Gestational diabetes mellitus: An overview.

The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance occurring for the first time during pregnancy. The prevalence of GDM varies in direct proportion to the prevalence of Type 2 diabetes for a given ethnic group or population. It is crucial to detect women with GDM as the condition is associated with diverse range of adverse maternal and neonatal outcomes. In addition, having a history of GDM puts the mother at risk for the development of Type 2 diabetes mellitus or recurrent GDM. Various screening guidelines have been introduced depending upon the suitability of test to the population characteristics, cost and screening accuracy. Still there are lots of controversies to which test to be used, when should the screening be done and who should be screened. However, recognizing GDM is becomimg a major health challenge for clinicians, and treating it results in lowering of both maternal and fetal complications. Also, clinicians must followup women with GDM postpartum so that the prevalence of Type 2 diabetes may start declining.

Delayed Response of Amylin Levels after an Oral Glucose Challenge in Children with Prader-Willi Syndrome

PURPOSE: Amylin secretion is increased parallel to insulin in obese subjects. Despite their marked obesity, a state of relative hypoinsulinemia occurs in children with Prader-Willi syndrome (PWS). Based on the hypothesis that amylin levels may be relatively low in PWS children, contributing to their excessive appetite, we studied amylin levels after oral glucose loading in children with PWS and overweight controls. MATERIALS AND METHODS: Plasma levels of amylin, glucagon, insulin, and glucose were measured at 0, 30, 60, 90, and 120 min after a glucose challenge in children with PWS (n = 18) and overweight controls (n = 25); the relationships among the variables were investigated in these two groups. RESULTS: Amylin levels were significantly correlated with insulin during fasting and during the oral glucose tolerance test in both groups. Amylin levels between 0 and 60 min after glucose loading were statistically different between the two groups. They were lower in children with PWS than in the controls between 0 and 30 min after glucose loading. CONCLUSION: The relatively low levels of amylin, compared to those in overweight controls, during the early phase of glucose loading in patients with PWS, may contribute, in part, to the excessive appetite of PWS patients as compared to the overweight controls.

Clinical efficiency of 50 g oral glucose challenge test, 75 g and 100 g oral glucose tolerance test for screening and diagnosis of gestational diabetes / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to compare the clinical efficiency of 75 g oral glucose tolerance test (OGTT) with those of 100 g OGTT for diagnosing gestational diabetes mellitus (GDM) after abnormal 50 g oral glucose challenge test (OGCT). METHODS: Data of 616 pregnant women delivered at Ewha Womans University Dongdaemoon hospital from January, 2003 to June, 2007 was reviewed and analyzed retrospectively. The positive diagnostic rate of GDM for the group resulted in the range of 130 and 140 mg/dl and in 140 mg/dl and higher on the 50 g OGCT group was analyzed. Pregnancy and fetal outcomes were compared for the women who showed positive results in the 75 g and 100 g OGTT. RESULTS: Of the 28 pregnant women whose results were in the range of 130 and 140 mg/dL on the 50 g OGCT, three women (10.7%) were diagnosed as GDM. Among women who showed the results of 140 mg/dL and higher, positive rate of GDM by 75 g OGTT (51.6%) was significantly higher than those by 100 g OGTT (31.6%) (p=0.047). The positive result group of 75 g and 100 g OGTT did not show significant differences in pregnancy and fetal outcomes except that BMI of 100 g OGTT positive group was more increased at early pregnancy (25.2+/-3.53 kg/m2 vs 22.9+/-3.26 kg/m2, p=0.043). CONCLUSION: 75 g OGTT may be a more convenient and useful tool in the diagnosis of GDM to protect for adverse outcomes in untreated gravidas with minimal hyperglycemia.