BACKGROUND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is t...BACKGROUND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is the recommended screening test in the United Kingdom as per National Institute for Health and Care Excellence(NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is unclear.AIM To determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth weight.METHODS All deliveries between 2009 and 2013 at the local maternity unit of the University hospital were reviewed. Of the total number of 24,154 women without preexisting diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study(n =3537). Blood samples for fasting plasma glucose(FPG), 2-hour plasma glucose(2-h PG) and HbA1 c had been obtained. Birth weight was categorised as low(≤ 2500 g), normal or Macrosomia(≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ~2 test and comparison between group means was by one-way ANOVA.RESULTS Amongst the study cohort(3537 deliveries), 96(2.7%) women had babies with LBW(< 2500 g). Women who delivered a LBW baby had significantly lower FPG(4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies(8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L,whereas maternal age, 2-h PG ≥ 7.8 mmol/L and HbA1c were not significant predictors.CONCLUSION A low FPG and 2-h PG ≤ 3.5 mmol/L on 75-gram OGTT are significantly associated with low birth weight in women identified as high risk for GDM.Women of ethnic backgrounds(Asians) appear to be more susceptible to this increased risk and may serve as a separate cohort in whom we should offer more intensive follow up and screening for complications. Cost implications and resources for follow up would need to be looked at in further detail to support these findings.展开更多
Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could...Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. Objective: To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. Methods and Patients: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospective case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012. Results: The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and contributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided. Conclusion: Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevented by proper education and preparation.展开更多
目的研究胰岛素低血糖激发试验(insulin tolerance test,ITT)按指南推荐剂量注射胰岛素后出现不充分低血糖的影响因素。方法采用横断面研究设计,选取2010年01月至2021年12月于重庆医科大学附属第一医院内分泌科就诊的可疑成人生长激素(g...目的研究胰岛素低血糖激发试验(insulin tolerance test,ITT)按指南推荐剂量注射胰岛素后出现不充分低血糖的影响因素。方法采用横断面研究设计,选取2010年01月至2021年12月于重庆医科大学附属第一医院内分泌科就诊的可疑成人生长激素(growth hormone,GH)缺乏患者,共416例(男性121例,女性295例),均行ITT。收集患者资料及生化信息,根据ITT过程中单次指南推荐剂量注射胰岛素(0.1~0.15 U/kg)后低血糖是否充分进行分组(充分低血糖组321人,不充分低血糖组95人)。采用多因素Logistic回归模型分析不充分低血糖的影响因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析相关指标对不充分低血糖的预测价值,得出切点值。结果充分低血糖组的年龄、体质指数(body mass index,BMI)、首次胰岛素剂量、基线血糖、基线GH、空腹胰岛素、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterin,LDL-C)、甘油三酯(triglyceride,TG)均低于不充分低血糖组,高密度脂蛋白胆固醇(high density lipoprotein cholesterin,HDL-C)高于不充分低血糖组(P<0.05)。多因素Logistic回归分析结果显示,高BMI、高基线血糖、高LDL-C、低HDL-C是不充分低血糖的影响因素(P<0.05)。BMI预测不充分低血糖的ROC曲线下面积(area under the ROC curve,AUC)为0.880,约登指数计算此时BMI切点值为24.012,敏感度为0.832,特异度为0.804。BMI、基线血糖、LDL-C、HDL-C四者联合诊断预测不充分低血糖的AUC为0.909,敏感度为0.895,特异度为0.782。结论高BMI、高基线血糖、高LDL-C、低HDL-C为不充分低血糖的影响因素,四者联合检测和BMI单一指标均对不充分低血糖有较高的预测价值。展开更多
文摘BACKGROUND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is the recommended screening test in the United Kingdom as per National Institute for Health and Care Excellence(NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is unclear.AIM To determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth weight.METHODS All deliveries between 2009 and 2013 at the local maternity unit of the University hospital were reviewed. Of the total number of 24,154 women without preexisting diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study(n =3537). Blood samples for fasting plasma glucose(FPG), 2-hour plasma glucose(2-h PG) and HbA1 c had been obtained. Birth weight was categorised as low(≤ 2500 g), normal or Macrosomia(≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ~2 test and comparison between group means was by one-way ANOVA.RESULTS Amongst the study cohort(3537 deliveries), 96(2.7%) women had babies with LBW(< 2500 g). Women who delivered a LBW baby had significantly lower FPG(4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies(8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L,whereas maternal age, 2-h PG ≥ 7.8 mmol/L and HbA1c were not significant predictors.CONCLUSION A low FPG and 2-h PG ≤ 3.5 mmol/L on 75-gram OGTT are significantly associated with low birth weight in women identified as high risk for GDM.Women of ethnic backgrounds(Asians) appear to be more susceptible to this increased risk and may serve as a separate cohort in whom we should offer more intensive follow up and screening for complications. Cost implications and resources for follow up would need to be looked at in further detail to support these findings.
文摘Background: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. Objective: To better understand fasting-evoked en route hypoglycemia in diabetes (FEEHD), a recently recognized overlooked safety problem in diabetes management. Methods and Patients: A recent study reported that some patients with diabetes who fast overnight for laboratory tests are at risk of developing hypoglycemia, which could occur while patients are in risky situations which could result in harm to patients or others. Due to limitation in study design of the aforementioned study, the causes of hypoglycemia could not be elucidated. We undertook this retrospective case series study, which enrolled 4 consecutive cases of fasting hypoglycemia in patients with diabetes who were on diverse antidiabetic medications. The study duration was June 1, 2010 to June 1, 2012. Results: The 4 cases (3 women, 1 man), with either type 1 or type 2 diabetes, revealed multiple defects in either the patients’ knowledge and education regarding preparation for lab tests requiring fasting. The degree of hypoglycemia ranged from mild (65 mg/dl) to severe (31 mg/dl), and the events were either mildly symptomatic or asymptomatic. The possible causes of, and contributing factors to hypoglycemia are discussed, and recommendations for preventive measures are provided. Conclusion: Some patients with diabetes who fast for lab tests are at risk of hypoglycemia, and there seems to be an overall lack of proper education of patients with diabetes about this form of hypoglycemia. This overlooked problem can be prevented by proper education and preparation.
文摘目的研究胰岛素低血糖激发试验(insulin tolerance test,ITT)按指南推荐剂量注射胰岛素后出现不充分低血糖的影响因素。方法采用横断面研究设计,选取2010年01月至2021年12月于重庆医科大学附属第一医院内分泌科就诊的可疑成人生长激素(growth hormone,GH)缺乏患者,共416例(男性121例,女性295例),均行ITT。收集患者资料及生化信息,根据ITT过程中单次指南推荐剂量注射胰岛素(0.1~0.15 U/kg)后低血糖是否充分进行分组(充分低血糖组321人,不充分低血糖组95人)。采用多因素Logistic回归模型分析不充分低血糖的影响因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析相关指标对不充分低血糖的预测价值,得出切点值。结果充分低血糖组的年龄、体质指数(body mass index,BMI)、首次胰岛素剂量、基线血糖、基线GH、空腹胰岛素、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterin,LDL-C)、甘油三酯(triglyceride,TG)均低于不充分低血糖组,高密度脂蛋白胆固醇(high density lipoprotein cholesterin,HDL-C)高于不充分低血糖组(P<0.05)。多因素Logistic回归分析结果显示,高BMI、高基线血糖、高LDL-C、低HDL-C是不充分低血糖的影响因素(P<0.05)。BMI预测不充分低血糖的ROC曲线下面积(area under the ROC curve,AUC)为0.880,约登指数计算此时BMI切点值为24.012,敏感度为0.832,特异度为0.804。BMI、基线血糖、LDL-C、HDL-C四者联合诊断预测不充分低血糖的AUC为0.909,敏感度为0.895,特异度为0.782。结论高BMI、高基线血糖、高LDL-C、低HDL-C为不充分低血糖的影响因素,四者联合检测和BMI单一指标均对不充分低血糖有较高的预测价值。