Glycemic variability in diagnosis of gestational diabetes as predictor of pharmacological treatment.

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 (p < 0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (p = 0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81 mg/dL for mean glycemia, and 86.70 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.

Continuous Glucose Monitoring and Glycemic Patterns in Pregnant Women with Gestational Diabetes Mellitus.

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.

Déficit de hormona de crecimiento por depósitos de hierro hipofisarios en paciente con carencia de piruvato cinasa / Growth hormone deficiency secondary to pituitary iron deposition in a pyruvate kinase deficient patient

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Afección hepática en adolescente con diabetes mellitus tipo 1 y mal control metabólico / Hepatic involvement in a teenager with type1 diabetes and poor metabolic control

Las alteraciones hepáticas en la diabetes pueden ser muy diversas; la más frecuente es la enfermedad de hígado graso no alcohólico. La glucogenosis hepática adquirida es un cuadro caracterizado por acumulación de glucógeno intrahepatocitaria en la diabetes mellitus tipo 1 mal controlada y en tratamiento con altas dosis de insulina. Se presenta el caso de un adolescente diabético con una elevación progresiva de fermentos hepáticos junto con mal control metabólico. Tras descartar otras causas de hepatopatía, se llegó al diagnóstico clínico de glucogenosis hepática secundaria por la recuperación de los parámetros tras la mejoría del control glucémico sin necesidad de realizar biopsia hepática. La glucogenosis hepática secundaria es un proceso quizá más frecuente de lo publicado, reversible y con buena evolución en función del control metabólico. El diagnóstico puede ser clínico y la biopsia hepática debería reservarse a los pacientes sin mejoría tras alcanzar un mejor control glucémico (AU)

There are several manifestations of hepatic involvement 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 (AU)

Hepatic involvement in a teenager with type 1 diabetes and poor metabolic control.

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.