 (95% CI 1.07–3.545, p = 0.028) in comparison to HbA1c < 6%). ConclusionDR was present in about 6% of the Asian Indians with prediabetes. Higher HbA1c values among individuals with prediabetes was associated with twice the relative risk for DR. Robust control of HbA1c should be encouraged even before the diagnosis of diabetes is established.

Evolution of Combined Impaired Fasting Glucose and Impaired Glucose Tolerance in β-Thalassemia Major: Results in 58 Patients with a Mean 7.7- year Follow-Up.

Background:Advances in β- thalassemia major (β-TM) care have transformed a disease which had previously led to an early childhood death into a chronic condition. With increased lifespan, comorbidities associated with the disease have become more common, among them glucose dysregulation (GD) which develops insidiously, aggravating prognosis and patients’ quality of life.Objectives:The objectives of this study were to retrospectively review the extent to which β-TM patients, having combined impaired fasting glucose (IFG) and impaired glucose tolerance test (IGT) on oral glucose tolerance test (OGTT), progressed to diabetes and to analyze the potential determinants inducing this progression, or regression to normal glucose tolerance test (NGT).Research design and method:Data of 58 β-TM patients, followed for a mean duration of 7.7 years (range: 1-20 years) with annual or biennial OGTT, were retrieved. Insulin release and insulin sensitivity (IS) were also analyzed.Results:During the follow-up, FPG and 2-h PG levels after OGTT reverted to NGT in 13 patients (22.4%), deteriorated in 13 patients (22.4%) who developed diabetes mellitus, and did not change in the remaining 32 patients (55.2%). A significant correlation was observed between FPG and ALT level (r: 0.3158; P:0.01) and an inverse correlation was found between chronological age and serum ferritin (SF) level (r: -0.321; P:0.014). Finally, SF and ALT, both at the baseline and at the time of last observation, were independent predictors of evolution to diabetes mellitus.Conclusion:The combination IFG/IGT in β-TM patients with severe iron overload constitutes a high-risk state for developing diabetes. (www.actabiomedica.it)

Impact of optimizing pre-analytical phase on the diagnosis of gestational diabetes and related outcomes.

Pre-analytical plasma glucose (PG) sampling methodology may significantly affect gestational diabetes mellitus (GDM) incidence, but no studies directly examined the impact on perinatal outcomes. We compared the effect on oral glucose tolerance test (OGTT) results of using for blood sampling the traditional sodium fluoride (NaF) tubes, batched at controlled temperature, and the more effective citrate-buffered tubes, in terms of GDM diagnosis and related outcomes. We evaluated 578 pregnant women performing OGTT between 24- and 28-weeks' gestation. Paired NaF and citrate blood samples were drawn and analyzed for PG. GDM diagnosis was made by applying the 'one-step' American Diabetes Association strategy. Data on perinatal outcomes were collected in a subset of 330 women who delivered in our hospital network. Using the standard NaF approach, 69 (11.9%) GDM women were detected. Using citrate PG values, 90 women were additionally identified as GDM, increasing the GDM prevalence to 27.5%. Perinatal outcomes were analyzed according to the different diagnostic allocation (NaF-diagnosed GDM, additional citrate-diagnosed GDM, and no GDM). NaF-diagnosed GDM showed a higher incidence of large for gestational age (LGA) (p=0.034), and of cesarean and preterm delivery (p<0.01) vs. no GDM. The only outcome remaining more frequent in the additional citrate diagnosed GDM when compared with no GDM group was LGA (17.2 vs. 6.8%, p=0.025). If a health care system plans to use citrate tubes for GDM diagnosis, considerations about clinical implications are mandatory by balancing higher sensitivity in detecting a poor glycemic control with effects on outcomes to avoid "overdiagnosis".

Value of Early Post-Operative Growth Hormone Testing in Predicting Long-Term Remission and Residual Disease after Transsphenoidal Surgery for Acromegaly

Introduction: Surgical remission for acromegaly is dependent on a number of factors including tumour size, invasiveness, and surgical expertise. We studied the value of early post-operative growth hormone (GH) level as a predictor of outcome and to guide early surgical re-exploration for residual disease in patients with acromegaly. Methods: Patients with acromegaly undergoing first-time endoscopic transsphenoidal surgery between 2005 and 2015, in 2 regional neurosurgical centres, were studied. Insulin-like growth factor-1 (IGF-1), basal GH (i.e., sample before oral glucose), and GH nadir on oral glucose tolerance test (OGTT) were tested at various time points, including 2–5 days post-operatively. Definition of disease remission was according to the 2010 consensus statement (i.e., GH nadir <0.4 μg/L during an OGTT and normalized population-matched IGF-1). Forward stepwise logistic regression was used to determine factors associated with remission. Results: We investigated 81 consecutive patients with acromegaly, 67 (83%) of which had macroadenomas and 22 (27%) were noted to be invasive at surgery. Mean follow-up was 44 ± 25 months. Overall, surgical remission was achieved in 55 (68%) patients at final follow-up. On univariate analysis, the remission rates at the end of the study period for patients with early post-operative GH nadir on OGTT of <0.4 (N = 43), between 0.4 and 1 (N = 28), and >1 μg/L (N = 8) were 88, 54, and 20%, respectively. Similar results were seen with basal GH on early post-operative OGTT. On multivariate regression analysis, pre-operative IGF-1 (odds ratio of 13.1) and early post-operative basal GH (odds ratio of 5.0) and GH nadir on OGTT (odds ratio of 6.8) were significant predictors of residual disease. Based on a raised early GH nadir and post-operative MR findings, 10 patients underwent early surgical re-exploration. There was reduction in post-operative GH levels in 9 cases, of which 5 (50%) achieved long-term remission. There was an increased risk of new pituitary hormone deficiencies in patients having surgical re-exploration compared to those having a single operation (60 vs. 14%). Conclusions: An early post-operative basal GH and GH nadir on OGTT are reliable predictors of long-term disease remission. It can be used to guide patients for early surgical re-exploration for residual disease, although there is increased risk of hypopituitarism.

Mean Adiponectin Levels and Frequency of Hypoadiponectinemia in Gestational Diabetes Mellitus

Background: Insulin resistance, a major pathogenic factor in Gestational Diabetes Mellitus (GDM), has an inverse correlation with adiponectin; therefore, the role of adiponectin in the pathogenesis of GDM has been suggested. The study aimed to determine mean adiponectin levels and the frequency of hypoadiponectinemia in patients with GDM. Methods: The study was carried out at Dr. Ziauddin University Hospital, Karachi from June 2016 to December 2017. A total of 99 women of age group 15-45 years diagnosed with GDM on Oral Glucose Tolerance Test (OGTT) at 24-28 weeks of gestations were included in the study. Patient’s data was recorded on proposed proforma, regarding age, gestational age, parity, ethnicity, Body Mass Index (BMI). Serum samples for quantitative estimation of Adiponectin were collected while performing OGTT and were analyzed on Immunoassay in conjunction with control materials. Mean±Std. was calculated for quantitative variables. Percentages and frequencies were calculated for categorical variables. For significant differences between categories, an independent t-test and Chi-square test were used. Results: High frequency of hypoadiponectinemia was observed in GDM women with mean adiponectin levels of 6.90±2.86 µg/ml (95%CI: 6.33 to 7.47). Out of 99 GDM women, 91(91.92%) had hypoadiponectinemia while 8(8.08%) had normal Adiponectin levels. A significant (p=0.05) association was found between BMI and hypoadiponectinemia. Conclusion: In the majority of GDM females, hypoadiponectinemia was observed. The high frequency of hypoadiponectinemia suggests further large-scale studies, are warranted to ascertain the diagnostic accuracy of adiponectin as a potential biomarker for GDM.

Diabetes mellitus in pheochromocytoma and paraganglioma: Prevalence, dynamics of insulin secretion / sensitivity and predictors of remission

Background and aimsPheochromocytoma and paraganglioma (PPGL) are associated with dysglycemia and diabetes mellitus (DM) much of which improves post operatively. In this study, we set out to ascertain pre and post-operative prevalence of DM in patients with PPGL based on oral glucose tolerance test (OGTT) and HbA1c and to evaluate effect of insulin secretion and sensitivity indices on DM pre-operatively. MethodsClinical and anthropometric data collection, HbA1c, 75 g OGTT with serum insulin estimation were done pre-operatively (n = 34) and at follow-up after successful surgery (n = 24) in patients with PPGL. ResultsPre and post-operative prevalence of DM were 48%(18/37) and 17% (4/24) respectively. Comparison of patients with highest (Q4) and lowest (Q1) quartiles of insulinogenic index (IGI),a parameter of insulin secretion, revealed trends towards higher prevalence of DM in patients with lower IGI (Q4 to Q1: 29% versus 71%,n = 28, p = 0.24)but no association was observed with HOMA-IR (Q4 to Q1:50% versus 57%, n = 28, p = 1.00), an insulin sensitivity index. DM remitted in 77% patients post-operatively, predicted by duration of DM of<3 years. ConclusionThere is high prevalence of DM in PPGL, with marked remission post-operatively, especially predicted by shorter duration of DM. Impaired insulin secretion is more strongly associated with pre-operative DM than increased insulin resistance.

A Novel Antidiabetic Monomers Combination Alleviates Insulin Resistance Through Bacteria-Cometabolism-Inflammation Responses.

The present study sought to examine the therapeutic effect of a novel antidiabetic monomer combination (AMC) in treating type 2 diabetes mellitus (T2DM); while also elucidating the potential functional mechanism. Male C57BL/6J mice were fed a high-fat diet (HFD) for 12 weeks to establish T2DM. The AMC group showed significant reduction in weight, fasting blood glucose (FBG), serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C), and experienced reduced insulin resistance based on oral glucose tolerance testing (OGTT) and hyperinsulinemic-euglycemic clamp testing (“gold standard” for determining in vivo insulin sensitivity). Further, AMC restored the altered intestinal flora by increasing the abundance of the beneficial bacteria Akkermansia, and decreasing the number of harmful bacteria, including Bacteroides, Odoribacter, Prevotella 9, Alistipes, and Parabacteroides. Components of the host-microbial metabolome were also significantly changed in the AMC group compared to the HFD group, including hydroxyphenyllactic acid, palmitoleic acid, dodecanoic acid, linoleic acid, and erucic acid. Furthermore, AMC was found to inhibit inflammation and suppress signaling pathways related to insulin resistance. Lastly, spearman correlation analysis revealed relationships between altered microbial community and co-metabolite levels, co-metabolites and inflammatory cytokines. Hence, the potential mechanism responsible for AMC-mediated alleviation of insulin resistance was suggested to be involved in modulation of bacteria-cometabolism-inflammation responses.

Abnormal fasting, post-load or combined glucose values on oral glucose tolerance test and pregnancy outcomes in women with gestational diabetes mellitus

AimsThis study aimed to investigate whether pregnancies complicated by gestational diabetes mellitus (GDM) present differences in the outcomes according to the findings on oral glucose tolerance test (OGTT), including fasting, post-load or combined abnormal blood glucose. MaterialsThis was a prospective cohort study including 831 singleton pregnancies with GDM per the IADPSG criteria. According to their fasting blood glucose value on OGTT the women were categorized in three groups: (i) GDM women with fasting plasma glucose levels > 92 mg/dl and normal post-load values (T0 abnormal group), (ii) patients with abnormal values at 60′ and/or 120′ and normal fasting values (T-post group) and (iii) patients with combined fasting and post-load abnormal blood glucose values (T-comb). Regression analysis was used to test the independent contribution of the different groups, along with maternal and fetal characteristics, in prediction of (i) large for gestational age (LGA), (ii) need for insulin treatment and (iii) birthweight centile. ResultsGDM with abnormal fasting blood glucose was an independent risk factor for LGA (OR 2.91, 95% CI 1.33–6.36) and was associated with higher birthweight centile (10.25, 95% CI 0.27–20.25). GDM with combined fasting and post-load abnormal blood glucose was an independent risk factor for insulin treatment (OR 2.94, 95% CI 1.93–4.47). ConclusionsWomen with GDM and abnormal fasting blood glucose are at increased risk for large for gestational age neonates, while women with GDM and combined fasting and post-load abnormal blood glucose are at increased risk for insulin therapy.

Synthesis of a 1,2,3-bistriazole derivative of embelin and evaluation of its effect on high-fat diet fed-streptozotocin-induced type 2 diabetes in rats and molecular docking studies.

The embelin derivative 2a was synthesized with the 1,2,3-bistriazole and spectral data confirmed its structural identity. Anti-diabetic and anti-lipidemic effects were evaluated using HFD-STZ induced type 2 diabetic rats. The derivative 2a (30mg/kg b wt.) supplementation significantly (P≤0.01) normalized the changed biochemical parameters like fasting blood glucose (FBG), body weights, plasma insulin level, total cholesterol (TC), triglycerides (TG) and marker enzymes of carbohydrate metabolism. The derivative 2a (30mg/kg) also showed a significant effect on oral glucose tolerance test (OGTT) and intraperitoneal insulin tolerance test (ITT). But 15mg/kg dose of derivative2afailed to show any significant effects in HFD-STZ induced type2 diabetic rats.Histopathology analysis substantiated the protective effect of this derivative 2a(30mg/kg b wt.) on the β-cells of the pancreatic, liver and adipose tissues in diabetic treated rats. Further, the expressions of PPARγ and GLUT4 were significantly enhanced in the epididymal adipose tissue. The HOMO and LUMO energies characterized the molecular stability of the derivative 2a with 6-311G++ (d, p) in DFT/B3LYP/LanL2DZ method using Gaussian09 program package. The molecular docking analysis also confirmed the activity of derivative 2a through hydrogen bond interaction with ARG 288, GLU 343, SER 342 and least energy value (-7.72kcal/mol). Hence, the embelin-1,2,3-bis triazole derivative 2a (30mg/kg) enhanced the activity of embelin and might be acting as a suitable drug for type 2 diabetes, obesity and its complications.

Antidiabetic effect of Cordia morelosana, chemical and pharmacological studies.

CORDIA MORELOSANA: Standley (Boraginaceae) is commonly used in folk medicine for the treatment of diarrhoea, kidney inflammation, diabetes, lung pain, bronchitis, asthma, hoarseness, cough and fever. Current work was conducted to develop a bio-guided isolation of antidiabetic compounds from ethanolic extract of Cordia morelosana (EECm). The phytochemical bio-guided study was conducted by successive chromatographic techniques, and isolated compounds were characterized by 1D and 2D-NMR experiments. The in vivo antihyperglycemic and antidiabetic activities of EECm (100mg/kg), and methyl rosmarinate (MR, 50mg/kg) were determined on normoglycemic and diabetic murine models. Additionally, the in vitro activity was conducted to determine α-glucosidase inhibitory effect, and PPARs, GLUT4 and FATP expression on 3T3-L1 cells by RT-PCR. Acute and sub-chronic toxicological studies for EECm were conducted on rats, following the OECD guidelines (No. 420 and 407). EECm promotes significant α-glucosidase inhibition (55.6%) at 1mg/kg respect to the control. Also, EECm (100mg/kg) showed significant antihyperglycemic effect on oral glucose tolerance test (OGTT), and in non-insulin dependent type 2 diabetes (NIDD) model, had antidiabetic activity (p<0.001) compared to controls. The bio-guided isolation allowed to obtain four known compounds described as rosmarinic acid (RA), methyl rosmarinate (MR), nicotiflorine and 1-O-methyl-scyllo-inositol. On the other hand, MR showed significant antidiabetic and anthiyperglycemic activities (p<0.05), and overexpression of PPARγ, PPARα, GLUT-4 and FATP than control. Docking studies were conducted with PPARγ and PPARα, showing interesting binding mode profile on those targets. Finally, EECm displayed a LD50>2000mg/kg and sub-chronic toxicological study reveals no toxic signs in animals tested compared to control. EECm showed significant antihyperglycemic and antidiabetic actions being RA and MR the main antidiabetic metabolites.

Berberine and Prediabetes: A Clinical Observational Study

Objective: To observe the clinical efficacy and safety of berberine in treating patients with prediabetes. Methods: A total of 76 patients with prediabetes were enrolled, and at the end of a one-month run-in period, 70 patients were eligible to participate in the clinical trial and randomly assigned to two groups in a 1:1 ratio, namely a treatment group (n = 35) and a control group (n = 35). Members of the control group underwent lifestyle interventions, including dietary interventions and exercise prescriptions, while participants of the treatment group received both lifestyle interventions and oral administration of 300 mg berberine, three times daily for three months. Subsequently, the treatment group entered a washout period of two months, during which time the medication was stopped, and the lifestyle interventions continued. Following the washout period, the oral administration of berberine was resumed at the same dose and lasted for three months. Blood glucose parameters were evaluated after different treatment periods. Results: 1) Intra-group comparison: Following the first and the second treatment periods, the treatment group experienced a significant decrease in fasting plasma glucose (FPG), 2-hour PG (2hPG) based on oral glucose tolerance test (OGTT), HbA1c, and HOMA-IR (P < 0.05); for the control group, although the blood glucose parameters exhibited a downward trend, the differences lacked statistical significance. 2) Intergroup comparison: Compared to the control group, the treatment group showed a signifi-cant decline in the levels of FPG, 2hPG, and HbA1c, whereas the decrease in HOMA-IR had no statistical significance. 3) Safety evaluation: No serious adverse events occurred in either group. Conclusion: Berberine is safe and effective in controlling blood glucose levels in patients with prediabetes and deserves to be promoted in clinical practice.