RESUMEN
INTRODUCTION: To establish whether glycemic variability (GV) parameters used when gestational diabetes mellitus (GDM) has been diagnosed could help predict the probability that a patient will need pharmacological treatment, and to analyze the link of these parameters to the development of maternal-fetal complications. MATERIALS AND METHODS: A prospective study of 87 women with GDM who underwent retrospective continuous glucose monitoring (CGM) for six days between weeks 26 and 32 of gestation, following diagnosis. The mean glycemia levels and GV variables were analyzed together with their link to maternal-fetal complications, and the need for pharmacological treatment. ROC (receiver operating characteristic) curves were developed to determine validity to detect the need for pharmacological treatment. RESULTS: Patients with higher mean glycemia (pâ¯<â¯0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (pâ¯=â¯0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81â¯mg/dL for mean glycemia, and 86.70â¯mg/dL for CONGAn, with 83.3% sensitivity and 67.8% specificity for both parameters. No relation between the GV parameters and development of maternal-fetal complications was observed. CONCLUSIONS: The use of CGM, once GDM is diagnosed, enables us to identify those patients who would benefit from closer monitoring during gestation, and facilitate a speedier take-up of pharmacological treatment. However, prospective studies involving a higher number of patients are needed, as well as a cost assessment for recommending the use of CGM following GDM diagnosis.
Asunto(s)
Diabetes Gestacional , Hiperglucemia , Embarazo , Humanos , Femenino , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/tratamiento farmacológico , Estudios Prospectivos , Glucemia , Estudios Retrospectivos , Automonitorización de la Glucosa SanguíneaRESUMEN
Background: Continuous glucose monitoring (CGM) could detect certain patterns of hyperglycemia at different times of the day that may help predict the development of maternal-fetal complications and the probability of needing pharmacological treatment. Methods: This study prospectively examined 77 women with gestational diabetes mellitus (GDM) who were placed on a CGM system for 6 days after diagnosis between 26 and 32 weeks of gestation. Patterns of hyperglycemia before meals (period of time of an hour just before meal) (>95 mg/dL), after meals (time interval of 2 h and half just after meal) (>140 mg/dL), and overnight (0-7 am) (>120 mg/dL) and their association with maternal-fetal complications and pharmacological treatment were analyzed. Receiver operating characteristic curves were developed to estimate the validity of the various patterns in detecting the need for pharmacological treatment. Results: A statistically significant relationship was observed between time in hyperglycemia after lunch and macrosomia (P = 0.035) and large for gestational age infants (P = 0.010). Pharmacological treatment was required for patients with time above range (TAR; P = 0.006) and those with hyperglycemia patterns before breakfast (P < 0.001), after breakfast (P = 0.006), before dinner (P = 0.012), and overnight (P = 0.001). Every additional percentage point of TAR was associated with a 24% increase in the probability of pharmacological treatment. Conclusions: The use of CGM for the diagnosis of GDM allows the identification of those patients who would benefit from closer monitoring during pregnancy, including self-monitoring of both pre- and postprandial blood glucose levels, facilitating the initiation of early pharmacological treatment.
Asunto(s)
Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/sangre , Diabetes Gestacional/sangre , Control Glucémico/estadística & datos numéricos , Hiperglucemia/diagnóstico , Adulto , Glucemia/análisis , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Gestacional/tratamiento farmacológico , Femenino , Macrosomía Fetal/etiología , Edad Gestacional , Humanos , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/etiología , Hipoglucemiantes/uso terapéutico , Comidas/fisiología , Periodo Posprandial/fisiología , Embarazo , Estudios Prospectivos , Curva ROCAsunto(s)
Anemia Hemolítica Congénita no Esferocítica/complicaciones , Hemosiderosis/complicaciones , Hormona de Crecimiento Humana/deficiencia , Hormona de Crecimiento Humana/uso terapéutico , Hipoglucemia/etiología , Hipopituitarismo/etiología , Hierro/análisis , Adenohipófisis/química , Piruvato Quinasa/deficiencia , Errores Innatos del Metabolismo del Piruvato/complicaciones , Adulto , Anemia Hemolítica Congénita/etiología , Anemia Hemolítica Congénita/terapia , Femenino , Humanos , Hiperesplenismo/etiología , Hipopituitarismo/diagnóstico , Hipopituitarismo/metabolismo , Hipopituitarismo/patología , Factor I del Crecimiento Similar a la Insulina/deficiencia , Adenohipófisis/fisiopatología , Esplenectomía , Reacción a la Transfusión , Trombosis de la Vena/etiologíaRESUMEN
There are several manifestations of hepaticinvolvement in diabetes but the most frequent is non-alcoholic steatohepatitis. Acquired hepatic glycogenosis is characterized by intrahepatocyte glycogen accumulation in poorly controlled type 1 diabetes under treatment with high doses of insulin. We report the case of a diabetic teenager with progressive elevation of liver enzymes associated with poor metabolic control. After ruling out other causes of hepatic derangement, we made a clinical diagnosis of secondary hepatic glycogenosis without performing liver biopsy, as all parameters improved after better glycemic control was achieved. Secondary hepatic glycogenosis is probably more frequent than previously reported. This process is reversible and has a benign clinical course that depends on good metabolic control. Diagnosis can be made clinically. Liver biopsy should be reserved for patients with no improvement in liver tests after good metabolic control has been achieved.