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Improving Diagnosis of Gestational Diabetes Mellitus? 75g-OGTT vs. SMBG
Abstracts / Can J Diabetes 40 (2016) S2–S20
54 Impact of Normal Postpartum Glucose Tolerance on Postpartum Weight Change in Women with Recent Gestational Diabetes Mellitus NABILA PURNO*, TANJA DURBIC, KEVIN THORPE, JULIA LOWE, JOEL RAY, DENICE FEIG, LORRAINE LIPSCOMBE* Toronto, ON Objective: Although women with gestational diabetes mellitus (GDM) are at increased risk for type 2 diabetes, most revert to normal glucose tolerance after delivery. Awareness of normal glucose tolerance may mislead women regarding their risk of diabetes and decrease motivation for lifestyle changes. The objective was to investigate whether women with GDM who reported normal postpartum glucose tolerance had higher weight and body mass index (BMI) in the second year after delivery. Methods: Toronto-area women with GDM were surveyed during pregnancy, at 3 to 12 and 13 to 24 months postpartum. We compared women who self-reported normal postpartum glucose tolerance at 3 to 12 months postpartum to those who reported not performing the test or not knowing the results. The outcomes were weight (kilograms [kg]) and BMI (kilograms/metre2 [kg/m2]) at 13 to 24 months postpartum. We used multivariable linear regression models adjusting for baseline weight and other clinical, behavioural and sociodemographic variables, and for propensity to complete the final survey. Results: Three hundred fifty-six women completed surveys at the 3 time points; 180 (51%) women reported normal glucose tolerance, 148 (42%) were unaware of their results and 28 (8%) with abnormal glucose tolerance were excluded. After adjustment for covariates, women who reported normal glucose tolerance had a mean 2.93 kg higher weight (95% confidence interval [CI] 0.09 to 5.77, p=0.043) and 1.18 kg/m2 higher BMI (95% CI 0.14 to 2.21, p=0.026) at 13 to 24 months postpartum compared to women who were unaware. Conclusion: Our study shows that informing women of normal glucose tolerance results after delivery is associated with significantly higher weight retention by the second year postpartum.
55 Improving Diagnosis of Gestational Diabetes Mellitus? 75gOGTT vs. SMBG AMÉLIE ARDILOUZE, PATRICIA BOUCHARD, CATHERINE ALLARD, JEAN-PATRICE BAILLARGEON, CATHERINE SIMARD, MARIE-FRANCE HIVERT, JULIE MÉNARD, GHISLAINE HOUDE, MARIE-HÉLÈNE PESANT, PATRICE PERRON, ANNIE OUELLET, JEAN-LUC ARDILOUZE Sherbrooke, QC Rationale: Diagnosis of gestational diabetes mellitus (GDM) is routinely performed using an oral glucose tolerance test (75g-OGTT). Positive 75g-OGTT requires immediate therapy and self-monitoring of blood glucose (SMBG), as per CDA-recommended glucose targets (fasting:<5.3 mmol/L; 2-hour postprandial:<6.7 mmol/L). We propose to use SMBG to assess glucose control under usual diet in order to treat only women with documented hyperglycemia, i.e. with glucose values over CDA targets. Objective: To determine if women with positive OGTT (OGTT+) are hyperglycemic in everyday life. Methods: Women with singleton pregnancies and a positive (≥7.2 mmol/L) 50 g screening test at 24 to 28 weeks performed a 75g-OGTT followed by 7 consecutive days of SMBG (4 tests/day: fasting and 2-hour postprandial). Hyperglycemia (SMBG+) was defined as at least 4 glucose values above target at a same given time of day over the 7 days.
S19
Results: We recruited 103 women aged 30±5 years at 27.6±1.0 weeks of pregnancy. Results revealed 4 groups: 1) OGTT+/SMBG+ (12%), 2) OGTT+/SMBG− (13%), 3) OGTT−/SMBG+ (9%), 4) OGTT−/SMBG− (66%). Baseline characteristics, risk factors and maternal outcomes did not differ significantly between groups. Care was identical in groups 1, 2 and 3. Neonatal hypoglycemia rates (75%, 50%, 55.5%, 8.8%, p≤0.009) were lower in group 4. Conclusions: Among women with positive GDM 50 g screening, we found that 22% displayed divergent OGTT and SMBG results: 13% were normoglycemic, but detrimental outcomes in neonates suggest that therapy should not be delayed. A total of 9% were overlooked by OGTT alone, suggesting SMBG as a useful complementary strategy. 56 Islet Engraftment Measured by BETA-2 Score Predicts Islet Transplant Outcomes ANNA LAM, RICHARD A. ORAM, A.M. JAMES SHAPIRO, PETER A. SENIOR Edmonton, AB Islet engraftment is critical for long-term function after clinical islet transplantation, but is difficult to measure. Current measures of islet function, including glycemic control and C-peptide secretion, are interdependent and are unlikely to capture early changes in graft function individually. We assessed islet engraftment at 1 week after transplant using the BETA-2 score, a novel and validated composite score that incorporates several indices of islet function, to determine whether early engraftment predicts long-term graft function. Sixteen patients transplanted between 2009 and 2014 were selected on the basis of having optimal engraftment (insulin independent after a single islet infusion, n=9) or suboptimal engraftment (requiring a second islet infusion to achieve insulin independence within 6 months of initial infusion, n=7). BETA-2 score at 1 week was significantly higher in patients with optimal engraftment compared to those with suboptimal engraftment (14.9±2.5 vs. 8.4±2.6, p<0.05) and 2 years post-transplant (21.6±4.2 vs. 9.2±0.17, p<0.05) although peak BETA-2 was similar (33.4±12.4 optimal engraftment vs. 22.3±5.6 suboptimal engraftment, p=0.18). Linear regression was calculated to predict long-term graft function based on early engraftment measured by fasting C-peptide, fasting blood glucose or BETA-2 score. BETA-2 score at 1 week predicted graft function at 3, 6 and 24 months posttransplantation. Fasting blood glucose at 1 week was predictive of graft function at 6 months only and fasting C-peptide was not predictive of long-term graft function at any time (Table). This study demonstrates that the BETA-2 score is a useful tool to assess early engraftment and can predict long-term islet transplant outcomes.
57 Regulation of Autotaxin and its Role in Obesity-Induced Tissue Insulin Resistance KENNETH D’SOUZA, ERIN E. KERSHAW, THOMAS PULINILKUNNIL, PETRA C. KIENESBERGER Saint John, NB Autotaxin (ATX) is an adipokine that has recently been implicated in obesity-related insulin resistance in mice and humans. However, the nutritional and hormonal regulation of ATX and the role of ATX in tissue insulin signalling remains unclear. We observed that serum ATX activity is upregulated in obese male C57Bl6 mice following 16 weeks of high fat-high sucrose (HFHS) diet feeding. Moreover, fasting
54 Impact of Normal Postpartum Glucose Tolerance on Postpartum Weight Change in Women with Recent Gestational Diabetes Mellitus NABILA PURNO*, TANJA DURBIC, KEVIN THORPE, JULIA LOWE, JOEL RAY, DENICE FEIG, LORRAINE LIPSCOMBE* Toronto, ON Objective: Although women with gestational diabetes mellitus (GDM) are at increased risk for type 2 diabetes, most revert to normal glucose tolerance after delivery. Awareness of normal glucose tolerance may mislead women regarding their risk of diabetes and decrease motivation for lifestyle changes. The objective was to investigate whether women with GDM who reported normal postpartum glucose tolerance had higher weight and body mass index (BMI) in the second year after delivery. Methods: Toronto-area women with GDM were surveyed during pregnancy, at 3 to 12 and 13 to 24 months postpartum. We compared women who self-reported normal postpartum glucose tolerance at 3 to 12 months postpartum to those who reported not performing the test or not knowing the results. The outcomes were weight (kilograms [kg]) and BMI (kilograms/metre2 [kg/m2]) at 13 to 24 months postpartum. We used multivariable linear regression models adjusting for baseline weight and other clinical, behavioural and sociodemographic variables, and for propensity to complete the final survey. Results: Three hundred fifty-six women completed surveys at the 3 time points; 180 (51%) women reported normal glucose tolerance, 148 (42%) were unaware of their results and 28 (8%) with abnormal glucose tolerance were excluded. After adjustment for covariates, women who reported normal glucose tolerance had a mean 2.93 kg higher weight (95% confidence interval [CI] 0.09 to 5.77, p=0.043) and 1.18 kg/m2 higher BMI (95% CI 0.14 to 2.21, p=0.026) at 13 to 24 months postpartum compared to women who were unaware. Conclusion: Our study shows that informing women of normal glucose tolerance results after delivery is associated with significantly higher weight retention by the second year postpartum.
55 Improving Diagnosis of Gestational Diabetes Mellitus? 75gOGTT vs. SMBG AMÉLIE ARDILOUZE, PATRICIA BOUCHARD, CATHERINE ALLARD, JEAN-PATRICE BAILLARGEON, CATHERINE SIMARD, MARIE-FRANCE HIVERT, JULIE MÉNARD, GHISLAINE HOUDE, MARIE-HÉLÈNE PESANT, PATRICE PERRON, ANNIE OUELLET, JEAN-LUC ARDILOUZE Sherbrooke, QC Rationale: Diagnosis of gestational diabetes mellitus (GDM) is routinely performed using an oral glucose tolerance test (75g-OGTT). Positive 75g-OGTT requires immediate therapy and self-monitoring of blood glucose (SMBG), as per CDA-recommended glucose targets (fasting:<5.3 mmol/L; 2-hour postprandial:<6.7 mmol/L). We propose to use SMBG to assess glucose control under usual diet in order to treat only women with documented hyperglycemia, i.e. with glucose values over CDA targets. Objective: To determine if women with positive OGTT (OGTT+) are hyperglycemic in everyday life. Methods: Women with singleton pregnancies and a positive (≥7.2 mmol/L) 50 g screening test at 24 to 28 weeks performed a 75g-OGTT followed by 7 consecutive days of SMBG (4 tests/day: fasting and 2-hour postprandial). Hyperglycemia (SMBG+) was defined as at least 4 glucose values above target at a same given time of day over the 7 days.
S19
Results: We recruited 103 women aged 30±5 years at 27.6±1.0 weeks of pregnancy. Results revealed 4 groups: 1) OGTT+/SMBG+ (12%), 2) OGTT+/SMBG− (13%), 3) OGTT−/SMBG+ (9%), 4) OGTT−/SMBG− (66%). Baseline characteristics, risk factors and maternal outcomes did not differ significantly between groups. Care was identical in groups 1, 2 and 3. Neonatal hypoglycemia rates (75%, 50%, 55.5%, 8.8%, p≤0.009) were lower in group 4. Conclusions: Among women with positive GDM 50 g screening, we found that 22% displayed divergent OGTT and SMBG results: 13% were normoglycemic, but detrimental outcomes in neonates suggest that therapy should not be delayed. A total of 9% were overlooked by OGTT alone, suggesting SMBG as a useful complementary strategy. 56 Islet Engraftment Measured by BETA-2 Score Predicts Islet Transplant Outcomes ANNA LAM, RICHARD A. ORAM, A.M. JAMES SHAPIRO, PETER A. SENIOR Edmonton, AB Islet engraftment is critical for long-term function after clinical islet transplantation, but is difficult to measure. Current measures of islet function, including glycemic control and C-peptide secretion, are interdependent and are unlikely to capture early changes in graft function individually. We assessed islet engraftment at 1 week after transplant using the BETA-2 score, a novel and validated composite score that incorporates several indices of islet function, to determine whether early engraftment predicts long-term graft function. Sixteen patients transplanted between 2009 and 2014 were selected on the basis of having optimal engraftment (insulin independent after a single islet infusion, n=9) or suboptimal engraftment (requiring a second islet infusion to achieve insulin independence within 6 months of initial infusion, n=7). BETA-2 score at 1 week was significantly higher in patients with optimal engraftment compared to those with suboptimal engraftment (14.9±2.5 vs. 8.4±2.6, p<0.05) and 2 years post-transplant (21.6±4.2 vs. 9.2±0.17, p<0.05) although peak BETA-2 was similar (33.4±12.4 optimal engraftment vs. 22.3±5.6 suboptimal engraftment, p=0.18). Linear regression was calculated to predict long-term graft function based on early engraftment measured by fasting C-peptide, fasting blood glucose or BETA-2 score. BETA-2 score at 1 week predicted graft function at 3, 6 and 24 months posttransplantation. Fasting blood glucose at 1 week was predictive of graft function at 6 months only and fasting C-peptide was not predictive of long-term graft function at any time (Table). This study demonstrates that the BETA-2 score is a useful tool to assess early engraftment and can predict long-term islet transplant outcomes.
57 Regulation of Autotaxin and its Role in Obesity-Induced Tissue Insulin Resistance KENNETH D’SOUZA, ERIN E. KERSHAW, THOMAS PULINILKUNNIL, PETRA C. KIENESBERGER Saint John, NB Autotaxin (ATX) is an adipokine that has recently been implicated in obesity-related insulin resistance in mice and humans. However, the nutritional and hormonal regulation of ATX and the role of ATX in tissue insulin signalling remains unclear. We observed that serum ATX activity is upregulated in obese male C57Bl6 mice following 16 weeks of high fat-high sucrose (HFHS) diet feeding. Moreover, fasting