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1.
Diabetes Res Clin Pract ; 187: 109854, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35341777

RESUMO

AIMS: To examine insulin pump and continuous glucose monitoring (CGM) use with pregnancy-related outcomes in women with type 1 diabetes. METHODS: We abstracted medical records of 646 pregnancies in 478 women with type 1 diabetes, with information on insulin pump versus multiple daily injection (MDI) use and CGM use. We analyzed the associations of pump vs. MDI use, CGM use vs. non-use and pregnancy-related outcomes using mixed effect models. RESULTS: Pump use was associated with lower HbA1c levels in the first [ß (95% CI) = -0.33 (-0.51, -0.15) %] and second trimester [ß (95% CI) = -0.13 (-0.24, -0.02) %], increased birth weight [ß (95% CI) = 0.14 (0.02, 0.26) kg], birth weight percentile [ß (95% CI) = 4.87 (0.49, 9.26) %], higher odds of large for gestational age [OR (95% CI) = 1.65 (1.06, 2.58)] and macrosomia [OR (95% CI) = 1.81 (1.03, 3.18)]. CGM use was associated with lower first [ß (95% CI) = -0.38 (-0.64, -0.13) %] and third trimester [ß (95% CI) = -0.17 (-0.33, -0.00) %] HbA1c levels. CONCLUSIONS: Women with type 1 diabetes who used pump or CGM had better glycemic control during pregnancy; however, pump use was associated with higher birth weight measures.


Assuntos
Diabetes Mellitus Tipo 1 , Peso ao Nascer , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Gravidez
2.
J Perinatol ; 40(8): 1145-1153, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32488037

RESUMO

OBJECTIVE: To examine time trends in US pregnant women with type 1 diabetes mellitus for maternal characteristics and pregnancy outcomes. STUDY DESIGN: We abstracted clinical data from the medical records of 700 pregnant women from 2004 to 2017. For each time period, means and percentages were calculated. P values for trend were calculated using linear and logistic regression. RESULTS: HbA1c in each trimester was unchanged across the analysis period. The prevalence of nephropathy decreased from 4.8% to 0% (P = 0.002). Excessive gestational weight gain increased (P = 0.01). Gestation length also increased (P = 0.01), as did vaginal deliveries (P = 0.03). There were no change in birthweight over time (P = 0.07) and the percentage of neonates with macrosomia and large for gestational age (LGA) neonates also remained unchanged. CONCLUSION: Obstetric guideline changes may have improved gestation length and mode of delivery; however, other outcomes need more attention, including excessive gestational weight gain, macrosomia, and LGA.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Gestacional , Peso ao Nascer , Índice de Massa Corporal , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido , Sobrepeso , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos
3.
Endocr Rev ; 25(5): 807-30, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15466941

RESUMO

Type 2 diabetes is a complex disorder with diminished insulin secretion and insulin action contributing to the hyperglycemia and wide range of metabolic defects that underlie the disease. The contribution of glucose metabolic pathways per se in the pathogenesis of the disease remains unclear. The cellular fate of glucose begins with glucose transport and phosphorylation. Subsequent pathways of glucose utilization include aerobic and anaerobic glycolysis, glycogen formation, and conversion to other intermediates in the hexose phosphate or hexosamine biosynthesis pathways. Abnormalities in each pathway may occur in diabetic subjects; however, it is unclear whether perturbations in these may lead to diabetes or are a consequence of the multiple metabolic abnormalities found in the disease. This review is focused on the cellular fate of glucose and relevance to human type 2 diabetes.


Assuntos
Células/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Glucose/metabolismo , Transporte Biológico , Gluconeogênese , Glicogênio/biossíntese , Glicogênio/metabolismo , Glicólise , Hexosaminas/biossíntese , Hexosefosfatos/metabolismo , Humanos , Proteínas de Transporte de Monossacarídeos , Via de Pentose Fosfato , Pentoses/metabolismo , Fosforilação
4.
Semin Reprod Med ; 20(2): 123-30, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12087497

RESUMO

Leptin, a 16-kilodalton protein secreted by the adipose tissue in proportion to the amount of energy stored in adipose tissue, conveys to the hypothalamus information on energy homeostasis and regulates reproductive function. In addition, there is accumulating evidence that leptin produced by placental or fetal tissues acts through specific leptin receptors to regulate fetal growth and development. Although leptin levels are correlated with insulin and insulin-like growth factor (IGF)-1 levels, observational studies in humans indicate that its effects on fetal growth are independent of these axes and of adiposity. The extent to which leptin per se mediates the fetal growth and developmental abnormalities associated with disease states such as diabetes, hypoxia, or preeclampsia remains to be fully clarified by future studies in humans. It is hoped that clarification of these mechanisms may provide novel therapeutic approaches.


Assuntos
Desenvolvimento Embrionário e Fetal , Leptina/fisiologia , Animais , Desenvolvimento Ósseo , Encéfalo/crescimento & desenvolvimento , Feminino , Feto/metabolismo , Expressão Gênica , Hematopoese , Humanos , Leptina/biossíntese , Neovascularização Fisiológica , Placenta/metabolismo , Gravidez , Complicações na Gravidez , Receptores de Superfície Celular/genética , Receptores para Leptina , Reprodução/fisiologia
5.
Diabetes Technol Ther ; 6(2): 179-89, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15117584

RESUMO

Type 2 diabetes is a rapidly growing disorder that affects millions of Americans. It usually results from a combination of insulin resistance and a beta-cell secretory defect leading to hyperglycemia and microvascular and macrovascular complications, including cardiovascular disease. With the increasing number of options available for the treatment of type 2 diabetes, it can be difficult to determine which medication to prescribe for each patient. Ideally, an agent that effectively lowers glucose concentrations while also minimizing disease progression should be chosen. The thiazolidinediones (TZDs), a relatively newer class of antidiabetic agents, have been shown to be efficacious in lowering glucose concentrations, maintaining glycemic control, and improving other cardiovascular risk factors. These include reduction of visceral adiposity, alteration of lipoprotein concentrations with a favorable distribution of cholesterol subfractions, and decreasing markers of inflammation and endothelial dysfunction. Overall, the TZDs appear to be a promising therapeutic option for consistent control of glucose levels and may slow the progression of type 2 diabetes.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Tiazolidinedionas/uso terapêutico , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/fisiopatologia , Humanos , Resistência à Insulina , Ilhotas Pancreáticas/efeitos dos fármacos , Ilhotas Pancreáticas/metabolismo
6.
Hypertens Pregnancy ; 33(1): 81-92, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24354578

RESUMO

OBJECTIVE: To assess whether glycemic control, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) were associated with the development of preeclampsia (PE) or gestational hypertension (GHTN) in women with preexisting diabetes. METHODS: Maternal circulating angiogenic factors (sFlt1 and PlGF) measured on automated platform were studied at four time points during pregnancy in women with diabetes (N = 159) and reported as multiples of the median (MOM) of sFlt1/PlGF ratio (median, 25th-75th percentile) noted in non-diabetic non-hypertensive control pregnant population (N = 139). Diagnosis of PE or GHTN was determined by review of de-identified clinical data. RESULTS: PE developed in 12% (N = 19) and GHTN developed in 23% (N = 37) of the women with diabetes. Among diabetic women without PE or GHTN, median sFlt1/PlGF levels at 35-40 weeks was threefold higher than in non-diabetic controls [MOM 3.21(1.19-7.24), p = 0.0001]. Diabetic women who subsequently developed PE had even greater alterations in sFlt1/PlGF ratio during the third trimester [MOM for PE at 27-34 weeks 15.18 (2.37-26.86), at 35-40 weeks 8.61(1.20-18.27), p ≤ 0.01 for both windows compared to non-diabetic controls]. Women with diabetes who subsequently developed GHTN also had significant alterations in angiogenic factors during third trimester; however, these findings were less striking. Among women with diabetes, glycosylated hemoglobin (HbA1c) during the first trimester was higher in subjects who subsequently developed PE (7.7 vs 6.7%, p = 0.0001 for diabetic PE vs diabetic non-PE). CONCLUSIONS: Women with diabetes had a markedly altered anti-angiogenic state late in pregnancy that was further exacerbated in subjects who developed PE. Altered angiogenic factors may be one mechanism for the increased risk of PE in this population. Increased HbA1c in the first trimester of pregnancies in women with diabetes was strongly associated with subsequent PE.


Assuntos
Hemoglobinas Glicadas/metabolismo , Pré-Eclâmpsia/etiologia , Proteínas da Gravidez/sangue , Gravidez em Diabéticas/sangue , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Fator de Crescimento Placentário , Gravidez , Fatores de Risco
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