Maternal residual beta-cell function and the outcome of diabetic pregnancy.

Preservation of own insulin production (residual pancreatic beta-cell function) has been shown to have a beneficial effect on glycemic control in insulin-dependent diabetic subjects, and its total lack has been suggested to be an independent risk factor during diabetic pregnancy. We studied the influence of residual beta-cell activity on the glucose control and the outcome of pregnancy in 29 diabetic women by sequentially measuring gestational postprandial plasma C-peptide (CPR) levels, diurnal blood glucose curves and blood glycosylated hemoglobin (Hb A1c) and by analyzing the morbidity and mortality of the offsprings. The 9 diabetics with moderate own insulin secretion (CPR levels over 1.0 microgram/l, White classes B and C, later referred to as group I) had significantly better glucose control than the remaining 20 subjects with lower CPR values (White classes C, D and NF, later referred to as group II) (figure 1, table I). There were two intrauterine deaths, both in group II. These deaths (one caused by multiple congenital contracture syndrome and the other by severe intrauterine growth retardation without any evident cause) could not be straightly connected with diabetes. Respiratory distress syndrome was seen in group II only. There was no other significant difference in the neonatal morbidity between the two groups (table II). All mothers of RDS infants were in White class NF where the birthweight was also smaller than in classes B and C. These were the only differences in neonatal morbidity between the White classes (table III). In conclusion, moderate residual beta-cell function seemed to be clinically important in maintaining strict glucose control during gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

Residual B-cell function and glycaemic control in diabetic pregnancy.

Serum C-peptide immunoreactivity (CPR), mean blood glucose and blood glycosylated haemoglobin Hb A1c were measured in 23 insulin-dependent diabetic women at 11-12, 23-24, 33-34 and 37-38 gestational weeks in order to elucidate changes in residual B-cell function during pregnancy and their influence on the glycaemic control. CPR values generally increased at the 23-33 gestational weeks, with a significant difference between the mean of the peak values and the mean of the values at the first admission. When the subjects were divided into two groups on the basis of the residual B-cell function at the first admission, the glycaemic control during pregnancy was significantly better in those with higher residual B-cell activity. The overall prevalence of marked residual B-cell activity was higher than previously reported in non-pregnant insulin-dependent diabetic subjects. The results indicate clinically important enhancement in residual B-cell function during pregnancy. The mechanism of this improvement is poorly known although the more strict management of diabetes during gestation may be an important factor.

Cardiovascular response to exercise in young women with insulin-dependent diabetes mellitus.

To evaluate the cardiovascular response to exercise in diabetes, a graded maximal exercise test was performed on 50 women with insulin-dependent diabetes mellitus, aged 15-40 years, and on 15 healthy women in the same age group. The diabetic subjects were divided into 3 groups according to the duration of disease: group 1: 0-5 years, group 2: 6-14 years, group 3: 15-29 years. The maximal work load was lower in the diabetic subjects than in the controls. The difference was most marked between the controls and group 3 (167 +/- 14 W vs 132 +/- 23 W, p less than 0.001). The maximal heart rate was lower in groups 2 and 3 than in the controls (173 +/- 16 vs 187 +/- 11, p less than 0.05). The diabetic women with long-standing disease had a slightly higher blood pressure response to exercise resulting in comparable rate-pressure products in the study groups. Two diabetic women in group 3 and one healthy woman had 1 mm ST depressions during the test without appearance of arrhythmias or chest pain. These studies suggest that exercise tolerance is reduced in young diabetic women, especially in patients with long-standing disease. The frequency of pathological exercise ECGs does not, however, seem to be increased.