<strong>Background: </strong>Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a...<strong>Background: </strong>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. <strong>Aims:</strong> To determine indices of insulin resistance (IR) and <em>β</em>-cell function in gestational diabetes mellitus (GDM). <strong>Methods:</strong> 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), <em>β</em>-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. <strong>Results: </strong>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 <em>β</em>-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.展开更多
Introduction: In recent years, flow mediated dilatation (FMD) has become a popular technique in cardiovascular medicine. HOMA-IR was accepted to determine the insulin sensitivity as a valuable standard. In this study,...Introduction: In recent years, flow mediated dilatation (FMD) has become a popular technique in cardiovascular medicine. HOMA-IR was accepted to determine the insulin sensitivity as a valuable standard. In this study, we evaluated the association between HOMA-IR (homeostasis model assessment of insulin resistance) and vascular endothelial dysfunction, as assessed by endothelium- dependent flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD), in type 2 Diabetic (DM) patients. Material and Methods: Eighty four (84) consecutive out-patients were enrolled. HOMA-IR was calculated as fasting insulin (μU/ml) multiplied by fasting plasma glucose (FPG) (mg/dl) and divided by 405. The ultrasound method for measuring FMD and NMD has been used. Out of 84 patients, 42 patients were in control group and 42 patients were in diabetic group, which were further subdivided into two groups based on HOMA-IR > 3.0 and above was considered as Group I and HOMA IR < 3.0 and below was considered as Group II. Fasting Plasma Glucose (mmol/dl) (7.74 ± 2.56, 6.81 ± 1.9, p < 0.001) and Fasting Insulin (μU/dl) (13.26 ± 8.09, 6.65 ± 2.36, p < 0.001) were statistically significant in Group I. The baseline mean FMD in controls and cases (Group I and Group II) was 15.36 ± 9.56, 4.15 ± 2.29, 12.21 ± 6.24 (p < 0.001) respectively. By logistic regression analysis the factors which were effective on FMD percentage change (<5.5%) in Group I were BMI (p < 0.02), plasma Insulin (p < 0.04) and triglycerides (p < 0.02). There was a negative co-relation for FMD, NMD and HOMA-IR. Discussion: We conclude that increased HOMA-IR in hyperglycaemic patients is associated with severe endothelial dysfunction which is the marker of the atherosclerosis. Thus the measurement of endothelial vasomotor function which is a comprehensive analysis of atherosclerotic burden may provide a better predictive value of future cardiovascular events than the analysis of each of the traditional risk factors alone.展开更多
文摘<strong>Background: </strong>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. <strong>Aims:</strong> To determine indices of insulin resistance (IR) and <em>β</em>-cell function in gestational diabetes mellitus (GDM). <strong>Methods:</strong> 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), <em>β</em>-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. <strong>Results: </strong>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 <em>β</em>-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.
文摘Introduction: In recent years, flow mediated dilatation (FMD) has become a popular technique in cardiovascular medicine. HOMA-IR was accepted to determine the insulin sensitivity as a valuable standard. In this study, we evaluated the association between HOMA-IR (homeostasis model assessment of insulin resistance) and vascular endothelial dysfunction, as assessed by endothelium- dependent flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD), in type 2 Diabetic (DM) patients. Material and Methods: Eighty four (84) consecutive out-patients were enrolled. HOMA-IR was calculated as fasting insulin (μU/ml) multiplied by fasting plasma glucose (FPG) (mg/dl) and divided by 405. The ultrasound method for measuring FMD and NMD has been used. Out of 84 patients, 42 patients were in control group and 42 patients were in diabetic group, which were further subdivided into two groups based on HOMA-IR > 3.0 and above was considered as Group I and HOMA IR < 3.0 and below was considered as Group II. Fasting Plasma Glucose (mmol/dl) (7.74 ± 2.56, 6.81 ± 1.9, p < 0.001) and Fasting Insulin (μU/dl) (13.26 ± 8.09, 6.65 ± 2.36, p < 0.001) were statistically significant in Group I. The baseline mean FMD in controls and cases (Group I and Group II) was 15.36 ± 9.56, 4.15 ± 2.29, 12.21 ± 6.24 (p < 0.001) respectively. By logistic regression analysis the factors which were effective on FMD percentage change (<5.5%) in Group I were BMI (p < 0.02), plasma Insulin (p < 0.04) and triglycerides (p < 0.02). There was a negative co-relation for FMD, NMD and HOMA-IR. Discussion: We conclude that increased HOMA-IR in hyperglycaemic patients is associated with severe endothelial dysfunction which is the marker of the atherosclerosis. Thus the measurement of endothelial vasomotor function which is a comprehensive analysis of atherosclerotic burden may provide a better predictive value of future cardiovascular events than the analysis of each of the traditional risk factors alone.
