[High level of hemoglobin during the first trimester of pregnancy associated with the risk of gestational diabetes mellitus].

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic ß cell function index (HOMA-ß) were used to evaluate insulin resistance and pancreatic ß cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-ß within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

Ageing and type 2 diabetes in an elderly Chinese population: the role of insulin resistance and beta cell dysfunction.

OBJECTIVE: The aim of this longitudinal study was to examine the effects of ageing on glucose regulation in elderly Chinese men and women. SUBJECTS AND METHODS: A total of 4,566 older Chinese men and women (mean age: 70.4 ± 6.7 years) were enrolled in the study. Oral glucose tolerance tests were performed in all participants at baseline and in 3,174 individuals (69.5%) after 3 years of follow-up. Insulin resistance and beta cell function were estimated by the homeostasis model assessment for insulin resistance (HOMA-IR) and beta function (HOMA%-b), respectively. RESULTS: At baseline, 1,143 had type 2 diabetes (T2D), 517 had prediabetes and 2,906 had normal glucose tolerance (NGT). After 3 years of follow-up, 769 (42.2%) of 1,821 individuals with NGT at baseline progressed to prediabetes and 153 (8.4%) progressed to T2D. Of individuals with prediabetes at baseline, 17.3% progressed to T2D. In individuals who maintained NGT during follow-up ageing was associated with increased insulin resistance (p ≤ 0.001) and a compensatory increase in beta function (p ≤ 0.001). Individuals with NGT or prediabetes who progressed to T2D during follow-up had a significantly increased insulin resistance and a decreased beta cell function (p < 0.01). In contrast, individuals who regressed from prediabetes to NGT increased both insulin resistance and beta cell function (p < 0.01). CONCLUSIONS: Ageing is associated with development of insulin resistance in an Elderly Chinese population. Therefore, maintenance of normal glucose regulation depends on the ability to compensatory increase of the beta cell function.