Alfonso L. Calle-Pascual

Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study

OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) for the diagnosis of gestational diabetes mellitus (GDM) results in an increased prevalence of GDM. Whether their introduction improves pregnancy outcomes has yet to be established. We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan (CC) criteria. RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospectively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation. Both groups received the same treatment and follow-up regimes. RESULTS The use of IADPSGC resulted in an important increase in GDM rate (35.5% vs. 10.6%) and an improvement in pregnancy outcomes, with a decrease in the rate of gestational hypertension (4.1 to 3.5%: −14.6%, P < 0.021), prematurity (6.4 to 5.7%: −10.9%, P < 0.039), cesarean section (25.4 to 19.7%: −23.9%, P < 0.002), small for gestational age (7.7 to 7.1%: −6.5%, P < 0.042), large for gestational age (4.6 to 3.7%: −20%, P < 0.004), Apgar 1-min score <7 (3.8 to 3.5%: −9%, P < 0.015), and admission to neonatal intensive care unit (8.2 to 6.2%: −24.4%, P < 0.001). Estimated cost savings was of €14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC. CONCLUSIONS The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population, as well as significant improvements in pregnancy outcomes, and was cost-effective. Our results support their adoption.

Statistical models to predict type 2 diabetes remission after bariatric surgery.

Type 2 diabetes (T2D) remission may be achieved after bariatric surgery (BS), but rates vary according to patients baseline characteristics. The present study evaluates the relevance of several preoperative factors and develops statistical models to predict T2D remission 1 year after BS.

Diagnosis of diabetes remission after bariatic surgery may be jeopardized by remission criteria and previous hypoglycemic treatment.

BackgroundControversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT).MethodsWe performed a retrospective study from a cohort of 657 BS from a single center (2006–2011), of which 141 (57.4xa0% women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6xa0%, fasting glucose (FG) <100xa0mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment.ResultsPreoperative characteristic were (meanu2009±u2009SD): age 53.9u2009±u20099.8xa0years, BMI 43.7u2009±u20095.6xa0kg/m2, T2D duration 7.4u2009±u20097.6xa0years, FG 160.0u2009±u200954.6xa0mg/dL, HbA1c 7.6u2009±u20091.6xa0%. Fifty-six (39.7xa0%) individuals had IT. At 1-year follow-up, 74 patients (52.5xa0%) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5u2009±u20098.1 vs. 30.2u2009±u20099.5xa0%, pu2009=u20090.001; 73.6u2009±u200918.4 vs. 66.3u2009±u200922.8xa0%, pu2009=u20090.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3u2009±u20099.4 vs. 4.7u2009±u20093.8xa0years, pu2009<u20090.001; 55.1u2009±u20099.3 vs. 51.2u2009±u20099.9xa0years, pu2009=u20090.017; 58.9 vs. 33.3xa0%, pu2009=u20090.004, respectively. Prior treatment revealed differences in remission rates: 67.1xa0% in case of oral therapy (OT) vs. 30.4xa0% in IT, pu2009<u20090.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157–0.327 (pu2009<u20090.05), adjusting by different models.ConclusionsConsensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission.

Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: A three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups

BACKGROUND & AIMSnWomen with prior gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes mellitus (DM2) in later life. The study aim was to evaluate the efficacy of a lifestyle intervention for the prevention of glucose disorders (impaired fasting glucose, impaired glucose tolerance or DM2) in women with prior GDM.nnnMETHODSnA total of 260 women with prior GDM who presented with normal fasting plasma glucose at six to twelve weeks postpartum were randomized into two groups: a Mediterranean lifestyle intervention group (nxa0=xa0130) who underwent an educational program on nutrition and a monitored physical activity program and a control group (nxa0=xa0130) with a conventional follow-up. A total of 237 women completed the three-year follow-up (126 in the intervention group and 111 in the control group). Their glucose disorders rates, clinical and metabolic changes and rates of adherence to the Mediterranean lifestyle were analyzed.nnnRESULTSnLess women in the intervention group (42.8%) developed glucose disorders at the end of the three-year follow-up period compared with the control group (56.75%), pxa0<xa00.05. The multivariate analysis indicated a reduction in the rate of glucose disorders with a BMI of less than 27xa0kg/m(2) (OR 0.28; 0.12-0.65; pxa0<xa00.003), low fat intake pattern (OR 0.30; 0.13-0.70; pxa0<xa00.005), low saturated fat pattern (OR 0.30; 0.13-0.69; pxa0<xa00.005) and healthy fat pattern (OR 0.34; 0.12-0.94; pxa0<xa00.04).nnnCONCLUSIONSnLifestyle intervention was effective for the prevention of glucose disorders in women with prior GDM. Body weight gain and an unhealthy fat intake pattern were found to be the most predictive factors for the development of glucose disorders. Current Controlled trials: ISRCTN24165302. http://www.controlled-trials.com/isrctn/pf/24165302.

Statistical models to predict type 2 diabetes remission after bariatric surgery 预测2型糖尿病患者减肥手术后缓解情况的统计学模型

Type 2 diabetes (T2D) remission may be achieved after bariatric surgery (BS), but rates vary according to patients baseline characteristics. The present study evaluates the relevance of several preoperative factors and develops statistical models to predict T2D remission 1 year after BS.

Remission of Type 2 Diabetes Mellitus Should Not Be the Foremost Goal after Bariatric Surgery

BackgroundRemission of type 2 diabetes (T2D) is a desired outcome after bariatric surgery (BS). Even if this goal is not achieved, individuals who do not strictly fulfill remission criteria experience an overall improvement. The aim of this study was to evaluate the metabolic control status in patients considered as diabetes “non-remitters.”MethodsA retrospective study of 125 patients (59.2xa0% women) with preoperative diagnosis of T2D who underwent BS in a single center (2006–2011) was conducted. We collected anthropometric and metabolic parameters before surgery and at 1-year follow-up. T2D remission was defined according to the 2009 consensus statement: glycosylated hemoglobin (HbA1c) <6xa0%, fasting glucose (FG) <100xa0mg/dLs, and absence of pharmacologic treatment. We evaluated metabolic status of non-remitters, according to the American Diabetes Associations (ADA) target recommendations: HbA1c <7xa0%, LDL-c <100xa0mg/dL, triglycerides <150xa0mg/dL, and HDL-c >40 (male) or >50xa0mg/dL (female). Statistics: analysis of variance.ResultsBaseline characteristics (mean ± SD): age 53.5u2009±u20099.7xa0years, BMI 43.5u2009±u20095.6xa0kg/m2, time since diagnosis of T2D 7.7u2009±u20097.9xa0years, FG 162.0u2009±u200956.3xa0mg/dL, HbA1c 7.7u2009±u20091.6xa0%. ADAs target recommendations were present in 12 patients (9.6xa0%) preoperatively, and in 45 (36.0xa0%) at 1-year follow-up (p <0.001). Sixty-two (49.6xa0%) patients did not achieve diabetes remission; 26 (41.9xa0%) had now diet treatment, 30 (48.4xa0%) oral medications, and 6 (9.7xa0%) required insulin. Of the non-remitters, 57 (91.9xa0%) had HbA1c <7xa0% and 18 (40.0xa0%) achieved ADAs target recommendations. There were no differences between remitters and non-remitters in the number of individuals reaching ADAs combined metabolic control.ConclusionsAlthough almost 50xa0% of the patients may not be classified as diabetes remitters, their significant improvement in metabolic control should be regarded as a success, according to most scientific societies target recommendations.

A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study

Background Gestational diabetes mellitus (GDM) prevalence is increasing and becoming a major public health concern. Whether a Mediterranean diet can help prevent GDM in unselected pregnant women has yet to be studied. Methods We conducted a prospective, randomized controlled trial to evaluate the incidence of GDM with two different dietary models. All consecutive normoglycemic (<92 mg/dL) pregnant women at 8–12 gestational weeks (GW) were assigned to Intervention Group (IG, n = 500): MedDiet supplemented with extra virgin olive oil (EVOO) and pistachios; or Control Group (CG, n = 500): standard diet with limited fat intake. Primary outcome was to assess the effect of the intervention on GDM incidence at 24–28 GW. Gestational weight gain (GWG), pregnancy-induced hypertension, caesarean section (CS), preterm delivery, perineal trauma, small and large for gestational age (SGA and LGA) and admissions to neonatal intensive care unit were also assessed. Analysis was by intention-to-treat. Results A total of 874 women completed the study (440/434, CG/IG). According to nutritional questionnaires and biomarker analysis, women in the IG had a good adherence to the intervention. 177/874 women were diagnosed with GDM, 103/440 (23.4%) in CG and 74/434(17.1%) in IG, p = 0.012. The crude relative risk (RR) for GDM was 0.73 (95% CI: 0.56–0.95; p = 0.020) IG vs CG and persisted after adjusted multivariable analysis, 0.75(95% CI: 0.57–0.98; p = 0.039). IG had also significantly reduced rates of insulin-treated GDM, prematurity, GWG at 24–28 and 36–38 GW, emergency CS, perineal trauma, and SGA and LGA newborns (all p<0.05). Conclusions An early nutritional intervention with a supplemented MedDiet reduces the incidence of GDM and improves several maternal and neonatal outcomes.

The impact of switching to the one-step method for GDM diagnosis on the rates of postpartum screening attendance and glucose disorder in women with prior GDM. The San Carlos Gestational Study

AIMSnTo compare rates of FPG-HbA1C-based postpartum-glucose disorder (PGD) of women with prior gestational diabetes mellitus (GDM) by Carpenter-Coustan criteria (CCc) versus International Association of Diabetes and Pregnancy Study Groups criteria (IADPSGc).nnnMETHODSn1620 women with GDM were divided into CCc group (2007-March 2012, n=915), and IADPSGc group (April 2012-2013, n=705). Pregravid (PG) body weight (BW) and body mass index (BMI) and postdelivery (PD) BW, BMI, waist circumference (WC), HOMA-insulin resistance (HOMA-IR), HbA1c, glucose and lipid profile were analysed. PGD definition: HbA1c ≥5.7% and/or FPG ≥5.6mmol/l.nnnRESULTSnPostpartum screening attendance rates (PSAr) were similar in both groups, CCc: 791 (86.5%) and IADPSGc: 570 (81%) as in PGD rates (PGDr), CCc: 233 (29.5%) and IADPSGc: 184 (32.3%). Both cohorts had similar PG-BMI, WC and PD-BMI. Both CCc and IADPSGc women had a significantly higher probability of having PGD when PG-BMI ≥25Kg/m(2) (CCc: OR: 1.55; IC 95% 1.06-2.26; p=0.016), (IADPSGc: OR: 1.42; IC 95% 1.03-2.38; p=0.046) as well as when WC ≥89.5cm, and age ≥34years, and in CCc women when PD-WG >0Kg, all adjusted by ethnicity and parity.nnnCONCLUSIONSnChanging GDM diagnostic methodology did not affect PSAr and PGDr, in spite of screening more women. Thus, using IADPSGc allowed the identification of a larger number of women with PGD.

Lifestyle patterns in early pregnancy linked to gestational diabetes mellitus diagnoses when using IADPSG criteria. The St Carlos gestational study

UNLABELLEDnEarly-pregnancy lifestyle (EPL) could influence the development of gestational diabetes mellitus(GDM), depending on the diagnostic criteria used.nnnOBJECTIVEnWe studied EPL in 1750 pregnant women using Carpenter-Coustan criteria(CCc), and in 1526 with the International Association of Diabetes and Pregnancy Study Groups criteria(IADPSGc).nnnMETHODSnGDM risk factors were assessed in women between 24 and 28 weeks of gestational age during two consecutive years. A semiquantitative frequent-food-consumption questionnaire was used to evaluate lifestyle during pregnancy. Multiple logistic regression analysis was conducted to assess GDM risk with different lifestyle patterns.nnnRESULTSnUsing IADPSGc, the GDM ORs (95%CI) for intake/week were: nuts >3 times: 0.59 (0.39-0.91; pxa0<xa00.015), refined cereals ≤1 serving: 0.72(0.58-0.89; pxa0<xa00.003), juices <4 servings: 0.77 (0.62-0.95; pxa0<xa00.017), cookies and pastries <4 servings: 0.71(0.57-0.89; pxa0<xa00.003) as compared to opposite habits. No significant nutritional patterns were found to be significant using CCc. The OR (95%CI) for GDM with none of the four risk patterns as compared to having three-four risk factors was 0.21(0.07-0.62; pxa0<xa00.005), remaining significant after stratification by BMI, age, obstetric events, parity and family history. The multiple logistic regression model including nutritional categories and pregestational BMI, age, obstetric history, parity, personal/family history, had an area under the curve(AUC) of the receiver operating curve(ROC) for the probability to predict GDM of 0.66 (CI 95%: 0.63-0.69; pxa0<xa00.001).nnnCONCLUSIONnOur study is the first to identify four early-pregnancy nutritional patterns associated with the GDM when using IADPSGc. Adherence to a low-risk nutritional pattern from early pregnancy on could be an effective strategy for GDM prevention.

Glucose Variability After Bariatric Surgery: Is Prediction of Diabetes Remission Possible?

We aimed to corroborate glycemic control after bariatric surgery (BS) using continuous glucose monitoring (CGM) and analyze if data could predict long-term outcome. We evaluated 24 of our patients with type 2 diabetes who underwent BS (12 Roux-en-Y gastric bypass, RYGB, and 12 single-anastomosis duodeno-ileal bypass with sleeve gastrectomy, SADI-S) and who were in remission after 18–24xa0months’ follow-up. At this time, a CGM device was placed for 7xa0days. Patients were reevaluated thereafter for at least 5xa0years. Glucose variability (GV) was lower in patients after SADI-S and in the 18 patients who were still in remission after 5xa0years, and provided more information on long-term status than classical diabetes-related characteristics.