Management of monogenic diabetes in pregnancy:A narrative review

Pregnancy in women with monogenic diabetes is potentially complex,with significant implications for both maternal and fetal health.Among these,maturity-onset diabetes of the young(MODY)stands out as a prevalent monogenic diabetes subtype frequently encountered in clinical practice.Each subtype of MODY requires a distinct approach tailored to the pregnancy,diverging from management strategies in non-pregnant individuals.Glucokinase MODY(GCK-MODY)typically does not require treatment outside of pregnancy,but special considerations arise when a woman with GCK-MODY becomes pregnant.The glycemic targets in GCK-MODY pregnancies are not exclusively dictated by the maternal/paternal MODY genotype but are also influenced by the genotype of the developing fetus.During pregnancy,the choice between sulfonylurea or insulin for treating hepatocyte nuclear factor 1-alpha(HNF1A)-MODY and HNF4A-MODY depends on the mother’s specific circumstances and the available expertise.Management of other rarer MODY subtypes is individu-alized,with decisions made on a case-by-case basis.Therefore,a collaborative approach involving expert diabetes and obstetric teams is crucial for the compre-hensive management of MODY pregnancies.

Facilitating effects of berberine on rat pancreatic islets through modulating hepatic nuclear factor 4 alpha expression and glucokinase activity

AIM： To observe the effect of berberine on insulin secretion in rat pancreatic islets and to explore its possible molecular mechanism. METHODS： Pdmary rat islets were isolated from male Sprague-Dawley rats by collagenase digestion and treated with different concentrations （1, 3, 10 and 30 μmol/L） of berberine or 1 μmol/L Glibenclamide （GB） for 24 h. Glucose-stimulated insulin secretion （GSIS） assay was conducted and insulin was determined by radioimmunoassay. 3-（4,5-Dimethylthiazol-2-yl）- 2,5-diphenyltetrazolium bromide （MTT） assay was performed to evaluate cytotoxicity. The mRNA level of hepatic nuclear factor 4 alpha （HAIF4α） was determined by reverse transcription polymerase chain reaction （RT-PCR）. Indirect immunofluorescence staining and Western blot analysis were employed to detect protein expression of HNF4α in the islets. Glucokinase （GK） activity was measured by spectrophotometric method. RESULTS： Berberine enhanced GSIS rather than basal insulin secretion dose-dependently in rat islets and showed no significant cytotoxicity on islet cells at the concentration of 10 μmol/L. Both mRNA and protein expressions of HNF4α were up-regulated by berberine in a dose-dependent manner, and GK activity was also increased accordingly. However, GB demonstrated no regulatory effects on HNF4α expression or GK activity. CONCLUSION： Berberine can enhance GSIS in rat islets, and probably exerts the insulinotropic effect via a pathway involving HNF4α and GK, which is distinct from sulphonylureas （SUs）.

Cost-Effectiveness Analysis of Oral Hypoglycemics for Type-2 Diabetes Mellitus at a Tertiary Care Hospital, Nepal

An observational follow-up study on 63 newly diagnosed Type-Ⅱ diabetic patients was conducted at Tribhuvan University Teaching Hospital, a tertiary care centre, Kathmandu, Nepal. The aims of the study were to determine demographics, prescribing patterns, drug costs and to analyze the effectiveness of different hypoglycemic therapies. The effectiveness of glucose control was analyzed by Wilcoxon signed rank test. The majority of patients (31%) fell into the age strata of 50-60 years. A total of 63 prescriptions were screened including anti-diabetics drugs and other drugs. The average number of drugs per prescription sheet was 2.72 ± 2.23. Eighty-two percent (82%) of the patients were recommended oral hypoglycemic agents. The prescribing frequency of biguanides was more than sulphonylureas. Biguanides were prescribed more frequently than sulfonylureas. The biguanide monotherapy group (p = 0.001) and the combination of biguanide and sulfonylureas (p = 0.028) were the most effective treatment methods, and the p-value of fasting blood glucose was the lowest at follow-up. Nearly 55% of patients receiving the combination achieved glucose control. In summary, this study reflects the best treatment for patients with diabetes. Future studies of larger patient populations need to evaluate existing treatment models to ensure good practice and quality of care.