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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of rigorous management of insulin-dependent diabetes mellitus (IDDM) during pregnancy on the perinatal outcome was assessed by comparing 78 prepartum gravid patients with IDDM managed prospectively with 78 matched controls. The diabetic women were treated with insulin by either infusion pump or split-dose therapy, with the goal of normalization of the fasting blood sugars and hemoglobin Hb A1c values. Differences in the perinatal outcome were evaluated by either chi-square or analysis of variance. Of the women with IDDM, 14% where White class B, 43% class C, 26% class D, 17% classes R and F. The mean Hb A1c value in the first half of pregnancy was 8.49% +/- 2.30%, and 7.34% +/- 1.79% in the second half. Women with IDDM had higher rates of premature delivery (31% vs. 10%, P = 0.003), pre-eclampsia (15% vs. 5%, P = 0.035), and cesarean section (55% vs. 27%, P = 0.002). Complications of infants born to diabetic mothers included large size for gestational age (41% vs. 16%, P = 0.0002), hypoglycemia (14% vs. 1%, P = 0.0025), hyperbilirubinemia (46% vs. 23%, P = 0.0002), and respiratory distress (12% vs. 1%, P = 0.008). The Apgar scores and mortality were similar. Congenital malformations occurred in 7.7% of infants of diabetic mothers and 1.3% of controls (P = 0.05). The maternal Hb A1c level did not correlate with the infant size for gestation. Although the improved medical management of IDDM has decreased neonatal mortality, significant perinatal complications persist.
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PMID:Rigorous management of insulin-dependent diabetes mellitus during pregnancy. 782 48

A randomized clinical trial of combination chemotherapy for adult acute lymphoblastic leukemia (ALL) with doxorubicin, vincristine and prednisolone with and without L-asparaginase (AdVP vs L-AdVP) was conducted, involving 58 institutions throughout Japan. After reaching complete remission (CR), patients were treated with the same regimen for more than 2 years. Among 166 evaluable cases of the 198 cases enrolled, CR rates were 63.1% (53/84) with AdVP and 64.6% (53/82) with L-AdVP (P = 0.837). Median survival times and 7-year survival rates were 12.7 months and 21.2% with AdVP, and 16.0 months and 22.3% with L-AdVP (P = 0.955 by generalized Wilcoxon test [GW], P = 0.952 by log-rank test [LR]). Median disease-free survival times and 7-year survival rates were 13.5 months and 23.8% with AdVP and 17.0 months and 30.6% with L-AdVP, showing some increments for L-AdVP but no statistical significance (P = 0.141 by GW, P = 0.300 by LR). Among the cases of extramurally confirmed FAB subtypes, CR rates were 75.9% (63/83) for the L1 subtype and 51.3% (39/76) for the L2 subtype (P = 0.001). As to adverse effects, pancreatitis was complicated more frequently in L-AdVP than in AdVP (P = 0.039). Other side effects such as hyperbilirubinemia, diabetes mellitus, diarrhea and hypofibrinogenemia were observed more frequently with L-AdVP, but with no statistical significance. Thus, addition of a single course of L-asparaginase in the induction phase of combination chemotherapy with doxorubicin, vincristine and prednisolone did not significantly enhance the effect of antileukemic treatment of adult ALL.
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PMID:Nation-wide randomized comparative study of doxorubicin, vincristine and prednisolone combination therapy with and without L-asparaginase for adult acute lymphoblastic leukemia. 830 8

Hypophosphatemia is uncommon in cats, but it has been reported in association with diabetes mellitus and hepatic lipidosis, where it can cause hemolysis, rhabdomyopathy, depression, seizures, and coma. The purpose of this article is to describe 9 cats that developed low serum phosphorus concentrations (< 2.5 mg/dL) subsequent to enteral alimentation. Serum biochemical analyses from more than 6,000 cats were reviewed. The medical records of all cats with hypophosphatemia were examined for history of enteral alimentation; diabetic cats were excluded from the study. Nine cats, ranging in age from 3 to 17 years, were identified. All cats had normal serum phosphorus concentrations before tube feeding began. Onset of hypophosphatemia occurred 12 to 72 hours after initiation of enteral alimentation, and the nadir for phosphorus concentrations ranged from 0.4 to 2.4 mg/dL. Hemolysis occurred in 6 of the 9 cats. Hypophosphatemia secondary to enteral alimentation is an uncommon clinical finding in cats. Cats with high alanine aminotransferase activity, hyperbilirubinemia, and weight loss should be closely monitored for hypophosphatemia during the first 72 hours of enteral alimentation.
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PMID:Hypophosphatemia associated with enteral alimentation in cats. 852 19

The authors have evaluated seven years' period of the intensive care of pregnant women suffering from diabetes mellitus. In the analysed period 175 patients suffering from diabetes gave birth to babies, and that was 0.69% of all the labours. The most frequent type of diabetes was gestational diabetes mellitus (53.7%), and diabetes of B type (23.5). Diabetes of G-1 type occurred in as many as 44% of the examined women. In the tested group of women the indication to conducting a cesarean section occurred in 16.6% of cases. It was found that the babies born by the mothers suffering from diabetes had in their early neonatal period the following biochemical disorders: hypoglycemia--37.7%, hyperbilirubinemia--17.4%, anemia--8.7% and hypocalcemia--5.8% of cases. Monitoring of pregnancy, the time and the way of its termination should be selected individually for each women suffering from diabetes mellitus.
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PMID:[Evaluation of a seven year period of managing pregnancies complicated by diabetes mellitus]. 857 79

Exchange transfusion has an important role in the treatment of hyperbilirubinemia of the newborn. It is used in attempts to prevent kernicterus when bilirubin levels are high. We describe our experience in 203 exchange transfusions performed on 143 infants (81 males and 62 females) with hyperbilirubinemia during 1983-1992. In only 30% of cases was there a specific etiological diagnosis of the jaundice based on a positive Coombs test, G6PD deficiency, or the presence of sepsis or maternal diabetes; the rest were idiopathic. 57% of the neonates were premature (26-36 weeks of gestation). Premature neonates underwent more transfusions than full-term infants (1.6 vs 1.2). There was no direct death from exchange transfusion; morbidity was 6.3% (including bradycardia, apnea, thrombocytopenia, hypoglycemia and hyponatremia). Most complications occurred in preterm infants and those severely ill. All complications were treated immediately and there were no sequelae.
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PMID:[Complications of exchange transfusion in term and preterm newborns]. 868 93

The purpose of this study was to determine which test is best for predicting adverse outcomes in pregnancies complicated by diabetes: the nonstress test, biophysical profile, or umbilical artery velocimetry. We evaluated 207 singleton pregnancies complicated by diabetes within 1 week of delivery using the afore-mentioned pregnancy surveillance tests. Adverse pregnancy outcome was defined as delivery before 37 weeks of gestation or the occurrence of fetal growth restriction, hypocalcemia, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, or fetal risk requiring cesarean delivery. The prognostic value of each of the three tests was assessed, after controlling for the mothers' White classification and third trimester glycosylated hemoglobin value. Among the 207 pregnancies, 75 (36.2%) had an adverse outcome. In pregnancies in which the umbilical artery systolic to diastolic ratio was > or = 3.0, the relative risk of adverse outcome was 2.6 (95% confidence interval: 1.9-3.5, P < 0.001). For those with a biophysical profile < or = 6 the relative risk was 1.7 (95% confidence interval: 0.9-2.9, P = 0.109). Patients with a nonreactive nonstress test had a relative risk of 1.7 (95% confidence interval: 1.2-2.5, P = 0.009). Umbilical artery Doppler velocimetry was superior to either the nonstress test or the biophysical profile in identifying the subgroup of pregnancies complicated by diabetes that resulted in an adverse outcome.
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PMID:Comparison of umbilical Doppler velocimetry, nonstress testing, and biophysical profile in pregnancies complicated by diabetes. 868 65

Of the total 25381 delivered in our Department, in the time from January 1987 to December 1993, 175 (0,69%) were from pregnancies with complicated by diabetes mellitus. 171 of that number ended with healthy babies (172), which is a relatively satisfactory outcome. Only 4 patients lost their babies. They were 3 patients admitted to our programme late in their pregnancy period. Already during their first medical examination the diagnosis was a) nonviable pregnancy in 1 case and b) multiple, congenital defects in the remaining 2 cases. 1 baby was died three days after delivery (congenital heart disease). All patients attended classes of special diabetes mellitus education in the Pathology Ward. Each patient underwent programmed control visits by obstetrician and diabetologist; metabolic therapy reached the level of near normoglycemia. In each case the time of delivery was selected individually. As result of such approach majority of patients gave natural birth. Only in 29 cases (16,6%) caesarean operation was performed. The reason for caesarean operation in 12 of the 29 cases was a previous operation of this kind. In the other 5 cases natural birth was impossible, because of the big foetus. Observation of the newborn babies during their first days of life showed that most of them suffered from the following complications: hypoglycaemia (39,8%), hyperbilirubinemia (25,1%), anaemia (12,9%) and hypocalcaemia (7%). All the babies being in generally good condition were discharged from the hospital on the 5th-10th day together with their mothers. It seems that such good results could obtained owing to special programme, which could by applied also in Regional Gynecological-Obstetrical Ward with help of a local diabetologist.
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PMID:[Diabetes mellitus complicating pregnancy]. 875 96

The perinatal mortality rate of infants of diabetic mothers (IDMs) has declined dramatically from 250 per 1000 live births in the 1960s to a near-normal 20 per 1000 live births in the 1980s. Five to 8% of all IDMs suffer from major congenital malformations, and it is the latter that are responsible for 50% of these perinatal deaths. It has been shown that tight glycemic control prior to conception and during pregnancy can prevent an excess rate of congenital malformations, fetal macrosomia, birth trauma, and neonatal respiratory distress syndrome. We briefly review the short- and long-range complications that occur in offspring of diabetic mothers (ODMs) from gestation through young adulthood. Short-term neonatal complications, such as hypoglycemia, hypocalcemia, hypomagnesemia, hyperbilirubinemia, and polycythemia, are related mainly to fetal hyperinsulinemia, hypoxemia, and prematurity. They are readily controllable within the setup of modern neonatal intensive care units. Long-range complications include an increased rate of childhood and adolescent obesity, impaired glucose tolerance or diabetes mellitus, and subtle neuropsychological dysfunctions. These may be related to the severity of the maternal hyperglycemia during pregnancy, the consequent fetal hyperinsulinemia, and third trimester maternal lipid metabolism disturbances. Today we have at hand the knowledge and tools to properly treat both pregestational and gestational diabetes. Increased education of the general practitioner and the target population regarding early referral of pregestational diabetic mothers and the implementation of screening programs for gestational diabetes will further reduce diabetic pregnancy-related morbidity.
J Diabetes Complications
PMID:Short- and long-range complications in offspring of diabetic mothers. 888 19

Current increase in the incidence of diabetes mellitus complicating pregnancy is of concern since it is associated with an increase in mortality and morbidity of the fetus and neonate. Pregnancy itself is diabetogenic caused by increased insulin resistance due to the production of hormones like estrogen, progesterone, cortisol, human chorionic somatomammotropin (hCS) and human placental lactogen (hPL). The latter increases lypolysis which provides free fatty acids and ketones as fuels for energy for the pregnant mother. This spares maternal blood glucose, amino acids and ketones which cross the placenta to the fetus. The influx of nutrients increases fetal insulin production which together with hPL induce somatogenesis. Maternal hyperglycemia and fetal hypoxemia are shown to be responsible for structural congenital anomalies of the rapidly developing organs of the fetus during the early weeks of gestation while continuing hyperglycemia and hypoxemia in the second and third trimester are factors related to the production of macrosomia, including cardiomyopathy, delay in lung maturation, and polycythemia. Metabolic problems such as hypoglycemia, hypocalcemia, hypomagnesemia and hyperbilirubinemia are common neonatal morbidities. Follow-up of the infants of diabetic mothers indicates that these infants have a 20 fold increase in acquiring diabetes. Early identification of maternal diabetes with strict metabolic control prior to conception as well as throughout pregnancy together with careful fetal monitoring can reduce the incidence of congenital anomalies and morbidities in the fetus and neonate.
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PMID:Infant of diabetic mother: a continuing challenge for perinatal-neonatal medicine. 894 23

If untreated, severe unconjugated hyperbilirubinemia is neurotoxic. Management of the condition therefore includes preventing serum bilirubin from reaching toxic levels. Identifying infants at risk of developing severe hyperbilirubinemia and early intervention have reduced levels of morbidity and mortality associated with bilirubin encephalopathy. The incidence of neonatal jaundice and the etiological factors associated with hyperbilirubinemia vary by locale. All infants born at Al Ain Hospital, United Arab Emirates, between January 1 and June 30, 1995, who developed clinically relevant hyperbilirubinemia defined as jaundice requiring investigation and treatment were prospectively studied. 85 (3.7%) of the 2300 live births developed hyperbilirubinemia. Of those, 22 were premature, 22 had ABO hemolytic disease of the newborn, 8 had G6PD deficiency (Mediterranean), 7 had breast milk jaundice, 5 were born to mothers with diabetes mellitus, and 1 had Rh incompatibility. No specific factor was identified in 20 (24%) infants. Significant differences in the distribution of diagnostic categories were found among the major ethnic groups in the population studied.
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PMID:Epidemiology of clinical hyperbilirubinaemia in Al Ain, United Arab Emirates. 992 69


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