Miguel A. Rubio

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.

Which criteria should be used to define type 2 diabetes remission after bariatric surgery

BackgroundComparison of diabetes remission rates after bariatric surgery using two different models of criteria.MethodsRetrospective analysis of data from 110 patients with type 2 diabetes and morbid obesity who underwent bariatric surgery, preoperatively and at 18-month follow-up. Comparison of two models of remission: 1) 2009 consensus statement criteria; 2) simple criteria using ADA’s HbA1c diabetes diagnostic cut-off values.ResultsPatients’ meanu2009±u2009SD preoperative characteristics were: age 53.3u2009±u20099.5u2009years, BMI 43.6u2009±u20095.5u2009kg/m2, HbA1c 7.9u2009±u20091.8%, duration of diabetes 7.6u2009±u20097.5u2009years. 44.5% of patients with previous insulin therapy. With 2009 consensus statement criteria: complete, partial and no remission in 50%, 12.7% and 37.3%, respectively; with HbA1c criteria: 50%, 15% and 34.5% in the analogous categories (pu2009=u20090.673).ConclusionsWe suggest a simpler approach to evaluate diabetes remission after bariatric surgery, following the rationale of the definition of diabetes itself.

Prevalence of the metabolic syndrome in Spain using regional cutoff points for waist circumference: the di@bet.es study

The aim of the study is to assess the prevalence of metabolic syndrome (MetS) in Spain using specific cutoff points for waist circumference (WC) (>94.5xa0cm for men and >89.5xa0cm for women) and evaluating the influence of several socio-demographic and economic factors. Data on MetS were obtained from a national study of 4,727 subjects from 18 to 90xa0years of age, conducted in Spain between 2009 and 2010 (The di@bet.es study). MetS was defined applying the new Harmonized definition (evaluating the use of abdominal obesity (AO) as a obligatory criterion for MetS or not) as well as with other widely used criteria. Results were then compared with data from previous studies. Multiple logistic regression models were used to evaluate the influence of different social factors. The age-standardized MetS prevalence was 38.37xa0% (CI 35.74–40.99) in men and 29.62xa0% (CI 27.56–31.69) in women, when AO was required as a diagnostic criterion; 42.13xa0% (CI 39.37–44.89) and 32.31xa0% (CI 30.15–34.47) in men and women, respectively, if AO was not considered mandatory. Prevalence of MetS increased with age (pxa0<xa00.001 for trend). Women with a lower educational level were more likely to have MetS (OR 4.4; 95xa0% CI: 2.84-6.7) as compared with those with a higher educational level. Subjects with MetS had a worse physical quality of life. The combination of AO, hypertension and carbohydrate alterations was the most common MetS’ pattern. A high prevalence of MetS was detected in the Spanish population especially in men, the elderly and women with a low educational level.

IPO8 and FBXL10: New Reference Genes for Gene Expression Studies in Human Adipose Tissue

Housekeeping genes frequently used in gene expression studies are highly regulated in human adipose tissue. To ensure a correct interpretation of results, it is critical to select appropriate reference genes. Subcutaneous (SC) and omental (OM) adipose tissue expression was analyzed from lean and obese subjects using whole genome complementary DNA (cDNA) microarrays to identify stably expressed genes and commercial TaqMan low density arrays (LDAs), with 16 common control genes. The best candidate gene from microarrays analysis was F‐box and leucine‐rich repeat protein‐10 (FBXL10) (fold‐change 10−3 P < 0.01), an ubiquitous nucleolar protein evolutionarily conserved. Hypoxanthine phosphoribosyltransferase 1 (HPRT1) and importin 8 (IPO8), were the best reference genes among the 16 genes in the LDAs with coefficient of variation (CV) of 4.51 and 4.55%, respectively. However, when the LDAs data were further analyzed by the geNorm and NormFinder softwares, IPO8, a nuclear protein mediating import of proteins, was the first and the third better reference gene, respectively. IPO8 and FBXL10 were further validated by real‐time PCR in additional OM and SC fat samples and primary cultured preadipocytes. According to their CV, IPO8 resulted more suitable than FBXL10 in both adipose tissue depots and SC preadipocytes, whereas FBXL10 performed better than IPO8 in OM cultured preadipocytes. Both genes expression levels did not change throughout adipogenesis. Thus, we provide clear evidence that IPO8 and FBXL10 are good candidates to use as reference genes in gene expression studies in human OM and SC adipose tissues as well as differentiated primary preadipocytes.

Expression Profile in Omental and Subcutaneous Adipose Tissue from Lean and Obese Subjects. Repression of Lipolytic and Lipogenic Genes

The adipose tissue is a highly regulated endocrine and paracrine organ that secretes a wide variety of biologically active molecules involved in the control of energy balance and the regulation of body weight. Our work aimed to analyze the dysregulation of the adipocyte metabolism and compare the gene expression patterns between omental (OM) and subcutaneous (SC) adipose tissue from obese and lean subjects by using whole-genome DNA microarrays. OM and SC adipose tissues were obtained from 43 obese subjects undergoing bariatric surgery and from six lean individuals. Gene expression analysis was performed by whole-genome microarrays and Taqman RT-PCR. The analysis of microarrays showed upregulation of 545 genes in OM and 47 in SC adipose tissue, whereas 723 and 27 genes were downregulated in OM and SC tissue, respectively, in obese patients. Significantly altered genes showed at least a twofold change of pu2009<u20090.05. Validation of the arrays with 28 genes was carried out by using low density microfluidic cards which confirmed the changes found in most genes. We focused on the altered expression of gene coding for enzymes and transcription factors involved in lipid metabolism. Interestingly, some of these genes have not been previously described in obesity. Our results show that adipose tissue from obese subjects entails defense mechanisms against an excessive expansion and fat accumulation, repressing both lipogenesis and lipolysis.

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.

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.