Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is a frequent transient or rare permanent complication of pregnancy. The role of autoimmune phenomena in this gestational form of diabetes is incompletely understood. We have examined sera from 312 pregnant women who had abnormal glucose tolerance (based on a screening examination during the second trimester) for the presence of islet cell surface antibodies or insulin autoantibodies. Fifty-eight of these women were lost to follow-up. Of the remaining subjects, 144 (57.1%) had gestational diabetes diagnosed by formal glucose tolerance testing and the others (42.9%) were normal. Sixty percent of the women with gestational diabetes eventually required insulin to control their blood glucose during pregnancy. One serum from the non-diabetic women was positive for insulin antibodies (0.9%); 8 of the sera from the patients with gestational diabetes were positive (5.6%). Subsequent analysis revealed that all nine of the women whose sera were positive for insulin autoantibodies had been treated with insulin previously. Islet cell surface antibodies were strongly correlated with gestational diabetes. Forty-five of 144 gestational diabetic sera were positive (31.3%) whereas only 9 of 108 suspect control sera (8.3%) and 7 of 60 unknown sera (11.7%) were positive. These data suggest that a high percentage of pregnant women who screen positive for glucose intolerance have serological evidence of an autoimmune response against the pancreatic islets, in spite of the state of relative immune tolerance during pregnancy. These data suggest that autoimmune phenomena may play a role in gestational diabetes and that the presence of islet cell antibodies can predict insulin-requiring gestational diabetes.
 ...
PMID:Gestational diabetes mellitus: evidence for autoimmunity against the pancreatic beta cells. 191 56

Each year 90,000 women in the United States are diagnosed with gestational diabetes. The transition from diagnosis to home management is a time of high stress for these women. Anxiety may lead to difficulty with self-care in general and the diabetic diet in particular. Follow-up education by a diabetes educator can help clients plan meals that comply with the nutritional meal plan without disrupting the family's eating habits. The client should be taught to measure portions, to recognize sugar as an ingredient in foods and medicines, and to deal with special occasions such as holiday meals, travel, and illness. If extended home care is not feasible, the creative diabetes educator will devise other educational opportunities, such as home videos, telephone support networks, special childbirth classes for women with gestational diabetes, and luncheon meetings at which nutritionally correct meals are served.
Diabetes Educ
PMID:From diagnosis to home management: nutritional considerations for women with gestational diabetes. 193 52

Gestational diabetes is the most common complication of pregnancy. If maternal hyperglycemia is not well controlled, excess glucose is transmitted to the fetus, which can lead to fetal macrosomia and maternal and fetal complications. Dietary treatment for gestational diabetes varies among practitioners. A case review is presented of a 32-year-old white woman with gestational diabetes whose condition was complicated by her blood glucose intolerance to lactose in milk. By following a carefully monitored regimen using specific dietary manipulation to maintain normoglycemia, the woman was able to deliver a normal, healthy baby by spontaneous vaginal delivery.
Diabetes Educ
PMID:Euglycemic control of gestational diabetes mellitus by specific dietary manipulation: a case study presentation. 193 53

To evaluate the validity of the diagnostic criteria of gestational diabetes (GDM) recommended by the Japan Society of Obstetrics and Gynecology (JSOG), we investigated women with mild glucose intolerance during pregnancy, using the borderline criteria of the Japan Diabetes Society (JDS), cut-off values of which are lower than those of the JSOG criteria. Five hundred seventy one pregnant women were screened for GDM after 20 weeks' gestation using a 50g glucose challenge test. Only ten women (1.8% of total), who fulfilled the JSOG criteria, were found (GDM group). At the same time, eighteen women (3.2% of total), who did not fulfill the JSOG criteria but who met two or more abnormal values of the JDS borderline criteria, were also found (A2 group). There was no significant difference between the two groups in either mean maternal age or the percentage of women over 30 years of age. delta IRI/delta BS in a 75g glucose tolerance test in the A2 group was 0.58 (median), which was similar to that in the GDM group (0.42). This result, however, was significantly lower than that in both the normal control group (1.00, p less than 0.01) and the group of women with only one abnormal value among the JDS criteria (A1 group, 0.88, less than 0.01). Before therapy, there was no significant difference in the diurnal plasma glucose level between the GDM group, who could be treated with diet therapy, and the A2 group.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Evaluation of the diagnostic criteria of gestational diabetes mellitus in Japan: a study of women with mild glucose intolerance during late pregnancy]. 194 May 45

The diagnosis of gestational diabetes requires that two of the four 100 gm, 3-hour oral glucose tolerance test values be elevated. Our report evaluates the usefulness of repeating the oral glucose tolerance test in patients who have only one abnormal value. One hundred six patients who had abnormal results of diabetes screening tests (glucose level greater than or equal to 130 mg/dl) and whose glucose tolerance test had one abnormal value underwent repeat glucose tolerance testing at an average of 4.6 weeks later. Thirty-six patients (34%) had two abnormal values on the repeat test and were classified as having gestational diabetes. Our results indicate that the finding of one abnormal value on a glucose tolerance test denotes a significant risk for the development of gestational diabetes.
 ...
PMID:The role of repeat glucose tolerance tests in the diagnosis of gestational diabetes. 195 34

To determine the incidence and risk factors associated with an abnormal postpartum glucose tolerance in women with gestational diabetes, 103 patients with gestational diabetes had a 2-hour, 75 gm oral glucose tolerance test 6 +/- 2 weeks (mean +/- SD) after delivery. Twenty-two percent (23/103) of results were abnormal: Three showed frank diabetes, four showed impaired glucose tolerance, and 16 were, nondiagnostic. There was a significant difference in gravidity, pregravid weight and body mass index, delivery weight, gestational age at diagnosis, fasting and 2- and 3-hour glucose level at the time of the oral glucose tolerance test during pregnancy, need for insulin therapy during gestation, and neonatal weight greater than 4000 gm in the abnormal group as compared with the normal group. Elevated fasting glucose level (p = 0.0001) and earlier gestational age at time of diagnosis of gestational diabetes (p = 0.013) were found to be most predictive of an abnormal postpartum glucose tolerance test result. These results support the importance of postpartum oral glucose tolerance testing in women with gestational diabetes.
 ...
PMID:Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes. 195 53

The management of the woman with diabetes diagnosed before the onset of pregnancy, or who develops it during pregnancy, requires a team approach involving the woman and her partner, the diabetes nurse educator, the dietitian, the endocrinologist, the obstetrician, the ultrasonologist and the paediatrician. It should start before pregnancy so that normoglycaemia is achieved before conception and maintained throughout gestation and labour. Fetoplacental surveillance commences with an early ultrasound to confirm fetal viability, repeated around 20 weeks to exclude major fetal malformations and then later in the third trimester to monitor fetal growth. CTG and biophysical profile assessment are major adjuncts to ensuring fetal well-being. The pregnancy should be allowed to go to full term when maternal blood glucose control has been satisfactory, fetal growth is within the normal range and other obstetrical complications, e.g. pre-eclampsia, are absent. Such an approach will ensure that the caesarean section rate can be minimized. During labour, the progress of labour and fetal well-being should be closely monitored. The woman who has microvascular complications of her diabetes (including proliferative retinopathy and nephropathy) requires even closer surveillance and premature delivery is more likely to be needed. The principles of management of the woman who develops gestational diabetes are similar, with even greater emphasis being placed on not inducing labour before full term unless complications dictate otherwise.
 ...
PMID:Obstetrical management of patients with diabetes in pregnancy. 195 20

Women with GDM have a greater risk of developing diabetes in the future compared with those women who have normal glucose tolerance during pregnancy. Using life table techniques, 17 years after the initial diagnosis of GDM, 40% of women were diabetic compared with 10% in a matched control group of women who had normal glucose tolerance in pregnancy. The incidence of diabetes was higher among women who were older, more obese, of greater parity and with more severe degrees of glucose intolerance during pregnancy. Diabetes also occurred more commonly among women who had a first-degree relative who was diabetic, in women born in Mediterranean and East Asian countries, and in those who had GDM in two or more pregnancies. Despite differing testing techniques and varying criteria for the diagnosis of GDM, follow-up studies from across the world consistently show a higher rate of subsequent diabetes among GDM mothers. NIDDM is associated with increased morbidity and a higher mortality rate, especially in women. Cardiovascular and cerebrovascular diseases are the leading causes of death. High lipid levels, hypertension and obesity are often already present when diabetes is diagnosed and may antedate the development of overt diabetes; treatment of diabetes at this stage may therefore be too late to prevent complications occurring. A follow-up programme for women with GDM facilitates screening of a group known to be at increased risk of developing diabetes so that the diagnosis can be made before associated risk factors for complications develop. Intervention in the form of counselling regarding cigarette smoking, exercise and a healthy, high-residue, unrefined carbohydrate, low cholesterol diet, given together with weight monitoring, may prevent the onset of both diabetes and its associated cerebrovascular and cardiovascular problems.
 ...
PMID:Long-term implications of gestational diabetes for the mother. 195 23

The best methods of contraception for women with insulin-dependent diabetes mellitus and gestational diabetes are discussed, with results of clinical trials in both types of patients. Women with IDDM require effective contraception since there are serious risks both to the mother and the fetus in case of unplanned pregnancy. For women reliable enough to use them consistently, barrier methods are satisfactory. IUDs are the choice for most diabetic women. In a trial of copper-T 200 IUDs in 103 diabetics compared to 119 normal controls, the effectiveness, expulsion rate, removals for bleeding and pain, and continuation rates were comparable. It was noted that there were no added infections in the diabetic group, who have an increased risk for infection generally. Oral contraceptives may worsen glucose tolerance, due to the effect of the progestogen decreasing diabetes, except in women with history of gestational diabetes. The authors found that a triphasic pill, with lower progestin dose, decreased insulin sensitivity more than did a combined pill, in both normal women and in those with previous gestational diabetes. Since natural estrogens, as used in estrogen replacement therapy in climacteric women, do not affect glucose tolerance as much as synthetic alkylated estrogens (i.e., ethinyl estradiol), the authors tried a combination of 4 mg estradiol, 2 mg estriol and 3 mg norethisterone for contraception in diabetic women. This experimental combination was compared with a low dose ethinyl estradiol-norethisterone monophasic, a progestin only pill, and an ethinyl estradiol-levonorgestrel triphasic. There were no differences among the groups in fasting plasma glucose, 24-hour insulin requirements, HbA1C levels, LDL, or free fatty acids. VLDL and HDL cholesterol and total cholesterol decreased in the natural estrogen group. There was a small, significant increase in LDL, VLDL and total cholesterol in the combined group. The authors also have preliminary results of a trial of a low-dose monophasic with ethinyl estradiol and gestodene, showing no adverse effects on glycemic control in IDDM patients. Thus low dose progestin, triphasic and natural estrogen-progestagen combination oral contraceptives can be recommended as safe to diabetics.
 ...
PMID:Contraception for women with diabetes: an update. 195 24

A remarkably coordinated set of metabolic adaptations allows the intermittently feeding mother to provide not only for her own energy needs, but also for those of the continuously feeding and developing fetus. During feeding, progressive insulin resistance and compensatory hyperinsulinemia appear to promote storage of nutrients in maternal fat and serve to "shunt" nutrients to the fetus by slowing their uptake into maternal tissues, especially during late pregnancy. Between feedings, hormones liberated by the fetoplacental unit create an environment that progressively favors maternal fat catabolism as an energy substrate source, thus curbing maternal protein catabolism while keeping some carbohydrate available for the fetus. These normal changes have important implications for women with abnormal glucoregulation. Women with pre-gestational diabetes will need progressively greater insulin doses during gestation in order to maintain normoglycemia and, in the case of women with IDDM, to avoid ketosis. Women without known diabetes may develop glucose intolerance by late gestation if their pancreatic B cells are not capable of compensating for their inherent insulin resistance and/or the normal insulin resistance of pregnancy. Norbert Freinkel was a leader in the development of our current physiological understanding of these metabolic adaptations to pregnancy. That understanding has contributed greatly to the improved outcome of pregnancies complicated by maternal diabetes. A major challenge for present and future investigators will be to develop an understanding of those adaptations at the molecular and genetic levels so that we may have even greater impact on the well-being of diabetic women and their offspring.
 ...
PMID:Glucose metabolism during pregnancy: normal physiology and implications for diabetes mellitus. 196 41


<< Previous 1 2 3 4 5 6 7 8 9 10