Insulin Sensitivity and Insulin Secretion Estimated by Homeostatic Model Assessment (HOMA) in Gestational Diabetes Mellitus

Background: Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a parameter of the severity of insulin resistance. Aims: To determine indices of insulin resistance (IR) and β-cell function in gestational diabetes mellitus (GDM). Methods: This cross sectional study was conducted from March 2017 to September 2018 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was performed with 41 GDM and equal number of pregnant women with normal glucose tolerance (NGT) diagnosed on basis of WHO criterion-2013 during 24 - 40 weeks of gestation. Serum glucose was measured by glucose oxidase method and fasting serum insulin was measured by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate insulin indices like-insulin resistance (HOMA-IR), β-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. Results: A total of eighty-two (82) subjects [41 women with GDM (age: 28.29 ± 3.79 years, BMI: 27.16 ± 4.13 kg/m2) and 41 women with NGT (age: 26.22 ± 5.13 years, BMI: 25.27 ± 3.01 kg/m2)] were included in this study. It was observed that GDM women were significantly older (p = 0.041) and had significantly higher BMI (p = 0.020) than pregnant women with NGT. The GDM group had significantly higher IR as indicated by higher fasting insulin value [GDM vs. NGT;10.19 (7.71 - 13.34) vs. 6.88 (5.88 - 8.47) μIU/ml, median (IQR);p = 0.001] and HOMA-IR [GDM vs. NGT;2.31 (1.73 - 3.15) vs. 1.42 (1.15 - 1.76), median (IQR);p < 0.001], poor β-cell secretory capacity [GDM vs. NGT;HOMA-B: 112.63 (83.52 - 143.93) vs. 128.60 (108.77 - 157.58), median (IQR);p = 0.04] and low insulin sensitivity [GDM vs. NGT;HOMA-%S: 43.29 (31.77 - 57.98) vs. 70.42 (56.86 - 86.59), median (IQR);p < 0.001]. Conclusions: GDM is associated with both insulin resistance and inadequate insulin secretion.

Comparison of Serum Lipid Profile between Gestational Diabetes Mellitus and Pregnant Women with Normal Glucose Tolerance

Background: Aberrant lipid metabolism presumed to have important relationship with gestational diabetes mellitus (GDM), though previous studies revealed inconsistent results on this area. Objectives: To identify the difference of serum lipid profile between gestational diabetes mellitus (GDM) and pregnant woman with normal glucose tolerance (NGT). Methods: This cross sectional study was conducted from January 2017 to December 2017 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with 31 GDM and equal number of NGT pregnant women diagnosed on the basis of WHO criteria-2013, during 24 - 40 weeks of gestation. Glucose was measured by glucose oxidase method and fasting serum lipid profile [Total cholesterol (TC), High Density Lipoprotein-cholesterol (HDL-C) and Triglyceride (TG)] was measured by enzymatic-colorimetric method. Data were analyzed and compared by statistical tests. Results: Among total sixty-two (62) study subjects, 31 were GDM (age: 27.52 ± 4.8 years, body mass index (BMI): 27.17 ± 3.3 kg/m2) and 31 were pregnant women with NGT (age: 24.94 ± 4.2 years, BMI: 25.43 ± 6.5 kg/m2). Mean age of GDM group was significantly higher than that of NGT group (p = 0.028). Women with GDM showed relatively higher BMI than NGT women but that was not statistically significant (p = 0.194). Fasting lipid profiles between GDM and NGT (GDM vs. NGT;total cholesterol: 194.21 ± 42.18 vs. 208.52 ± 42.18 mg/dl, p = 0.187;HDL-C: 47.50 ± 16.17 vs. 47.18 ± 11.71 mg/dl, p = 0.928;LDL-C: 109.25 ± 28.80 vs. 119.30 ± 34.76 mg/dl, p = 0.220 and triglyceride 204.78 ± 58.50 vs. 202.34 ± 79.18 mg/dl, p = 0.891) were not significantly different. The variations in all lipid fraction values were not statistically significant among GDM women when analyzed between BMI groups holding BMI cut-off at 23 kg/m2. No significant differences of any values of lipid profile were found in GDM women according to various age categories (Age < 25 years vs. ≥25 years). Conclusions: Lipid profile does not differ between women with GDM and pregnant woman with NGT.

Clinical,biochemical and imaging characteristics of adrenal histoplasmosis in immunocompetent patients in a non-endemic area:A case series

Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45.00(39.25,56.25)years,median(IQR),m/f(16/2)]with adrenal histoplasmosis presenting in the Department of Endocrinology,BSMMU between 2014 and 2020 were retrospectively analyzed.Results:All patients were seronegative for HIV infection,and 27.8%(5/18)had well controlled diabetes mellitus.The median duration of the symptoms was 6.00(IQR:4.00,11.25)months.All had significant weight loss,anorexia and weakness.Fever was present in 61.1%(11/18)patients and night sweat was present in 27.8%(5/18)cases.Hypotension and hyperpigmentation were present in 55.6%(10/18)and 66.7%(12/18)cases,respectively.Three of 18 patients presented with adrenal crisis.Hyponatremia occurred in 55.6%(10/18)cases,but none had hyperkalemia.Thirteen of 18 patients had adrenal insufficiency whereas 83.3%(15/18)had high adrenocorticotropic hormone.CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin.All were hypodense having radiodensity 21-90 hounsfield unit,and 11.1%(2/18)were heterogeneous in contrast enhancement.None had noticeable calcification whereas 1.1%(2/18)cases had central necrosis with peripheral rim enhancement.Hepatomegaly was present in 6 cases,splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy.Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue.Conclusions:Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.