Lucrecia Herranz

Is Pregnancy Outcome Worse in Type 2 Than in Type 1 Diabetic Women

Most research on pregestational diabetes has focused on type 1 diabetes, and surprisingly little knowledge exists concerning outcomes of pregnancies of women with type 2 diabetes. A dearth of published data suggest outcomes similar to those of type 1 diabetic women (1,2), although recent studies report poorer outcomes in women with type 2 diabetes (3–7). We retrospectively compared maternal and perinatal outcomes of 93 consecutive singleton pregnancies in women with type 2 diabetes and 532 consecutive singleton pregnancies in women with type 1 diabetes referred to the Diabetes and Pregnancy Unit at University Hospital La Paz from 1984 to 2004. Women with type 2 diabetes were significantly older ([means ± SD] 31.8 ± 5.5 …

Use of insulin lispro during pregnancy in women with pregestational diabetes mellitus.

BACKGROUND AND OBJECTIVE To assess the safety and efficacy of insulin analogues versus human insulin in pregnant women with pregestational diabetes. PATIENTS AND METHODS We collected data on pregnant women with type 1 or type 2 diabetes who were attended at the Diabetes and Pregnancy Unit between January 1998 and April 2008 (N=351). Two hundred and forty one patients were treated with regular insulin and NPH and 110 were treated with different combinations of insulins including an insulin analogue (most of them with NPH and lispro). RESULTS There was no significant difference in terms of congenital malformation rate between groups (3.3% and 3.6%). The group on insulin analogue had slightly higher mean HbA1c during the first trimester than the group on human insulin (6.6 [1.0]% vs 6.9 [1.1]%; P=0,022) and needed smaller insulin doses during whole pregnancy. Severe hypoglycaemia was significantly less frequent among women treated with a rapid insulin analogue (2.3 vs 10.0%; P=0,025). Neonatal hypoglycaemia was significantly more frequent in the group treated with a rapid insulin analogue (34.9 vs 23.6%; P=0.043) due to the concomitant use of an insulin pump. Other obstetric and neonatal variables were not different between the two groups. CONCLUSION Our study shows that insulin analogues are safe during pregnancy in women with pregestational diabetes mellitus. Overall, glycaemic control, maternal and foetal outcome were similar to those with human insulin. The main advantage with respect to human insulin was to importantly reduce maternal severe hypoglycaemia.

Body weight, weight gain and hyperglycaemia are associated with hypertensive disorders of pregnancy in women with gestational diabetes

AIM The aim of this study was to measure the capacity of glucose- and weight-related parameters to predict pregnancy-induced hypertensive disorders in women with gestational diabetes. METHODS An observational study was conducted involving 2037 women with gestational diabetes. The associations of glycaemic and weight-related parameters with pregnancy-induced hypertensive disorders were obtained by univariate and adjusted multivariate analyses. Also, model predictability and attributable predictor risk percentages were calculated, and collinearity and factor interactions examined. RESULTS Multivariate analyses revealed that hypertensive disorders were mainly predicted by average third-trimester glycated haemoglobin (HbA(1c)) levels ≥ 5.9%, by being overweight or obese before pregnancy and by excess gestational weight gain after adjusting for age, tobacco use, chronic hypertension, parity, urinary tract infections and gestational age at delivery. Prepregnancy body weight (overweight and obesity) had the strongest impact on pregnancy-related hypertensive disorders (attributable risk percentages were 51.5% and 88.8%, respectively). The effect of being overweight or obese on hypertensive disorders was enhanced by HbA(1c) levels and gestational weight gain, with elevated HbA(1c) levels multiplying the effect of being overweight before pregnancy. CONCLUSION The average third-trimester HbA1c level is a novel risk factor for pregnancy-induced hypertensive disorders in women with gestational diabetes. HbA(1c) levels ≥ 5.9%, prepregnancy overweight or obesity and excess gestational weight gain are all independent risk factors of pregnancy-related hypertensive disorders in such women. In treated gestational diabetes patients, the strongest influence on hypertensive disorders is prepregnancy obesity.

Leuprolide suppression of androgen secretion by hilus cell hyperplasia within the wall of an ovarian cyst

Androgenic manifestations coexisting with hilus cell hyperplasia adjacent to a tumour or an ovarian cyst are extremely rare. We report the case of a post‐menopausal woman with hirsutism associated with hilus cell hyperplasia within the wall of an ovarian cyst. The pattern of steroid secretion revealed increased testosterone release. Suppression of testosterone to ‘normal range’ was seen in response to leuprolide administration. This new approach demonstrates gonadotrophin dependence of hilus cell hyperplasia within an ovarian cyst.

Protein intake during aggressive calorie restriction in obesity determines growth hormone response to growth hormone‐releasing hormone after weight loss

OBJECTIVE We evaluated the influence of two types of calorie restriction, total fast or very low calorie diet, on GH responsiveness to GHRH in severely obese patients.

Low Toe-Brachial Pressure Index Predicts Increased Risk of Recurrent Cardiovascular Disease in Type 2 Diabetes

Ankle-brachial pressure index (ABI) and toe-brachial pressure index (TBI) are used for the detection of peripheral arterial disease. Low ABI is associated with increased risk of myocardial infarction and cardiovascular death (1,2). The validity of TBI in the prediction of cardiovascular events in patients with diabetes has been hardly evaluated. After an acute coronary syndrome, 81 patients with type 2 diabetes were recruited (2003–2011). Baseline parameters (men 74.1%, age 65.3 ± 9.1 years, diabetes duration 13.4 ± 9.2 years) were collected and ABI and TBI were measured using standard procedures. TBI data were missing for eight patients, and three patients with an ABI ≥1.3 were excluded from the ABI analysis. During follow-up, all major cardiovascular events (new episode of myocardial infarction, ischemic cerebrovascular disease, or peripheral arterial disease) were registered. Adjusted Cox proportional hazards regression models were …

Identification of eight new mutations in the GCK gene by DHPLC screening in a Spanish population.

Maturity onset diabetes of the young (MODY) is a genetically heterogeneous disorder characterized by autosomal dominant inheritance, altered function of pancreatic beta cells and early onset diabetes mellitus, usually before 25 years old. The prevalence of specific mutations of MODY genes differs considerably among different countries. In this study we analyzed 53 index cases from unrelated MODY families who are potential carriers of mutations in GCK gene. In addition, 122 relatives were also studied. We have identified eight new mutations in the GCK gene. One of them is a non-frameshift deletion involving Lysine 143. This amino acid is part of the conserved stretch of basic residues (KHKKL) which spans from residue 140 to 144. The non-frameshift deletion might implicate the affinity of GCK for GCKRP, and potentially the abnormal nuclear localization of GCK. Additional studies should be performed to confirm this possibility.

Influencia del control metabólico preconcepcional en la evolución de la gestación de la paciente diabética

Fundamento En la paciente diabetica es preciso un control metabolico estricto en los momentos previos a la concepcion y en las primeras semanas del embarazo para disminuir la morbilidad maternofetal. En nuestro estudio tratamos de comprobar si dicho control se relaciona o no con la aparicion de abortos y de complicaciones neonatales Pacientes y metodo Se examina a 69 pacientes diabeticas, 62 diabeticas tipo 1 y 7 diabeticas tipo 2, sometidas a control preconcepcional en la unidad de diabetes y embarazo en el periodo 1992-1998. Se llevo a cabo control metabolico en el periodo preconcepcional y a lo largo de la gestacion. Se analiza la relacion entre los parametros de control metabolico en el periodo preconcepcional inmediato y la evolucion de la gestacion Resultados Un total de 50 mujeres (72,6%; intervalo de confianza [IC] del 95%: 62-83%) finalizaron el control preconcepcional con embarazo. De estas pacientes, 8 (16%; IC del 95%: 5,5–27%) abortaron. No hubo diferencias entre las pacientes que abortaron y las que no, en relacion con la hemoglobina glucosilada (HbA 1c) con que terminaron el control preconcepcional, edad, tiempo de evolucion de la diabetes y edad al diagnostico, presencia de anticuerpos antitiroideos o de vasculopatia. En los 41 embarazos con feto unico, hubo macrosomia en un 36,6% (IC del 95%: 21,2-52%), hipoglucemia neonatal en un 19,5% (IC del 95%: 6,9-32%) y malformaciones graves en un caso (2,4%; IC del 95% 2-7,4%). La HbA 1c media (desviacion estandar) de las 41 pacientes embarazadas con feto unico al inicio del periodo preconcepcional fue del 7,6 (1,3) (IC del 95%: 7,1-7,9%) y al final de dicho periodo del 6,5% (0,7) (IC del 95%: 6,3-6,7%) (p Conclusion Un mejor control metabolico en el periodo preconcepcional puede contribuir a disminuir la incidencia de macrosomia y de morbilidad neonatal

The Relative Contribution of Ethnicity, Overweight and Gestational Diabetes Severity to Postpartum Abnormal Glucose Tolerance

Aim: To analyze the influence of ethnicity, body mass index (BMI) and gestational diabetes (GDM) severity on abnormal glucose metabolism at the early postpartum. Methods: Glucose tolerance (WHO criteria) was evaluated at 3-9 months after delivery in a group of 71 GDM women (NDDG criteria) coming from Latin America, 43 from Africa and 14 from Asia or Pacific Islands. Their glucose tolerance was compared to 1,948 European control women by prepregnancy and postpartum BMI and by GDM severity. The effect of these parameters was adjusted for age, family history of diabetes, previous gestational diabetes, gestational age at GDM diagnosis and excess gestational weight gain. Results: Postpartum glucose tolerance was abnormal in 37.3% of women. Asian-Pacific Islanders (64.3%), Latinas (62.8%) and African (50.4%) had glucose metabolism abnormalities more frequently than European (35.5%) mothers (P<0.001). There was an effect of being overweight (AOR 1.38, 95% CI 1.121.71, P<0.001), obese (2.10, 1.56-2.83, P<0.001) prepregnancy and of non-European geographic origin (1.80, 1.2-2.7, P=0.004) on postpartum impaired glucose metabolism in the adjusted analysis. The main predictors of postpartum dysglycemia were prepregnancy obesity and GDM fasting glycemia in both non-European and European groups. The effect of ethnicity disappeared when the effect of postpartum BMI (2.14, 1.61-2.84, P<0.001 of overweight; 2.31, 1.60-3.32, P<0.001 of obesity) was considered. Conclusion: The effect of body weight is stronger than that of ethnicity on postpartum dysglycemia in women with recent gestational diabetes.

Metabolic syndrome and impaired glucose metabolism during early postpartum after twin pregnancies complicated by gestational diabetes mellitus: Is the risk comparable to singleton pregnancies?

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since mercredi 22 novembre 2017