Serum ferritin concentration in early pregnancy and risk of subsequent development of gestational diabetes: a prospective study

Background: elevated serum ferritin concentration is associated with insulin resistance and diabetes. Recently it has also been described in gestational diabetes mellitus [GDM]

Objective: a prospective study was done to determine whether there was a relationship between serum ferritin concentration in early pregnancy and the risk of GDM

Materials and Methods: a study was performed on 1,384 pregnant women with gestational age of 12-16 weeks. A blood sample was obtained for measurement of ferritin in the first trimester. Diagnosis of GDM was done by 75 gr oral glucose tolerance test between 24-28 wk

Results: women who developed GDM had a higher concentration of serum ferritin than women who did not develop GDM [p=0.01]. A ferritin concentration of 45 ng/ml was calculated to be the 75[th] percentile for healthy pregnant women. Considering this level 32% in the GDM group and 25.2%of normal subjects exhibited high ferritin levels [p=0.01]. The risk of GDM with these high levels of ferritin was 1.4-fold higher than that for subjects with lower concentrations. The Odds Ratio was 1.4 [95% CI= 1-1.87] [p=0.01]. After adjusted for age Odds Ratio was 1.38 [95% CI=1.02-1.86] [p=0.03] and after adjustment for pre-pregnancy Body Mass index, the adjusted odds ratio was 1.31 [CI= 0.96-1.79] [p=0.08]. After multivariable adjustment [age and body mass index], the adjusted odds ratio was 1.3 [0.95-1.8] [p=0.09]

Conclusion: high serum ferritin can be regarded as a significant risk factor for the development of gestational diabetes

effects of vitamin D supplementation on maternal and neonatal outcome: a randomized clinical trial

Background: Vitamin D supplementation during pregnancy has been supposed to defend against adverse gestational outcomes

Objective: This randomized clinical trial study was conducted to assess the effects of 50,000 IU of vitamin D every two weeks supplementation on the incidence of gestational diabetes [GDM], gestational hypertension, preeclampsia and preterm labor, vitamin D status at term and neonatal outcomes contrasted with pregnant women that received 400 IU vitamin D daily

Materials and Methods: 500 women with gestational age 12-16 weeks and serum 25 hydroxy vitamin D [25 [OH] D] less than 30 ng/ml randomly categorized in two groups. Group A received 400 IU vitamin D daily and group B 50,000 IU vitamin D every 2 weeks orally until delivery. Maternal and Neonatal outcomes were assessed in two groups

Results: The incidence of GDM in group B was significantly lower than group A [6.7% versus 13.4%] and odds ratio [95% Confidence interval] was 0.46 [0.24-0.87] [P=0.01]. The mean +/- SD level of 25 [OH] D at the time of delivery in mothers in group B was significantly higher than A [37.9 +/- 19.8 versus 27.2 +/- 18.8 ng/ml, respectively] [P=0.001]. There were no differences in the incidence of preeclampsia, gestational hypertension, preterm labor, and low birth weight between two groups. The mean level of 25 [OH] D in cord blood of group B was significantly higher than group A [37.9 +/- 18 versus 29.7 +/- 19ng/ml, respectively]. Anthropometric measures between neonates were not significantly different

Conclusion: Our study showed 50,000 IU vitamin D every 2 weeks decreased the incidence of GDM

Comparing effects of continuous insulin infusion with or without subcutaneous glargine insulin on glycemic control in diabetic patients undergoing coronary artery bypass graft [CABG]

Hyperglycemia is associated with increased morbidity and mortality in diabetic patients following coronary artery bypass grafting. Tight glycemic control in perioperative period can reduce these events. The goal of this study was to determine whether combination of continuous infusion and subcutaneous glargine as a basal insulin could improve glycemic control. Diabetic patients who were candidate for CABG were randomized to receive continuous insulin infusion with or without subcutaneous Glargine insulin for at least 72 hours which started 24 hours before surgery and continued for 48 hours after surgery. A total 84 subjects were required. In group A [n=45] continuous insulin infusion was used for glycemic control and in group B [n=39] we used continuous infusion with subcutaneous glargine insulin. Blood glucose level was significantly better in desirable range in group B in comparison to group A. Total mean blood glucose level in group A was 186.1 mg/dl and in group B was 174.3 mg/dl [P=0.008]. Frequency of hypoglycemia [blood glucose <70 mg/dl] was 0.66% in group A and 0.5% in group B that was similar [P=0.530]. The mean length of stay in the hospital was not different between two groups [P=0.288]. We found out that a combination of continuous insulin infusion and glargine insulin as main basal insulin can improve glycemic control in diabetic patients undergoing coronary artery bypass grafting

Comparison of the effects of sodium metavanadate and zinc sulfate supplementation on lipid and glucose in patients with type 2 diabetes

Type 2 diabetes mellitus is a chronic illness causing considerable morbidity and mortality. Enormous advances have been made in medical care but more people are still having tendency to use herbal or alternative remedies. This study is a randomized, controlled trial on type 2 diabetic patients. The subject consisted of 60 patients divided randomly into three groups and supplemented daily with 100 mg sodium metavanadate and 660 mg zinc sulfate or placebo for six weeks. The following were checked at baseline of the study and after six weeks: Body Mass Index [BMI], Blood Pressure [BP], Fasting Blood Sugar [FBS], 2-h postprandial glucose [2hpp], Glycated hemoglobin [HbA1c], Triglyceride [TG], Total Cholesterol [TC], Low-Density Lipoproteins, and High-Density Lipoproteins. Also HbA1c, BMI and BP were measured after 12 weeks to evaluate the long-term effects of drugs. Statistical analysis was performed using SPSS 11.5. Data of continuous variables are expressed as means +/- standard deviation. Differences between groups were assessed by the paired T-test. Comparison between three groups was done by Post Hoc Tests. Mean age of patients was 51.39 +/- 8.60 years. The results of this study show a significant decrease in TG [P=0.01] and BMI [P=0.03]. After 12 weeks, there was a significant decrease in BMI [P=0.01] in Sodium metavanadate group. Due to zinc sulfate administration, significant decrease was seen in TG [P=0.005], TC [P=0.02], LDL [P=0.01] and systolic blood pressure [P=0.02]. After 12 weeks, there was a significant decrease in HbA1c [P=0.04] with zinc sulfate consumption. Consumption of zinc sulfate in type 2 diabetic patients could be effective in lipid profile. It is recommended to use another vanadium compound to achieve better results

Incidence of gestational diabetes mellitus in pregnant women

Gestational Diabetes Mellitus [GDM] is the most common metabolic complications of pregnancy, and causes fetal mortality and morbidity. Therefore, early diagnosis of GDM is necessary to reduce maternal and fetal morbidity and to help prevent or delay the onset of type 2 diabetes This prospective study was carried out to determine the incidence of GDM in Yazd and to assess the effect of various contributing factors. One thousand and seventy one pregnant women were screened for GDM at 24-28 weeks. Initial screening was done by a glucose challenge test with 50 g glucose. If the 1-hour blood glucose level exceeded 130 mg/dl, then a 3-hour oral glucose tolerance test [OGTT] with 100g glucose was performed and diagnosis was established according to American Diabetes Association criteria. Three hundred and forty two [31.9%] women had an abnormal screening test and proceeded to oral glucose tolerance testing. The overall incidence of GDM was 10.2% [n=110]. Seventy six of subjects [7.1%] have one abnormal OGTT. There was a significant association between incidence of GDM and age, familial history of diabetes, BMI before pregnancy, parity, history of GDM, macrosomic baby, still birth during previous pregnancies and systolic and diastolic blood pressure. According to high incidence of GDM in our area we recommend screening for GDM in all pregnant women and modification of contributing factors in high risk women