Early detection of insulin sensitivity and beta-cell function with simple tests indicates future derangements in late pregnancy.

OBJECTIVE: Insulin sensitivity and secretion during early and late pregnancy were assessed in women with normal glucose tolerance and gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: The oral glucose tolerance test (OGTT) was performed in 903 women at 16-20th gestational week, of whom 37 had GDM (GDM1 group), and 859 repeated the OGTT at wk 26-30. At the second test, 55 had GDM (GDM2 group); the others remained normotolerant (ND group). Insulin sensitivity from OGTT (as quantitative insulin sensitivity check index and OGTT insulin sensitivity) and beta-cell function (as the ratio of the areas under the insulin and glucose concentration curves, adjusted for insulin sensitivity) were assessed in both tests. RESULTS: In early pregnancy the quantitative insulin sensitivity check index was not different in the three groups, whereas OGTT insulin sensitivity was lowest in GDM2, intermediate in GDM1, and highest in ND. In late pregnancy both indices were reduced in GDM compared with ND and lower than in early pregnancy. In early pregnancy GDM1, but not GDM2, had lower beta-cell function than ND. During the late visit, GDM2 also showed impaired beta-cell function compared with ND; furthermore, the adaptation to the increase to insulin resistance from early to late pregnancy was defective in GDM2. CONCLUSIONS: In early pregnancy insulin sensitivity, as assessed from the OGTT but not from fasting measurements, is impaired in women who developed GDM. beta-Cell function impairment is evident only when GDM is manifest and is characterized by inappropriate adaptation to the pregnancy induced increase in insulin resistance.

Physical disability among older Italians with diabetes. The ILSA study.

AIMS/HYPOTHESIS: We studied the role of diabetic complications and comorbidity in the association between diabetes and disability in the elderly. METHODS: Data were from a nationally representative sample of 5632 older Italians, aged 65 years and older, and who participated in the Italian Longitudinal Study on Aging. Clinical diagnoses of diabetes and other major chronic conditions were made by a physician, while disability was assessed by self-reported information on activities of daily living and physical performance tests. RESULTS: After adjusting for age, education and BMI, disability on the basis of activities of daily living was associated with diabetes in women, but not in men (odds ratio [OR] 1.65, CI: 1.22-2.23 and OR 1.21, CI: 0.84-1.75 respectively). In contrast, the association between severe and/or total disability on the basis of physical performance tests and diabetes was strong in both sexes (OR 2.81, CI: 1.44-5.41 and OR 2.16, CI: 1.25-3.73 respectively). Adjusting for traditional complications and comorbidity reduced the excess odds of disability by 38% in women and by 16% in men. CONCLUSIONS/INTERPRETATION: Disability in older Italians with diabetes is frequent and only partially attributable to traditional diabetic complications and comorbidity.

Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging.

Dementia is known to be associated with excess mortality. Physical disability, as a marker of dementia severity, is often considered the last step on the way from disease to death. The objective of this study was to investigate the direct effect of dementia on mortality in a population-based study, carried out in Italy, with a sample of 5,632 individuals aged 65-84 years. At 4-year follow-up, 998 participants had died. The independent predictors of death were: age (75-84 years; HR 2.63, CI = 2.11-3.27), male sex (HR 1.45, CI = 1.22-1.74), coronary heart disease (HR 1.61, CI = 1.34-1.94), moderate and severe instrumental activities of daily living disability (HR 1.98, CI = 1.30-3.03 and HR 3.26, CI = 2.09-5.09, respectively), diabetes in subjects with a survival time greater than 23 months (HR 0.68, CI = 0.43-1.08) and dementia (HR 2.07, CI = 1.62-2.66). These data provide evidence that dementia per se, independently from physical disability, is a strong predictor of death in the elderly.