The utility of diagnostic tests in the detection and prediction of glucose intolerance in the early and late postpartum period in women after gestational diabetes: a longitudinal cohort study.

BACKGROUND: Due to diverging international recommendations, the unclear role of HbA1c and the lack of longitudinal data, we investigated the accuracy of diagnostic tests in the early and late postpartum in women with gestational diabetes (GDM) especially to predict future glucose-intolerance. METHODS: This longitudinal cohort included 967 women with GDM from 2011 to 2020. A 75-g oGTT and HbA1c were performed at 4-12 weeks (early) postpartum. FPG and HbA1c were measured at 1 and 3-year (late) postpartum. ADA criteria were used as gold standards. At all time-points (4-12 weeks, 1-year and 3-year postpartum) women with diabetes and prediabetes were grouped together and referred to as glucose-intolerant, because at most 3% of the entire cohort population had diabetes at any time-point. RESULTS: The prevalence of glucose-intolerance in the early postpartum was higher using FPG and HbA1c (27.5%) than oGTT criteria (18.2%). Only 48-80% of women diagnosed with glucose-intolerance in the early postpartum actually remained intolerant. This was especially low when FPG or oGTT were combined with HbA1c (1-year: ≤ 62% and 3-years: ≤ 50%). Regardless of the test used, 1/3 of women with initially normal glucose-tolerance became glucose-intolerant in the late postpartum. HbA1c was unrelated to iron status/intake, remained stable throughout, but poorly predicted future glucose-intolerance. In the longitudinal analyses, all diagnostic tests in the early postpartum showed acceptable specificities (74-96%) but poor sensitivities (all < 38%) to predict glucose-intolerance after only 10-months. At 1-year postpartum however, the combination of FPG and HbA1c could best predict glucose-intolerance 2-years later. CONCLUSIONS: Combining FPG with HbA1c at 1-year postpartum represents a reliable choice to predict future glucose-intolerance. Given the poor prediction of tests including oGTT in the early postpartum, focus should rather be on continuous long-term screening.

[Insulin pump treatment: For whom and how to set it up on an outpatient?] / Traitement par pompe à insuline : pour qui et comment le mettre en place en ambulatoire ?

Pump therapy has existed for over 40 years and provides a more flexible delivery of insulin. To date, almost 25% of type 1 diabetic patients have chosen this therapeutic option. In recent years, it has also been offered to patients with type 2 insulin-requiring diabetes. The choice of insulin pump is based on its indication, the patient's preference, lifestyle and knowledge of the disease. A risk of developing ketoacidosis in case of interruption of insulin delivery exists. Its implementation therefore requires a specialized interdisciplinary care team available in case of emergency.

L'insulinothérapie par pompe existe depuis plus de 40 ans et permet une délivrance plus flexible de l'insuline. À ce jour, près de 25% des patients diabétiques de type 1 ont choisi cette option thérapeutique. Depuis quelques années, elle est aussi proposée aux patients diabétiques de type 2 insulino-requérants. Le choix de la pompe à insuline repose sur son indication, la préférence du patient, son style de vie et ses connaissances de la maladie. Un risque de survenue d'acidocétose en cas d'interruption de la délivrance d'insuline existe. Sa mise en place nécessite donc une équipe de soins interdisciplinaire spécialisée et disponible en cas d'urgence.

[Management of obesity-associated dyslipidemia : an approach based on food choices]. / Prise en charge de la dyslipidémie liée à l'obésité : une approche centrée sur l'alimentation.

Obesity is associated with elevated levels of triglycerides, sometimes LDL-cholesterol, and lower levels of HDL-cholesterol. Management should first focus on dietary advices and increased physical activity, while lipid-lowering drugs are indicated only in patients at intermediate or high cardiovascular risk. We summarize nutritional recommendations from scientific societies: although they do not always overlap, they agree on lowering consumption of dietary fat (20-35 % of total energy intake) and favoring non-saturated fatty acids. Physicians must review the intake of carbohydrates as well, by limiting added sugars and increasing dietary fibers (vegetables, wholegrain cereals, legumes and nuts). Multidisciplinary management shared between physicians and trained dieticians improves long-term healthy lifestyle.

L'obésité est associée à une élévation des triglycérides, parfois du LDL-cholestérol, et une diminution du HDL-cholestérol. La prise en charge se concentre d'abord sur les conseils nutritionnels et l'activité physique, alors qu'un traitement hypolipémiant n'est indiqué que pour un risque cardiovasculaire intermédiaire ou élevé. Nous résumons ici les recommandations des sociétés savantes, qui ne sont pas toujours congruentes, mais s'accordent sur une consommation modérée de graisses (20­35 % de l'apport énergétique) privilégiant les acides gras insaturés. Il faut aussi s'intéresser à l'apport en glucides, limiter les sucres ajoutés et augmenter les fibres (légumes, céréales complètes, légumineuses et oléagineux). Une prise en charge multidisciplinaire avec une diététicienne diplômée améliore le maintien de bonnes habitudes de vie à long terme.