Short sleep duration and risk of gestational diabetes.

ObjectiveSleep disturbances and short sleep duration are common in pregnancy and might contribute to the development of hyperglycemia. Therefore, we evaluated the association of sleep disturbances and gestational diabetes (GDM) in a cohort of women.MethodsWe collected data of 386 women consecutively screened for GDM in 2019 by 75 gr OGTT, according with IDPSG criteria. Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess self-reported poor sleep quality (PSQI score >5) and short nocturnal sleep duration (<6 h).ResultsOf 386 women, 148 (38.3%) had poor sleep quality and 87 (22.5%) short sleep duration. GDM prevalence was 26.9%. There was no difference in GDM prevalence between women with poor or good sleep quality (26% vs. 28%; n.s.), while GDM was more frequent in women with short sleep duration (35.6% vs. 24.4%; p = 0.038). On univariate logistic regression analysis, short sleep duration (OR 1.71; 95%CI: 1.03-2.86; p = 0.039), previous GDM (OR 3.52; 95%CI: 1.83-6.76; p < 0.0001), family history of diabetes (OR 1.96; 95%CI: 1.21-3.91; p = 0.007), pre-pregnancy overweight (OR 1.85; 95%CI: 1.06-3.23; p = 0.031) or obesity (OR 2.56; 95%CI: 1.40-4.70; p = 0.002) were associated to GDM. However, after adjustment for confounders, short sleep duration did not persist as an independent risk factor for GDM (OR: 1.55; 95%CI: 0.91-2.65; ns).ConclusionsSleep disturbances are relative common among pregnant women. Although GDM seems more common among women with short sleep duration, this sleep disturbance does not seem to be an independent risk factor for GDM in women at high risk.

Bone fragility in patients with diabetes mellitus: A consensus statement from the working group of the Italian Diabetes Society (SID), Italian Society of Endocrinology (SIE), Italian Society of Gerontology and Geriatrics (SIGG), Italian Society of Orthopaedics and Traumatology (SIOT).

Bone fragility is one of the possible complications of diabetes, either type 1 (T1D) or type 2 (T2D). Bone fragility can affect patients of different age and with different disease severity depending on type of diabetes, disease duration and the presence of other complications. Fracture risk assessment should be started at different stages in the natural history of the disease depending on the type of diabetes and other risk factors. The risk of fracture in T1D is higher than in T2D, imposing a much earlier screening and therapeutic intervention that should also take into account a patient's life expectancy, diabetes complications etc. The therapeutic armamentarium for T2D has been enriched with drugs that may influence bone metabolism, and clinicians should be aware of these effects. Considering the complexity of diabetes and osteoporosis and the range of variables that influence treatment choices in a given individual, the Working Group on bone fragility in patients with diabetes mellitus has identified and issued recommendations based on the variables that should guide screening of bone fragility and management of diabetes and bone fragility: (A)ge, (B)MD, (C)omplications, (D)uration of disease, & (F)ractures (ABCD&F). Consideration of these parameters may help clinicians identify the best time for screening, the appropriate glycaemic target and anti-osteoporosis drug for patients with diabetes at risk of or with bone fragility.

Exercise during pregnancy: how much active are pregnant women at risk of gestational diabetes despite few contraindications?

INTRODUCTION: Diet and physical activity are cornerstones in prevention and treatment of Gestational Diabetes (GDM) though some caution may be required under specific circumstances. The aims of this study were to evaluate activity habits during pregnancy and contraindications to physical activity in women at risk for GDM. METHODS: 536 pregnant women (age 35 ± 5 years; gestation week 25 ± 4; pre-pregnancy BMI 24.6 ± 12.9 kg/m2), selective screened for GDM, filled out a standardized questionnaire recording physical activity during pregnancy. RESULTS: Of 536 women, 73.4% reported regular exercise before pregnancy and 95.5% of them continued during pregnancy. 8.2% had absolute contraindications to exercise, such as placenta praevia /vaginal bleeding and incompetent cervix/cerclage. Physical activity during the last month was reported by 66.2% of women; frequency was 1-2 times/week (44%); intensity was light (83%) and duration on average (44%) 20-40 min/day. 48% of women spent most of their time in sedentary behaviors (sitting). Among women with GDM, physical activity was associated with better metabolic profile and lower needed of insulin therapy. CONCLUSION: Women at risk for GDM spent most of their time in sedentary behaviors, despite a low prevalence of contraindications to exercise. Therefore, our data call for the need of motivational counseling aimed to implement physical activity during pregnancy.

Risk factors associated with postpartum impaired glucose regulation in women with previous gestational diabetes.

AIMS: For women with previous gestational diabetes (GDM), international guidelines recommend 75 g oral glucose tolerance test (OGTT) at 4-12 weeks after delivery to assess glucose tolerance, considering their increased risk of type 2 diabetes. We evaluated prevalence of postpartum impaired glucose regulation (IGR) and identified associated risk factors. METHODS: We retrospectively collected data from 749 women with previous GDM (IADPSG criteria) who underwent postpartum OGTT for type 2 diabetes screening between 2011 and 2019. IGR was identified according to ADA criteria. RESULTS: Prevalence of IGR was 12.7%, lower in women with pre-pregnancy normal weight, higher in women with family history of type 2 diabetes and in those treated with insulin during pregnancy. Prevalence of IGR raised with increasing number of altered glucose values at OGTT performed during pregnancy for GDM screening. HbA1c and triglycerides measured during the third trimester of pregnancy were higher in women with postpartum IGR. At postpartum screening, women with IGR had higher BMI, waist, blood pressure. At multivariate logistic regression analysis, family history of diabetes (OR 2.21; 95% CI: 1.33-3.69; p < 0.01) and presence of all three glucose values exceeding threshold at OGTT during pregnancy (OR 2.89; 95% CI: 1.42-5.86; p < 0.01) were independently associated with IGR. CONCLUSIONS: In women with GDM, persistence of IGR in the immediate postpartum period is associated with family history of diabetes and the presence of all three glucose values exceeding diagnostic threshold for GDM at OGTT in pregnancy, suggesting that these women should undergo specific diabetes monitoring and prevention programs.

Use of non-nutritive-sweetened soft drink and risk of gestational diabetes.

In this observational study, we assessed the association between use of non-nutritive-sweetened soft drink (NNSSD) and risk of gestational diabetes (GDM) in 376 pregnant women consecutively screened for GDM, observing that NNSSD consumption is common among pregnant women and is associated with an increased risk of GDM, independently from traditional risk factors.

A Case of Oculocutaneous Albinism in a Patient with Hashimoto's Thyroiditis.

BACKGROUND: Oculocutaneous albinism (OCA) is a heterogeneous autosomal recessive disorder characterized by reduced or absent melanin synthesis. Its prevalence is approximately one in 17,000 individuals worldwide. OCA causes a complete or partial absence of pigment in the skin, hair, and eyes. Reduction of melanin in the eyes results in reduced visual acuity, photophobia, and nystagmus. To our knowledge, the coexistence of albinism and thyroid autoimmune diseases has not been reported. CASE REPORT: A 37-year-old male with OCA came to our observation for a familial history of autoimmune thyroiditis. He complained with mild asthenia. His brother was affected by OCA and autoimmune thyroiditis. Physical examination revealed the presence of fair skin, platinum white hair, and hypopigmentation of the iris. Laboratory data revealed the presence of subclinical hypothyroidism with positive serum anti-thyroid antibodies. Neck ultrasonography showed a markedly heterogeneously hypoechoic pattern of the thyroid, with a honeycomb-like appearance. DISCUSSION: In the majority of cases, OCA in Caucasians is caused by mutations in the tyrosinase gene. The tyrosinase peptide is normally expressed on the surface of melanocytes, although recent studies have shown its presence in thyroid follicular epithelial cells of patients with Hashimoto's thyroiditis. Therefore, although the mechanism is unclear, the present case report may suggest a pathogenetic link between OCA and Hashimoto's thyroiditis.

Freestyle Libre trend arrows for the management of adults with insulin-treated diabetes: A practical approach.

Freestyle Libre (FSL) system is a new method to detect glucose enabling a new paradigm in glucose monitoring and self-management. The sensor, reading the interstitial fluid glucose concentration, provides a numerical data of glucose level and a trend arrow that add context to static measurement of glucose level. Therefore, patients could easily follow the progression of their glucose levels over the time, allowing early detection and timely treatment of deviations from targeted glucose level range, thus preventing extreme fluctuations. In order to take full advantage of the system both the caregiver and the person with diabetes must appreciate the need of careful interpretation of the data generated by the FSL. To this purpose we have generated recommendations that are based on methods suggested for CGM, our clinical experience and discussion with experienced patients using FSL, to provide a pragmatic approach to use FSL trend arrow data for managing diabetes in adults.

Pre-pregnancy obesity, gestational diabetes or gestational weight gain: Which is the strongest predictor of pregnancy outcomes?

AIMS: Both obesity and gestational diabetes (GDM) are risk factors for adverse pregnancy outcomes. The aim of our study is to ascertain the independent role of prepregnancy BMI (pp-BMI), gestational weight gain (GWG), and GDM on pregnancy outcomes. METHODS: We analyzed data of 1198 pregnant women, who underwent selective screening for GDM. Data on pregnancy outcomes was collected from hospital discharge records. RESULTS: Cesarean section (CS) was comparable in GDM and NGT women. Prevalence of fetal macrosomia was 5.9%, with no difference between GDM and normal glucose tolerance (NGT), neonatal hyperbilirubinemia were more frequent in newborns of GDM women (63.3% vs. 52.2%; p < 0.01). Offspring of women with excessive GWG weighed more than those of women with regular GWG (3405 ±â€¯510 g vs. 3287 ±â€¯524 g; p < 0.01). On a logistic regression analysis, GWG was an independent risk factor for macrosomia (OR 1.08, 95% CI 1.02-1.13; p < 0.01) and delivery at a gestational age <37 weeks (OR 0.29, 95% CI 0.16-0.53; p < 0.0001). GDM and pp-BMI were not independent risk factors for adverse outcomes in this cohort. CONCLUSIONS: GWG rather than GDM is associated with adverse pregnancy outcomes. These findings call for an early education and implementation of a healthy lifestyle in women planning a pregnancy.