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PO062 VITAMIN D DEFICIENCY IS ASSOCIATED WITH HIGHER RISK OF POSTPARTUM GLUCOSE INTOLERANCE IN WOMEN WITH GESTATIONAL DIABETES MELLITUS
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Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
Result: The prevalence of gestational diabetes mellitus (GDM) of Bangladeshi women is 12.11%. Most of the GDM positive cases have been observed in first pregnancy. Mean blood pressure did not alter in pregnant women with or without gestational diabetes mellitus (GDM) in Bangladesh. Lipid profiles and metabolic syndrome are significantly different in pregnant women with or without gestational diabetes mellitus (GDM) case. gestational diabetes mellitus (GDM) positive cases have 11.62% positive family history of diabetes. More than 90% rural pregnant women in Bangladesh do not know about gestational diabetes mellitus (GDM). Still in Bangladesh, in rural context, around half of the pregnant women do not receive antenatal care. Still the acceptance of institutional delivery rate is very low in rural Bangladesh. Conclusion: From the present study, we found a high prevalence of gestational diabetes mellitus (GDM) in Bangladeshi rural women. The present study is the first report describing the prevalence of GDM among Bangladeshi rural women and calls for urgent action to stop and prevent the diabetes development in pregnancy and the associated complications both for mother and child. Funding: Health and Disease Research Center for Rural Peoples (HDRCRP), Dhaka, Bangladesh; World Diabetes Foundation, Denmark; Monbusho Overseas Kiban B. Reference(s) Health and Disease Research Center for Rural Peoples (HDRCRP), Dhaka, Bangladesh.
PO061 CHARACTERISTICS OF DAILY INSULIN REQUIREMENT AMONG KOREAN WOMEN WITH GESTATIONAL DIABETES S.W. Chun1 , A.J. Ryu1 , Y.J. Kim1 , S.J. Kim1 . 1 Internal medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea, Republic of Background: The goals and tactics for glycemic control for women with gestational diabetes are different from that for non-pregnant type 2 diabetic adult patients. After total daily insulin requirement was settled, premeal insulin dose was adjusted usually based on carbohydrate amount of each meal. Carbohydrate counting method (CCM) was widely accepted for intensive insulin therapy, but study showing CCM for gestational diabetes was rarely found. This retrospective investigation was conducted in an attempt to identify predictors for achieving euglycemia among high carbohydrate diet population. Method: We investigated the correlations between total and premeal insulin doses and several glycemic predictors including carbohydrate amount in the hospitalized gestational diabetic patients who had achieved adequate glycemic goal (premeal 95 mg/dL, postmeal 2hour 120 mg/dL). Glycemic predictors were screened using univariate statistical methods followed by multivariate screening, in which variables identified as univariately predictive of premeal insulin were entered into stepwise, linear analyses. Correlation (r2 ) between premeal insulin doses and each glycemic predictors were also calculated. Result: Among 723 seven-point blood glucose profiles of 35 patients, euglycemic 113 profiles were analyzed. To maintain adequate glycemia during pregnancy, premeal insulin was needed 59% of total daily insulin dose on average. The carbohydrate amount was not correlated with premeal insulin doses (r2 = −0.007, p = 0.364). The gestational age (r2 = 0.089, p < 0.01) and BMI (r2 = 0.634, p < 0.01) were well correlated with the insulin doses in GDM patients. Conclusion: Even though more premeal insulin would be required for the population with high carbohydrate diet, the premeal insulin doses were decided mainly by gestational age and BMI.
This observation suggested that insulin dose adjustment based on sole CCM might be inappropriate for gestational diabetic patients with high carbohydrate diet. Reference(s) [1] Diabetes Care, 2013 Aug: 36 2233–38. [2] Diabetes Care, 2014 Jan: 37 Supplement 1: S14–80. [3] Diabetes Care, 2007 Jul: 30 Supplement 2: S188–193. [4] J Am Diet Assoc. 1998 Aug; 98(8): 897–905. [5] Nutr Hosp. 2013 Nov 1; 28(6): 1806–14. [6] J Matern Fetal Neonatal Med. 2014 Jun 5: 1–5.
PO062 VITAMIN D DEFICIENCY IS ASSOCIATED WITH HIGHER RISK OF POSTPARTUM GLUCOSE INTOLERANCE IN WOMEN WITH GESTATIONAL DIABETES MELLITUS S.-K. Kim1 , K.-S. Kim1 , S.W. Park1 , Y.-W. Cho1 . 1 Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea, Republic of Background: Pregnant women who develop gestational diabetes mellitus are more likely to be vitamin D deficient compared to those who not gestational diabetes. However, there are few studies whether the vitamin D deficiency affect the status of glucose intolerance after delivery in women with gestational diabetes. Our aim was to determine the association between serum concentration of 25-hydroxyvitamin D (25(OH)D) and postpartum status of glucose tolerance in women with gestational diabetes. Method: This was an observational study performed in 114 Korean women with gestational diabetes between August 2012 and October 2013. Serum 25(OH)D levels were measured at 24 to 32 gestational weeks and a 75-g oral glucose tolerance test was performed at 8–12 weeks after delivery. Vitamin D deficiency was defined conservatively as < 25 nmol/L 25(OH)D, insufficiency as 25–50 nmol/L 25(OH)D. Postpartum glucose intolerance was defined as fasting plasma glucose 100 mg/dL or 2-h glucose 140 mg/dL. Result: Mean age was 32.7±3.5 years and mean prepregnancy body mass index was 22.4±3.5 kg/m2 . Mean serum 25(OH)D level was 32.3±15.5 nmol/L. The prevalence of vitamin D deficiency and insufficiency was 40.4% and 46.5%, respectively. After delivery, 50.9% in the whole subjects had an abnormal glucose tolerance. Serum 25(OH)D level was negatively correlated with postpartum fasting plasma glucose (r =-0.359; P = 0.005), glycated hemoglobin (r =-0.387; P = 0.002) and insulin resistance as calculated by homeostatic model assessment (r =-0.286; P = 0.028) after adjustment for maternal age, family history of diabetes, pre-pregnancy body mass index, treatment of gestational diabetes, and season. Women with vitamin D deficiency during pregnancy had had higher prevalence of postpartum glucose intolerance compared with those without vitamin D deficiency (63.0% vs. 42.6%, P = 0.033). After adjustment for the aforementioned covariates, women with vitamin D deficiency were 2.66 times (95% CI, 1.16–6.06) more likely to have postpartum glucose intolerance than those without vitamin D deficiency. Conclusion: In Korean women with gestational diabetes, vitamin D deficiency during pregnancy and postpartum glucose intolerance are very common. Vitamin D deficiency seems to be an independent factor for abnormal postpartum glucose tolerance in women with gestational diabetes. However, the cross-sectional nature of the study and small number of participants limits conclusions. Further longitudinal study is warranted. Reference(s) [1] Zuhur SS, Erol RS, Kuzu I, Altuntas Y. The relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus according to the severity of 25hydroxyvitamin D deficiency. Clinics (Sao Paulo) 2013; 68: 658–64.
Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
[2] Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S. Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med 2012; 23: 465–9.
PO063 ASSOCIATIONS OF OUTDOOR SULFUR DIOXIDE EXPOSURE AND GLUCOSE HOMEOSTASIS DURING PREGNANCY IN NON-DIABETIC WOMEN M.-C. Lu1 , P. Wang2 , Y.-H. Yan3 . 1 Medical Research, 2 Obstetrics and Gynecology, 3 Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan Background: Previous studies have demonstrated showed that outdoor sulfur dioxide (SO2 ) exposure and hyperglycemia during pregnancy were associated with adverse pregnancy outcomes, respectively. However, the relationship between SO2 exposure and glucose homeostasis during pregnancy was unknown. The objective of this study was to investigate the long-term effects of outdoor SO2 on glucose levels of 50-g glucose challenge test (GCT), 100-g oral glucose tolerance tests (OGTT) and glycated hemoglobin (HbA1c) at mid-pregnancy. Method: Based on 2-step approach for screening and diagnosing gestational diabetes mellitus (GDM). The OGTT at median 29.4 weeks gestation was performed in those women with positive GCT results. A total of 13205 non-diabetic pregnant women (aged 29.6±4.6) were enrolled from a tertiary teaching hospital in Chiayi, Taiwan between March 2006 and October 2013. Outdoor SO2 concentrations were obtained from nearby fixed-site monitoring stations. We used mixed model analyses adjusted for individual-specific effects (nulliparous status, age, and screening year) and corresponding study period of moving average of humidity and temperature to estimate relationships within 1-month to 12-month SO2 exposure and glucose levels of GCT, OGTT and HbA1c.
Result: A total of 3310 (25.1%) of pregnant women showed positive GCT results, 2848 (21.6%) completed 100-g OGTTs, and 1784 (13.5%) had HbA1c data. Average interquartile range (IQR ) concentrations for 1-month to 12-month SO2 during study period ranged from 1.6 to 0.3 p.p.b. The 5 to 8-month moving average of IQR increase in SO2 was associated with decreased of 1.36–2.35 mg/dL (95% CI −3.89 to −0.21, p < 0.05) in glucose level of GCT. The 2 to 11-month moving average of IQR increase in SO2 was associated with elevated of 0.52– 2.68 mg/dL (95% CI 0.03 to 3.88, p < 0.05) in fasting glucose level of OGTT. The 5 to 12-month moving average of IQR increase in SO2 was associated with elevated of 0.06–0.12 % (95% CI 0.03 to 0.19, p < 0.05) in HbA1c level. Conclusion: Long-term outdoor SO2 exposure was associated with glucose homeostasis in non-diabetic pregnant women. Further mechanistic studies are needed. PO064 METABOLIC PROFILE OF WOMEN WITH DIABETES TYPE 2 WITH AND WITHOUT A HISTORY OF GESTATIONAL DIABETES MELLITUS – HONG KONG JOINT ASIA DIABETES EVALUATION (JADE) E.G. Tutino1 , Y.Y. Zhang2 , A. Luk1 , H. Chung1 , R. Ozaki1 , A. Kong1 , W.Y. So1 , J.C.N. Chan1 , R. Ma1 . 1 Medicine & Therapeutics, 2 Asia Diabetes Foundation, The Chinese University of Hong Kong, Shatin, Hong Kong Background: Gestational diabetes mellitus (GDM) refers to hyperglycemia diagnosed for the first time during pregnancy. Recent epidemiologic studies indicated a marked increase
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in the prevalence of GDM, though the reported prevalence differs according to the population studied and diagnostic criteria applied. Women with a history of GDM are at increased risk for subsequent conversion to overt type 2 diabetes. We hypothesized that women with type 2 diabetes and prior GDM have different metabolic risk factor profile compared to diabetic women without a history of GDM. Method: A nested case–control cohort was identified from the Joint Asia Diabetes Evaluation (JADE) Program database. JADE is a web-based disease management program incorporating protocols for comprehensive diabetes assessment capturing key clinical characteristics including metabolic indices, diabetes complications, lifestyle and treatment. Between July 2007 and December 2012, 19,207 patients from Hong Kong were enrolled. Women with self-reported history of GDM were matched in 1:3 ratio for age of disease onset (±4 years) and duration of diabetes (±1 year) to women without GDM. Result: 124 women with history of GDM (mean±standard deviation [SD] age: 48.7±7.6years, disease duration: 8.2±7.3years) and 372 women without GDM (mean±SD age: 48.8±8.1years, disease duration: 8.2±7.3years) were compared. Both fasting plasma glucose and HbA1c were higher in the GDM group compared to the non-GDM group (8.6±2.9 mmol/L vs 7.9±2.6 mmol/L, p = 0.014 and 8.0±1.8% vs 7.6±1.5%, p = 0.017, respectively). Less of the women with GDM had hypertension (66.1% vs 75.8%, p = 0.028) and dyslipidemia (75.8% vs 88.7%, p = 0.001). Anthropometric parameters including body mass index and waist circumference were similar between the two groups. No difference was observed in the rates of micro- and macro-vascular complications except retinopathy, which was less frequent in the GDM group. Usages of insulin and noninsulin anti-diabetic drugs were not different. Conclusion: For the same age and disease duration, diabetic women with history of GDM had worse glycemic control than women without prior GDM. Our results suggest that women with preceding GDM may have differences in underlying pathophysiology and may respond differently to anti-hyperglycemic treatment. Prospective follow-up is required to evaluate the risks of long-term complications in this special patient group. Reference(s) Tutino GE, Tam WH, Yang X, Chan JC, Lao TT, Ma RC. Diabetes and pregnancy: perspectives from Asia. Diabet Med. 2014 Mar;31(3): 302–18. doi: 10.1111/dme.12396
PO065 INFLUENCE OF THE TIME OF DAY AND THE FASTING DURATION ON GLUCOSE LEVEL FOLLOWING A 1-HOUR, 50-GRAM GLUCOSE CHALLENGE TEST IN TAIWANESE PREGNANT WOMEN P. Wang1 , M.-C. Lu2 , C.-W. Yu3 , Y.-H. Yan2,4 . 1 Obstetrics and Gynecology, 2 Medical Research, 3 Nutrition, 4 Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan Background: Previous studies have shown that the time of day (TD) of glucose measurement and the fasting duration (FD) influence the glucose levels in adults [1–4]. Few studies have examined the effects of the TD and FD on the glucose level following a 1-hour, 50-gram glucose challenge test (GCT) in pregnant women in screening for or diagnosing gestational diabetes mellitus (GDM) [5]. The objective of this study was to investigate the influence of the TD (morning, afternoon, night) and the FD (the time of the last food ingestion as follows: 1 hour, 1–2 hours, and > 2 hours) by examining their combined effects on the glucose levels following a 50-gram GCT in pregnant women. Method: We analyzed the data of 1,454 non-diabetic pregnant Taiwanese women in a prospective study. Multiple linear regression and multiple logistic regression were used to estimate the relationships of the TD-FD group (n = 9) and the
Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
Result: The prevalence of gestational diabetes mellitus (GDM) of Bangladeshi women is 12.11%. Most of the GDM positive cases have been observed in first pregnancy. Mean blood pressure did not alter in pregnant women with or without gestational diabetes mellitus (GDM) in Bangladesh. Lipid profiles and metabolic syndrome are significantly different in pregnant women with or without gestational diabetes mellitus (GDM) case. gestational diabetes mellitus (GDM) positive cases have 11.62% positive family history of diabetes. More than 90% rural pregnant women in Bangladesh do not know about gestational diabetes mellitus (GDM). Still in Bangladesh, in rural context, around half of the pregnant women do not receive antenatal care. Still the acceptance of institutional delivery rate is very low in rural Bangladesh. Conclusion: From the present study, we found a high prevalence of gestational diabetes mellitus (GDM) in Bangladeshi rural women. The present study is the first report describing the prevalence of GDM among Bangladeshi rural women and calls for urgent action to stop and prevent the diabetes development in pregnancy and the associated complications both for mother and child. Funding: Health and Disease Research Center for Rural Peoples (HDRCRP), Dhaka, Bangladesh; World Diabetes Foundation, Denmark; Monbusho Overseas Kiban B. Reference(s) Health and Disease Research Center for Rural Peoples (HDRCRP), Dhaka, Bangladesh.
PO061 CHARACTERISTICS OF DAILY INSULIN REQUIREMENT AMONG KOREAN WOMEN WITH GESTATIONAL DIABETES S.W. Chun1 , A.J. Ryu1 , Y.J. Kim1 , S.J. Kim1 . 1 Internal medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea, Republic of Background: The goals and tactics for glycemic control for women with gestational diabetes are different from that for non-pregnant type 2 diabetic adult patients. After total daily insulin requirement was settled, premeal insulin dose was adjusted usually based on carbohydrate amount of each meal. Carbohydrate counting method (CCM) was widely accepted for intensive insulin therapy, but study showing CCM for gestational diabetes was rarely found. This retrospective investigation was conducted in an attempt to identify predictors for achieving euglycemia among high carbohydrate diet population. Method: We investigated the correlations between total and premeal insulin doses and several glycemic predictors including carbohydrate amount in the hospitalized gestational diabetic patients who had achieved adequate glycemic goal (premeal 95 mg/dL, postmeal 2hour 120 mg/dL). Glycemic predictors were screened using univariate statistical methods followed by multivariate screening, in which variables identified as univariately predictive of premeal insulin were entered into stepwise, linear analyses. Correlation (r2 ) between premeal insulin doses and each glycemic predictors were also calculated. Result: Among 723 seven-point blood glucose profiles of 35 patients, euglycemic 113 profiles were analyzed. To maintain adequate glycemia during pregnancy, premeal insulin was needed 59% of total daily insulin dose on average. The carbohydrate amount was not correlated with premeal insulin doses (r2 = −0.007, p = 0.364). The gestational age (r2 = 0.089, p < 0.01) and BMI (r2 = 0.634, p < 0.01) were well correlated with the insulin doses in GDM patients. Conclusion: Even though more premeal insulin would be required for the population with high carbohydrate diet, the premeal insulin doses were decided mainly by gestational age and BMI.
This observation suggested that insulin dose adjustment based on sole CCM might be inappropriate for gestational diabetic patients with high carbohydrate diet. Reference(s) [1] Diabetes Care, 2013 Aug: 36 2233–38. [2] Diabetes Care, 2014 Jan: 37 Supplement 1: S14–80. [3] Diabetes Care, 2007 Jul: 30 Supplement 2: S188–193. [4] J Am Diet Assoc. 1998 Aug; 98(8): 897–905. [5] Nutr Hosp. 2013 Nov 1; 28(6): 1806–14. [6] J Matern Fetal Neonatal Med. 2014 Jun 5: 1–5.
PO062 VITAMIN D DEFICIENCY IS ASSOCIATED WITH HIGHER RISK OF POSTPARTUM GLUCOSE INTOLERANCE IN WOMEN WITH GESTATIONAL DIABETES MELLITUS S.-K. Kim1 , K.-S. Kim1 , S.W. Park1 , Y.-W. Cho1 . 1 Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea, Republic of Background: Pregnant women who develop gestational diabetes mellitus are more likely to be vitamin D deficient compared to those who not gestational diabetes. However, there are few studies whether the vitamin D deficiency affect the status of glucose intolerance after delivery in women with gestational diabetes. Our aim was to determine the association between serum concentration of 25-hydroxyvitamin D (25(OH)D) and postpartum status of glucose tolerance in women with gestational diabetes. Method: This was an observational study performed in 114 Korean women with gestational diabetes between August 2012 and October 2013. Serum 25(OH)D levels were measured at 24 to 32 gestational weeks and a 75-g oral glucose tolerance test was performed at 8–12 weeks after delivery. Vitamin D deficiency was defined conservatively as < 25 nmol/L 25(OH)D, insufficiency as 25–50 nmol/L 25(OH)D. Postpartum glucose intolerance was defined as fasting plasma glucose 100 mg/dL or 2-h glucose 140 mg/dL. Result: Mean age was 32.7±3.5 years and mean prepregnancy body mass index was 22.4±3.5 kg/m2 . Mean serum 25(OH)D level was 32.3±15.5 nmol/L. The prevalence of vitamin D deficiency and insufficiency was 40.4% and 46.5%, respectively. After delivery, 50.9% in the whole subjects had an abnormal glucose tolerance. Serum 25(OH)D level was negatively correlated with postpartum fasting plasma glucose (r =-0.359; P = 0.005), glycated hemoglobin (r =-0.387; P = 0.002) and insulin resistance as calculated by homeostatic model assessment (r =-0.286; P = 0.028) after adjustment for maternal age, family history of diabetes, pre-pregnancy body mass index, treatment of gestational diabetes, and season. Women with vitamin D deficiency during pregnancy had had higher prevalence of postpartum glucose intolerance compared with those without vitamin D deficiency (63.0% vs. 42.6%, P = 0.033). After adjustment for the aforementioned covariates, women with vitamin D deficiency were 2.66 times (95% CI, 1.16–6.06) more likely to have postpartum glucose intolerance than those without vitamin D deficiency. Conclusion: In Korean women with gestational diabetes, vitamin D deficiency during pregnancy and postpartum glucose intolerance are very common. Vitamin D deficiency seems to be an independent factor for abnormal postpartum glucose tolerance in women with gestational diabetes. However, the cross-sectional nature of the study and small number of participants limits conclusions. Further longitudinal study is warranted. Reference(s) [1] Zuhur SS, Erol RS, Kuzu I, Altuntas Y. The relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus according to the severity of 25hydroxyvitamin D deficiency. Clinics (Sao Paulo) 2013; 68: 658–64.
Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
[2] Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S. Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med 2012; 23: 465–9.
PO063 ASSOCIATIONS OF OUTDOOR SULFUR DIOXIDE EXPOSURE AND GLUCOSE HOMEOSTASIS DURING PREGNANCY IN NON-DIABETIC WOMEN M.-C. Lu1 , P. Wang2 , Y.-H. Yan3 . 1 Medical Research, 2 Obstetrics and Gynecology, 3 Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan Background: Previous studies have demonstrated showed that outdoor sulfur dioxide (SO2 ) exposure and hyperglycemia during pregnancy were associated with adverse pregnancy outcomes, respectively. However, the relationship between SO2 exposure and glucose homeostasis during pregnancy was unknown. The objective of this study was to investigate the long-term effects of outdoor SO2 on glucose levels of 50-g glucose challenge test (GCT), 100-g oral glucose tolerance tests (OGTT) and glycated hemoglobin (HbA1c) at mid-pregnancy. Method: Based on 2-step approach for screening and diagnosing gestational diabetes mellitus (GDM). The OGTT at median 29.4 weeks gestation was performed in those women with positive GCT results. A total of 13205 non-diabetic pregnant women (aged 29.6±4.6) were enrolled from a tertiary teaching hospital in Chiayi, Taiwan between March 2006 and October 2013. Outdoor SO2 concentrations were obtained from nearby fixed-site monitoring stations. We used mixed model analyses adjusted for individual-specific effects (nulliparous status, age, and screening year) and corresponding study period of moving average of humidity and temperature to estimate relationships within 1-month to 12-month SO2 exposure and glucose levels of GCT, OGTT and HbA1c.
Result: A total of 3310 (25.1%) of pregnant women showed positive GCT results, 2848 (21.6%) completed 100-g OGTTs, and 1784 (13.5%) had HbA1c data. Average interquartile range (IQR ) concentrations for 1-month to 12-month SO2 during study period ranged from 1.6 to 0.3 p.p.b. The 5 to 8-month moving average of IQR increase in SO2 was associated with decreased of 1.36–2.35 mg/dL (95% CI −3.89 to −0.21, p < 0.05) in glucose level of GCT. The 2 to 11-month moving average of IQR increase in SO2 was associated with elevated of 0.52– 2.68 mg/dL (95% CI 0.03 to 3.88, p < 0.05) in fasting glucose level of OGTT. The 5 to 12-month moving average of IQR increase in SO2 was associated with elevated of 0.06–0.12 % (95% CI 0.03 to 0.19, p < 0.05) in HbA1c level. Conclusion: Long-term outdoor SO2 exposure was associated with glucose homeostasis in non-diabetic pregnant women. Further mechanistic studies are needed. PO064 METABOLIC PROFILE OF WOMEN WITH DIABETES TYPE 2 WITH AND WITHOUT A HISTORY OF GESTATIONAL DIABETES MELLITUS – HONG KONG JOINT ASIA DIABETES EVALUATION (JADE) E.G. Tutino1 , Y.Y. Zhang2 , A. Luk1 , H. Chung1 , R. Ozaki1 , A. Kong1 , W.Y. So1 , J.C.N. Chan1 , R. Ma1 . 1 Medicine & Therapeutics, 2 Asia Diabetes Foundation, The Chinese University of Hong Kong, Shatin, Hong Kong Background: Gestational diabetes mellitus (GDM) refers to hyperglycemia diagnosed for the first time during pregnancy. Recent epidemiologic studies indicated a marked increase
S77
in the prevalence of GDM, though the reported prevalence differs according to the population studied and diagnostic criteria applied. Women with a history of GDM are at increased risk for subsequent conversion to overt type 2 diabetes. We hypothesized that women with type 2 diabetes and prior GDM have different metabolic risk factor profile compared to diabetic women without a history of GDM. Method: A nested case–control cohort was identified from the Joint Asia Diabetes Evaluation (JADE) Program database. JADE is a web-based disease management program incorporating protocols for comprehensive diabetes assessment capturing key clinical characteristics including metabolic indices, diabetes complications, lifestyle and treatment. Between July 2007 and December 2012, 19,207 patients from Hong Kong were enrolled. Women with self-reported history of GDM were matched in 1:3 ratio for age of disease onset (±4 years) and duration of diabetes (±1 year) to women without GDM. Result: 124 women with history of GDM (mean±standard deviation [SD] age: 48.7±7.6years, disease duration: 8.2±7.3years) and 372 women without GDM (mean±SD age: 48.8±8.1years, disease duration: 8.2±7.3years) were compared. Both fasting plasma glucose and HbA1c were higher in the GDM group compared to the non-GDM group (8.6±2.9 mmol/L vs 7.9±2.6 mmol/L, p = 0.014 and 8.0±1.8% vs 7.6±1.5%, p = 0.017, respectively). Less of the women with GDM had hypertension (66.1% vs 75.8%, p = 0.028) and dyslipidemia (75.8% vs 88.7%, p = 0.001). Anthropometric parameters including body mass index and waist circumference were similar between the two groups. No difference was observed in the rates of micro- and macro-vascular complications except retinopathy, which was less frequent in the GDM group. Usages of insulin and noninsulin anti-diabetic drugs were not different. Conclusion: For the same age and disease duration, diabetic women with history of GDM had worse glycemic control than women without prior GDM. Our results suggest that women with preceding GDM may have differences in underlying pathophysiology and may respond differently to anti-hyperglycemic treatment. Prospective follow-up is required to evaluate the risks of long-term complications in this special patient group. Reference(s) Tutino GE, Tam WH, Yang X, Chan JC, Lao TT, Ma RC. Diabetes and pregnancy: perspectives from Asia. Diabet Med. 2014 Mar;31(3): 302–18. doi: 10.1111/dme.12396
PO065 INFLUENCE OF THE TIME OF DAY AND THE FASTING DURATION ON GLUCOSE LEVEL FOLLOWING A 1-HOUR, 50-GRAM GLUCOSE CHALLENGE TEST IN TAIWANESE PREGNANT WOMEN P. Wang1 , M.-C. Lu2 , C.-W. Yu3 , Y.-H. Yan2,4 . 1 Obstetrics and Gynecology, 2 Medical Research, 3 Nutrition, 4 Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan Background: Previous studies have shown that the time of day (TD) of glucose measurement and the fasting duration (FD) influence the glucose levels in adults [1–4]. Few studies have examined the effects of the TD and FD on the glucose level following a 1-hour, 50-gram glucose challenge test (GCT) in pregnant women in screening for or diagnosing gestational diabetes mellitus (GDM) [5]. The objective of this study was to investigate the influence of the TD (morning, afternoon, night) and the FD (the time of the last food ingestion as follows: 1 hour, 1–2 hours, and > 2 hours) by examining their combined effects on the glucose levels following a 50-gram GCT in pregnant women. Method: We analyzed the data of 1,454 non-diabetic pregnant Taiwanese women in a prospective study. Multiple linear regression and multiple logistic regression were used to estimate the relationships of the TD-FD group (n = 9) and the