Cardiometabolic and Mental Health in Women With Early Gestational Diabetes Mellitus: A Prospective Cohort Study.

CONTEXT: Early diagnosis and treatment of gestational diabetes (GDM) may reduce adverse obstetric and neonatal outcomes, especially in high-risk women. However, there is a lack of data for other outcomes. OBJECTIVE: We compared cardiometabolic and mental health outcomes in women with early (eGDM) and classical (cGDM) GDM. METHODS: This prospective cohort included 1185 All women with cGDM and 76 women with eGDM. The eGDM group had GDM risk factors (BMI >30 kg/m2, family history of diabetes, history of GDM, ethnicity), were tested at <20 weeks gestational age, and diagnosed using American Diabetes Association prediabetes criteria. All women underwent lifestyle adaptations. Obstetric, neonatal, mental, and cardiometabolic outcomes were assessed during pregnancy and postpartum. RESULTS: The eGDM group had lower gestational weight gain than cGDM (10.7 ±â€…6.2 vs 12.6 ±â€…6.4; P = 0.03) but needed more medical treatment (66% vs 42%; P < 0.001). They had similar rates of adverse maternal and neonatal outcomes, except for increased large-for-gestational-age infants (25% vs 15%; P = 0.02). Mental health during pregnancy and postpartum did not differ between groups. eGDM had more atherogenic postpartum lipid profile than cGDM (P ≤ 0.001). In eGDM, the postpartum prevalence of the metabolic syndrome (MetS) was 1.8-fold, prediabetes was 3.1-fold, and diabetes was 7.4-fold higher than cGDM (waist circumference-based MetS: 62% vs 34%/BMI-based MetS: 46% vs 24%; prediabetes: 47.5% vs 15.3%; diabetes: 11.9% vs 1.6%, all P < 0.001). These differences remained unchanged after adjusting for GDM risk factors. CONCLUSION: Compared with cGDM, eGDM was not associated with differences in mental health, but with increased adverse cardiometabolic outcomes, independent of GDM risk factors and gestational weight gain. This hints to a preexisting risk profile in eGDM.

[Post-transplantation diabetes in kidney transplant: from the diabetologist point of view]. / Diabète post-transplantation rénale: le point de vue du diabétologue.

Post-transplantation diabetes (PTDM) exposes to increased morbidity (cardiovascular or infectious complications, early graft dysfunction) and to a risk of premature death. Recognition of risk factors is essential for early and individualized care. The management of a PTDM requires the use of oral antidiabetic treatments (metformin or DPP4 inhibitors) or GLP1 receptor agonists for their favorable effects on weight and kidney that seem ideal in this context. Corticosteroid-induced diabetes or the rare occurrence of diabetic ketoacidosis require insulin therapy. In the long term, the main objective remains to integrate PTDM treatment in a more comprehensive management, targeting the reduction of cardiovascular risk of vulnerable transplant patients.

Le diabète post-transplantation (PTDM) expose le patient à une morbidité accrue (cardiovasculaire, infectieuse ou dysfonction précoce du greffon), ainsi qu'à un risque de décès prématuré. La reconnaissance des facteurs de risque est primordiale pour une prise en charge précoce et individualisée. La prise en charge d'un PTDM d'apparition progressive recourt à l'utilisation d'antidiabétiques oraux (metformine ou inhibiteurs de la dipeptidyl peptidase 4) ou aux agonistes du récepteur du glucagon-like peptide-1 dont l'effet pondéral et néphroprotecteur semble idéal dans ce contexte. Un diabète cortico-induit ou, plus rare, une acidocétose aiguë seront traités par une insulinothérapie précoce. À long terme, l'objectif reste d'intégrer le traitement du PTDM dans une prise en charge plus globale ciblant la réduction du risque cardiovasculaire de ces patients transplantés fragiles.

[The management of hypertriglyceridemia and the risk of pancreatitis]. / Prise en charge des hypertriglycéridémies et du risque de pancréatite.

In the face of hypertriglyceridemia, the potential causes must be assessed to choose the best medical therapeutic option. In cases of secondary hypertriglyceridemia, physicians should use treatments targeting the pathophysiological mechanisms underlying the lipid disorder. Lifestyle interventions are the cornerstone of an effective treatment, to achieve controlled glycemia, blood pressure and weight loss. Only in cases where these measures are insufficient, fibrates can be trialed although their clinical benefit is controversial, with special caution when combined with statins (risk of rhabdomyolysis). Plasmapheresis or intravenous insulin therapy are only used in severe situations after a multidisciplinary decision process in the hospital setting. The clinical case presented here reminds us to assess hypertriglyceridemia in the face of any acute pancreatitis.

Les causes d'une hypertriglycéridémie doivent être explorées pour choisir la meilleure approche thérapeutique. En cas d'hypertriglycéridémie secondaire, il est préférable de cibler le mécanisme physiopathologique du désordre lipidique. Les mesures hygiéno-diététiques restent la clé de voûte du traitement, pour atteindre un bon contrôle glycémique, tensionnel et pondéral. Uniquement en cas d'échec, les fibrates peuvent être évoqués bien que leur bénéfice clinique soit controversé, avec une attention particulière en cas de bithérapie par statine et fibrate (risque de rhabdomyolyse). La plasmaphérèse ou l'insulinothérapie intraveineuse sont réservées aux situations sévères et décidées avec les différents spécialistes en milieu hospitalier. Le cas clinique présenté ici est un rappel que l'hypertriglycéridémie devrait être recherchée devant toute pancréatite aiguë.