학술논문
DETERMINING THE IMPORTANCE OF GLYCEMIC VARIABILITY IN GESTATIONAL DIABETES MELLITUS USING VARIOUS TECHNIQUES/GESTASYONEL DIABETES MELLITUSTA GLISEMIK DEGISKENLIKLERIN ONEMI VE FARKLI YONTEMLERLE ARASTIRILMASI
RESEARCH/ARASTIRMA
RESEARCH/ARASTIRMA
Document Type
Report
Author
Source
Journal of Istanbul Faculty of Medicine. March 2023, Vol. 86 Issue 1, p44, 8 p.
Subject
Language
English
ISSN
1305-6433
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is defined as glucose intolerance resulting in maternal and fetal complications that first begin in pregnancy (1). Pancreatic beta cell defect and chronic insulin resistance [...]
Objective: The study aims to determine glycemic variation in patients with gestational diabetes mellitus (GDM) and to evaluate the effect on the fetal growth using a continuous glucose monitoring system (CGMS) and to investigate the correlation between glucose variation through biomarkers including HbA1c, fructosamine (FRM), and 1.5-Anhydroglucitol (1.5-AG). Materials and Methods: The study involves 31 women with GDM at gestational week [greater than or equal to] 35 who'd only had diet therapy. Blood glucose levels were monitored for three consecutive days using CGMS to evaluate mean blood glucose levels and mean absolute difference (MAD). Self-monitoring of blood glucose (SMBG) was required from the patients while having the CMGS on their body. Blood samples were collected to measure serum 1.5-AG, HbA1c, and FRM. Results: The mean levels were HbA1c=5.0[+ or -]0.3%, FRM=2.1[+ or -]0.2 pmol/L, 1.5-AG = 17.0[+ or -]4.9 ng/ml, and 3-day average max-min glucose range=131.1[+ or -]22.5 and 54.7[+ or -]11.6 mg/dl (MAD=6.7[+ or -]3.1%). The mean glucose levels measured using SMBG and CGMS were similar (82.9[+ or -]10.2 vs 86.1[+ or -]10.3 mg/dL). No correlation occurred between CMGS and biomarkers. The baby weight at birth and head circumference was determined to be lower for patients with glucose fluctuations. Conclusion: Biomarkers do not reflect glycemic fluctuation, and regular SMBG is required to achieve the desired glucose level, even in diet-regulated GDM. Lower head circumference and birth weight were determined in GDM mothers with high glycemic fluctuations, and CGMS may be an alternative method despite its cost and application difficulties. Keywords: Gestational diabetes, 1.5-anhydroglucitol, glycemic variability, HbA1c, fructosamine Amac: Gestasyonel Diabetes Mellitus (GDM)'da gun ici glukoz dalgalanmalari ve bunun bebek uzerine etkisini belirlemek; ayrica, glukozdaki dalgalanmalarin HbA1c, fruktozamin (FRM) ve 1,5-Anhidroglucitol (1,5-AG) ile korelasyonunu saptamaktir. Gerec ve Yontem: Sadece diyetle takip edilen GDM tanisi alan ve [greater than or equal to] 35 gebelik haftasindaki 31 hastada devamli glukoz olcum sistemi (CGMS) ile 72 saatlik glisemik degiskenlikler (ortalama mutlak deger %MAD ve ortalama glukoz degeri) olculdu, ayrica hastalardan, CGMS takili oldugu gunler, kendi kendine glukoz olcum sistemi (SMBG) her ogun oncesinde ve birinci saat sonrasinda parmak ucundan kan glukoz duzeylerini olcmeleri istendi. 1,5 AG, Hba1c ve FRM duzeyleri CGMS cikarildigi ucuncu gun hastalardan alindi. Bulgular: Hastalarin ortalama HbA1c, FRM ve 1,5-AG sirasiyla %5,00,3, 2,10,2 [micro]mol/L, ve 17,04,9 ng/mL idi. Uc gunluk izlemde maximum-minimum glukoz duzeyi ortalamasi 131,122,5 ve 54,711,6 mg/dL iken %MAD degeri %6,73,1 idi. SMBG ve CGMS ile olculen ortalama glukoz degeri birbiri ile koreleyken (82,910,2 ve 86,110,3 mg/dL); glukoz dalgalanmasi ile FRM, HbA1c ve 1,5-AG arasinda anlamli korelasyon yoktu. Hastalarin glikoz dalgalanmalari varsa dogumdaki bebek agirliginin ve bas cevresinin dusuk oldugu belirlendi. Sonuc: Calismamizda biyobelirteclerin glisemik dalgalanmayi yansitmadigi; istenilen glukoz seviyesinin saglanmasi icin, diyet le regule GDM de bile, SMBG'un sik, duzenli olarak yapilmasinin gerekliligi saptanmistir; ancak glisemik dalgalanmalari fazla olan GDM'li annenin bebeginde bas cevresi ve dogum kilosu daha dusuk saptanmistir ve glisemik dalgalanmayi daha yakindan gosteren CGMS' in her ne kadar maliyet ve uygulama zorlugu olsa da, SMBG' ye alternatif yontem olabilecegi gosterilmistir. Anahtar Kelimeler: Gestasyonel diabetes, 1.5 anhidroglucitol, glisemik degiskenlik, HbA1c, fruktozamin
Objective: The study aims to determine glycemic variation in patients with gestational diabetes mellitus (GDM) and to evaluate the effect on the fetal growth using a continuous glucose monitoring system (CGMS) and to investigate the correlation between glucose variation through biomarkers including HbA1c, fructosamine (FRM), and 1.5-Anhydroglucitol (1.5-AG). Materials and Methods: The study involves 31 women with GDM at gestational week [greater than or equal to] 35 who'd only had diet therapy. Blood glucose levels were monitored for three consecutive days using CGMS to evaluate mean blood glucose levels and mean absolute difference (MAD). Self-monitoring of blood glucose (SMBG) was required from the patients while having the CMGS on their body. Blood samples were collected to measure serum 1.5-AG, HbA1c, and FRM. Results: The mean levels were HbA1c=5.0[+ or -]0.3%, FRM=2.1[+ or -]0.2 pmol/L, 1.5-AG = 17.0[+ or -]4.9 ng/ml, and 3-day average max-min glucose range=131.1[+ or -]22.5 and 54.7[+ or -]11.6 mg/dl (MAD=6.7[+ or -]3.1%). The mean glucose levels measured using SMBG and CGMS were similar (82.9[+ or -]10.2 vs 86.1[+ or -]10.3 mg/dL). No correlation occurred between CMGS and biomarkers. The baby weight at birth and head circumference was determined to be lower for patients with glucose fluctuations. Conclusion: Biomarkers do not reflect glycemic fluctuation, and regular SMBG is required to achieve the desired glucose level, even in diet-regulated GDM. Lower head circumference and birth weight were determined in GDM mothers with high glycemic fluctuations, and CGMS may be an alternative method despite its cost and application difficulties. Keywords: Gestational diabetes, 1.5-anhydroglucitol, glycemic variability, HbA1c, fructosamine Amac: Gestasyonel Diabetes Mellitus (GDM)'da gun ici glukoz dalgalanmalari ve bunun bebek uzerine etkisini belirlemek; ayrica, glukozdaki dalgalanmalarin HbA1c, fruktozamin (FRM) ve 1,5-Anhidroglucitol (1,5-AG) ile korelasyonunu saptamaktir. Gerec ve Yontem: Sadece diyetle takip edilen GDM tanisi alan ve [greater than or equal to] 35 gebelik haftasindaki 31 hastada devamli glukoz olcum sistemi (CGMS) ile 72 saatlik glisemik degiskenlikler (ortalama mutlak deger %MAD ve ortalama glukoz degeri) olculdu, ayrica hastalardan, CGMS takili oldugu gunler, kendi kendine glukoz olcum sistemi (SMBG) her ogun oncesinde ve birinci saat sonrasinda parmak ucundan kan glukoz duzeylerini olcmeleri istendi. 1,5 AG, Hba1c ve FRM duzeyleri CGMS cikarildigi ucuncu gun hastalardan alindi. Bulgular: Hastalarin ortalama HbA1c, FRM ve 1,5-AG sirasiyla %5,00,3, 2,10,2 [micro]mol/L, ve 17,04,9 ng/mL idi. Uc gunluk izlemde maximum-minimum glukoz duzeyi ortalamasi 131,122,5 ve 54,711,6 mg/dL iken %MAD degeri %6,73,1 idi. SMBG ve CGMS ile olculen ortalama glukoz degeri birbiri ile koreleyken (82,910,2 ve 86,110,3 mg/dL); glukoz dalgalanmasi ile FRM, HbA1c ve 1,5-AG arasinda anlamli korelasyon yoktu. Hastalarin glikoz dalgalanmalari varsa dogumdaki bebek agirliginin ve bas cevresinin dusuk oldugu belirlendi. Sonuc: Calismamizda biyobelirteclerin glisemik dalgalanmayi yansitmadigi; istenilen glukoz seviyesinin saglanmasi icin, diyet le regule GDM de bile, SMBG'un sik, duzenli olarak yapilmasinin gerekliligi saptanmistir; ancak glisemik dalgalanmalari fazla olan GDM'li annenin bebeginde bas cevresi ve dogum kilosu daha dusuk saptanmistir ve glisemik dalgalanmayi daha yakindan gosteren CGMS' in her ne kadar maliyet ve uygulama zorlugu olsa da, SMBG' ye alternatif yontem olabilecegi gosterilmistir. Anahtar Kelimeler: Gestasyonel diabetes, 1.5 anhidroglucitol, glisemik degiskenlik, HbA1c, fruktozamin