Retrospective analysis of OGTT results of 26 558 pregnant women / 公共卫生与预防医学

Objective To investigate the prevalence of gestational diabetes mellitus (GDM) among pregnant women in Wuhan, and to explore the application value of oral glucose tolerance test (OGTT) results in the screening, diagnosis and treatment of GDM. Methods A retrospective analysis was carried out on the OGTT results of 26 558 pregnant women from Hubei Maternal and Child Health Hospital from January 2018 to December 2018. Results (1) A total of 1 754 cases were diagnosed with GDM, with a positive rate of 6.60%. Among them of 776 had fasting blood glucose ≥5.1mmol/L, 880 had 1-hour blood glucose ≥10.0mmol/L, and 798 had 2-hour blood glucose ≥8.5mmol/L. (2) The positive rates of fasting blood glucose, 1-hour blood glucose, and 2-hour blood glucose in the ≥35-year-old age group were all over two times higher than those in the <35-year-old age group (all P<0.01). (3) The ratio of people with single-point positive, two-point positive and three-point positive was 7:2:1. (4) FBG, 1-hour blood glucose and 2-hour blood glucose concentrations were all positively correlated with each other (all P＜0.01). Among these, the positive correlation between 1-hour blood glucose and 2-hour blood glucose was the most significant (r=0.618, P＜0.01). Conclusions The incidence rate of GDM among pregnant women in Wuhan reached 6.60%, and the prevalence in pregnant women over 35 years old was significantly higher. Blood glucose level during pregnancy should be monitored for early detection and intervention to prevent the development of GDM. The relationship between blood glucose concentrations at different time points in the OGTT test had reference value for clinical diagnosis and treatment.

Analysis of risk factors and establishment of prediction model for post transplantation diabetes mellitus in renal transplant recipients / 器官移植

Objective To analyze the risk factors for the occurrence of post transplantation diabetes mellitus (PTDM) in renal transplant recipients, establish a prediction model for PTDM and evaluate its prediction value. Methods Clinical data of 915 renal transplant recipients were retrospectively analyzed. According to the occurrence of PTDM, all recipients were divided into the PTDM group (n=78) and non-PTDM group (n=837). The main indexes of recipients were collected. The risk factors for the occurrence of PTDM in renal transplant recipients were analyzed by univariate and multivariate analysis. The prediction model for PTDM was established and its prediction value was evaluated. Results Family history of diabetes mellitus, body mass index (BMI), preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin were the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM was logit (P)=2.199×family history of diabetes (yes=1, no=0)+0.109×BMI+0.151×2 h postprandial blood glucose (mmol/L)+0.508×glycosylated hemoglobin (%)-9.123. The results of receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of these 4 predictors combined for predicting PTDM in renal transplant recipients was 0.830 [95% confidence interval (CI) 0.786-0.873], the cut-off value was 0.0608, the sensitivity was 0.821, the specificity was 0.700, and the Youden index was 0.521 (P < 0.05). Conclusions Family history of diabetes mellitus, BMI, preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin are the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM combined with4 predictors yield relatively high prediction value for PTDM.

Effect of Shenqi Maiwei Dihuangtang Combined with Acarbose on Blood Glucose Level，Body Mass Index and Abdominal Fat Thickness in Patients with Impaired Glucose Tolerance / 中国实验方剂学杂志

Objective:To explore the effect of Shenqi Maiwei Dihuangtang （SQMWDH） combined with acarbose on the level of 2-hour oral glucose tolerance test （2 h OGTT），body mass index （BMI）， and abdominal fat thickness in patients with impaired glucose tolerance （IGT）. Method:A total of 130 patients with IGT admitted to the First People's Hospital of Shuangliu District from February 2017 to January 2019 were divided into a control group and a treatment group by a random number table. All patients received conventional treatment， such as diet regulation and exercise. The patients in the control group received additional oral administration of acarbose，while those in the treatment group were treated with SQMWDH based on the control group. Fasting blood glucose （FBG），2 h OGTT， and glycated hemoglobin A1c（HbA1c）levels were measured by the blood glucose meter. Abdominal fat thickness was measured by ultrasound tomography，and serum total cholesterol （TC），triglyceride （TG），adiponectin， and leptin levels in fasting venous blood were measured. Result:After treatment，the total response rate of the treatment group was higher than that of the control group （95.00% vs. 81.67%， <italic>χ</italic>²=5.175，<italic>P</italic><0.05）. Before treatment，there was no significant difference in FBG，2 h OGTT，HbA1c， BMI，waist circumference，abdominal fat thickness，TC，TG，adiponectin， and leptin of IGT patients between the two groups. After treatment，the levels of FBG，2 h OGTT，HbA1c， BMI，waist circumference，abdominal fat thickness，TC，TG，and leptin of IGT patients were lower than those before treatment in both groups （<italic>P</italic><0.05）， and the treatment group was inferior to the control group（<italic>P</italic><0.05，<italic>P</italic><0.01）. The level of adiponectin after treatment was higher than that before treatment in both groups （<italic>P</italic><0.05），and the treatment group was superior to the control group （<italic>P</italic><0.05）. Conclusion:SQMWDH combined with acarbose is effective in treating IGT patients by effectively reducing 2 h OGTT and abdominal fat thickness to alleviate obesity and improve the constitution of patients.

Inhibition of puerarin on sodium-dependent glucose cotransporters 2 to promote urinary glucose excretion / 药物评价研究

Objective To study that puerarin can prevent the renal glucose reabsorbtion process and promote urinary glucose excretion by inhibiting sodium-dependent glucose cotransporters 2 (SGLT2) to reduce plasma glucose in diabetes rats.Methods Molecular docking was carried out on puerarin and the obtained SGLT2 complexes through homology modeling method with dapagliflozin as positive control.Chinese hamster ovary (CHO) cells stably expressing human SGLT2 and [14C]-MethylD-glucopyranoside ([14C]-AMG) as the substrate were used in vitro for the transport assays and IC50 for SGLT2.The antihyperglycemic activity ofpuerarin was operated by oral glucose tolerance test (OGTT) and urinary glucose excretion (UGE) test in rats.Results Puerarin was identified as the substrate of SGLT2 through molecular docking,but the overall effect was not as strong asdapagliflozin.In vitro experiments showed that puerarin can strongly inhibit hSGLT2,the maximum effect was about 84％ with the half inhibitory concentration (IC50) of 0.40 mol/L.OGTT results showed that glucose inhibition rates of puerarin 10,30,60 and 120 mg/kg doses were 5.1％,6.5％,16％,and 22％ respectively,in a dose-dependent manner.In the UGE experiment,the urine sugar increased with the increase of puerarin dose.Compared with model group,the 30,60,and 120 mg/kg dose groups had significant difference (P ＜ 0.05 and 0.01).Conclusion Puerarin exhibited antiglycemic activity through inhibiting SGLT2 and was considered to be a new lead compound of SGLT2 inhibitors.

Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus

ABSTRACT Objective Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). Subjects and methods The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients’ ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. Results From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Conclusion Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.

Simulation of Oral Glucose Tolerance Tests and the Corresponding Isoglycemic Intravenous Glucose Infusion Studies for Calculation of the Incretin Effect

The incretin effect, which is a unique stimulus of insulin secretion in response to oral ingestion of nutrients, is calculated by the difference in insulin secretory responses from an oral glucose tolerance test (OGTT) and a corresponding isoglycemic intravenous glucose infusion (IIGI) study. The OGTT model of this study, which is individualized by fitting the glucose profiles during an OGTT, was developed to predict the glucose profile during an IIGI study in the same subject. Also, the model predicts the insulin and incretin profiles during both studies. The incretin effect, estimated by simulation, was compared with that measured by physiologic studies from eight human subjects with normal glucose tolerance, and the result exhibited a good correlation (r > 0.8); the incretin effect from the simulation was 56.5% +/- 10.6% while the one from the measured data was 52.5% +/- 19.6%. In conclusion, the parameters of the OGTT model have been successfully estimated to predict the profiles of both OGTTs and IIGI studies. Therefore, with glucose data from the OGTT alone, this model could control and predict the physiologic responses, including insulin secretion during OGTTs and IIGI studies, which could eventually eliminate the need for complex and cumbersome IIGI studies in incretin research.

Respuesta de glucosa e insulina: Comparación entre dos tipos de desayunos y prueba de tolerancia oral con 75g. De glucosa

Objetivos: Comparar las respuestas glucémicas e insulinémicas de dos desayunos, con la prueba estándar de tolerancia a la glucosa oral (PTGO). Métodos: En 14 sujetos sanos se realizó la PTGO, con 75 gr de glucosa. Luego, con un intervalo de una semana, se efectuaron las pruebas de tolerancia con dos tipos de desayunos, elaborados con alimentos de uso común en nuestro medio y cuya principal diferencia fue el tipo de carbohidrato. A los 0, 30, 60 y 120 minutos se cuantificó la concentración de glucosa, por el método de glucosa-oxidasa y la insulina por radioinmunoanálisis. Se calculó el área bajo la curva para la respuesta de glucosa e insulina. Para el análisis estadístico se aplicó un análisis de varianza y las pruebas post-test, para determinar la diferencia entre los grupos. Resultados: Se observó que la respuesta de glucosa con el desayuno 1 fue significativamente menor (p<0,05) a los 30 y 60 minutos y con el desayuno 2 a los 60 minutos (p<0.05) en comparación con la obtenida con la PTGO. El área bajo la curva (ABC) de glucemia no fue diferente entre los 2 tipos de desayunos y fue significativamente menor que con la PTGO. La respuesta de insulina fue significativamente mas baja a los 120 minutos (p<0.05) con el desayuno 1 (arepa) en relación con el desayuno 2 (pan) y con la PTGO. El ABC de insulinemia no fue diferente entre los desayunos y la PTGO. Conclusiones: La respuesta de glucemia postprandial con mezcla de nutrientes es menor que la obtenida con la PTGO, por lo que no debe ser usada con fines diagnósticos.

Objectives: To compare the glycemic and insulinemic responses of two breakfasts with the standard oral glucose tolerance test (OGTT). Methods: In 14 healthy subjects, the OGTT with 75 g of glucose was performed. After an interval of one week, tolerance tests with two types of breakfasts elaborated with common food in our country, and whose main difference was the type of carbohydrate, were carried out. At 0, 30, 60 and 120 minutes, glucose concentration by the glucose oxidase method and insulin by radioimmunoassay were measured. Areas under the curve (AUC) for glucose and insulin response were calculated. An analysis of variance test was applied to determine the difference between the groups. Results: It was noted that the glucose response to breakfast 1 was significantly lower (p <0.05) at 30 and 60 minutes and to breakfast 2 at 60 minutes (p <0.05) compared with that obtained with OGTT. The glucose AUC was not different between the 2 types of breakfasts and was significantly lower than the obtained with OGTT. The insulin response was significantly lower at 120 minutes (p <0.05) with breakfast 1 (arepa) in relation to breakfast 2 (bread) and the OGTT. The insulin AUC was not different between breakfasts and the OGTT. Conclusions: The postprandial blood glucose response to mix of nutrients is lower than that obtained with the OGTT, so it should not be used for diagnostic purposes.

Significance of Postprandial Glucose Test for the Diagnosis of Type 2 Diabetes / 中国慢性病预防与控制

Objective To examined the relationship between the Fast Plasma Glucose(FPG) and the Postprandial Plasma Glucose(PPG) by analyzing 3 588 OGTT and IRT,and assessed the role of PPG in the diagnosis of type 2 diabetes.Methods Data of OGTT and IRT in 3 588 patients from 2000-Jan to 2007-June were collected and the distribution of the patients evaluated with cut-points of fasting plasma glucose by 5.6 mmol/L,6.1 mmol/L & 7.0 mmol/L and postprandial plasma glucose by 7.8 mmol/L and 11.1mmol/L were analyzed.T-test and corrected t-test of two independent samples have been done with SPSS 11.5.Results By WHO standard,3 097 T2DM were diagnosed.Of 2654 T2DM patients diagnosed by FPG≥7.0 mmol/L,54 patients showed 2 h PG0.05).202 cases were NGT(but hyperinsulinemia and/or delayed insulin secretion were found in 113 of them,55.94%).Other 289 cases were IFG and/or IGT.In the 291 cases diagnozed with 1 h PG≥11.1 mmol/L and 2 h PG