Experiencia en el uso de insulina lispro durante el embarazo en mujeres con diabetes mellitus pregestacional / Use of insulin lispro during pregnancy in women with pregestational diabetes mellitus

Fundamento y objetivo: Evaluar la seguridad y eficacia de los análogos de insulina en comparación con insulina humana en mujeres embarazadas con diabetes pregestacional. Pacientes y métodos: Se recogieron datos de las embarazadas con diabetes tipo 1 o 2 que fueron atendidas en la Unidad de Diabetes y Embarazo entre enero de 1998 y abril de 2008 (n=351). Doscientas cuarenta y una pacientes fueron tratadas con insulina regular y NPH, y 110 fueron tratadas con diferentes combinaciones de insulinas incluyendo un análogo de insulina (la mayoría con NPH y lispro). Resultados:No hubo diferencias en cuanto a malformaciones congénitas entre ambos grupos (3,3 y 3,6%). El grupo con análogo de insulina tuvo una HbA1c ligeramente más alta que el grupo con insulina humana durante el primer trimestre (6,9 [1,1]% vs 6,6 [1,0]%; p=0,022) y necesitó menor dosis de insulina durante todo el embarazo. La hipoglucemia grave fue significativamente menos frecuente entre las mujeres tratadas con un análogo de insulina rápida (2,3 vs 10,0%; p=0,025). La hipoglucemia neonatal fue significativamente más frecuente en dicho grupo (34,9 vs 23,6%; p=0,043) en relación con el uso concomitante de bomba de insulina. Otras variables obstétricas y neonatales no fueron diferentes entre ambos grupos (AU)

Background and objective: To assess the safety and efficacy of insulin analogues versus human insulin in pregnant women with pregestational diabetes. Patients and methods: We collected data on pregnant women with type 1 or type 2 diabetes who were attended at the Diabetes and Pregnancy Unit between January 1998 and April 2008 (N=351). Two hundred and forty one patients were treated with regular insulin and NPH and 110 were treated with different combinations of insulins including an insulin analogue (most of them with NPH and lispro). Results:There was no significant difference in terms of congenital malformation rate between groups (3.3% and 3.6%). The group on insulin analogue had slightly higher mean HbA1c during the first trimester than the group on human insulin (6.6 [1.0]% vs 6.9 [1.1]%; P=0,022) and needed smaller insulin doses during whole pregnancy. Severe hypoglycaemia was significantly less frequent among women treated with a rapid insulin analogue (2.3 vs 10.0%; P=0,025). Neonatal hypoglycaemia was significantly more frequent in the group treated with a rapid insulin analogue (34.9 vs 23.6%; P=0.043) due to the concomitant use of an insulin pump. Other obstetric and neonatal variables were not different between the two groups. Conclusion: Our study shows that insulin analogues are safe during pregnancy in women with pregestational diabetes mellitus. Overall, glycaemic control, maternal and foetal outcome were similar to those with human insulin. The main advantage with respect to human insulin was to importantly reduce maternal severe hypoglycaemia (AU)

Use of insulin lispro during pregnancy in women with pregestational diabetes mellitus.

BACKGROUND AND OBJECTIVE: To assess the safety and efficacy of insulin analogues versus human insulin in pregnant women with pregestational diabetes. PATIENTS AND METHODS: We collected data on pregnant women with type 1 or type 2 diabetes who were attended at the Diabetes and Pregnancy Unit between January 1998 and April 2008 (N=351). Two hundred and forty one patients were treated with regular insulin and NPH and 110 were treated with different combinations of insulins including an insulin analogue (most of them with NPH and lispro). RESULTS: There was no significant difference in terms of congenital malformation rate between groups (3.3% and 3.6%). The group on insulin analogue had slightly higher mean HbA1c during the first trimester than the group on human insulin (6.6 [1.0]% vs 6.9 [1.1]%; P=0,022) and needed smaller insulin doses during whole pregnancy. Severe hypoglycaemia was significantly less frequent among women treated with a rapid insulin analogue (2.3 vs 10.0%; P=0,025). Neonatal hypoglycaemia was significantly more frequent in the group treated with a rapid insulin analogue (34.9 vs 23.6%; P=0.043) due to the concomitant use of an insulin pump. Other obstetric and neonatal variables were not different between the two groups. CONCLUSION: Our study shows that insulin analogues are safe during pregnancy in women with pregestational diabetes mellitus. Overall, glycaemic control, maternal and foetal outcome were similar to those with human insulin. The main advantage with respect to human insulin was to importantly reduce maternal severe hypoglycaemia.

Fetal myocardial morphological and functional changes associated with well-controlled gestational diabetes.

OBJECTIVE: To make a global evaluation of the fetal myocardial changes in a well-controlled gestational diabetic population. STUDY DESIGN: Twenty-four pregnant well-controlled diabetic patients were selected. Sixteen normal pregnancies were randomly collected as a control group. Measurements of morphological and functional myocardial parameters were performed. Data from the left ventricular outflow tract and peripheral Doppler data were obtained. RESULT: The thickness of the interventricular septum was increased in diabetic pregnancies (p < 0.001). Tricuspid E/A index was the only functional parameter showing a significant variation, with lower values in diabetic pregnancies. Doppler parameters from the left ventricular outflow tract and peripheral Doppler waveforms were similar between groups. CONCLUSION: A tendency towards interventricular septum hypertrophy was observed even in well-controlled diabetic pregnancies. Mild hypertrophic cardiac changes were not associated with abnormal cardiac function or signs of left ventricular outflow obstruction, although minor changes in right ventricular diastolic function were recorded.

Identification of eight new mutations in the GCK gene by DHPLC screening in a Spanish population.

Maturity onset diabetes of the young (MODY) is a genetically heterogeneous disorder characterized by autosomal dominant inheritance, altered function of pancreatic beta cells and early onset diabetes mellitus, usually before 25 years old. The prevalence of specific mutations of MODY genes differs considerably among different countries. In this study we analyzed 53 index cases from unrelated MODY families who are potential carriers of mutations in GCK gene. In addition, 122 relatives were also studied. We have identified eight new mutations in the GCK gene. One of them is a non-frameshift deletion involving Lysine 143. This amino acid is part of the conserved stretch of basic residues (KHKKL) which spans from residue 140 to 144. The non-frameshift deletion might implicate the affinity of GCK for GCKRP, and potentially the abnormal nuclear localization of GCK. Additional studies should be performed to confirm this possibility.

Diabetes y embarazo. Guía Asistencial 2006 / Diabetes and pregnancy. Clinical guidelines 2006

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Impaired fasting glucose and impaired glucose tolerance in women with prior gestational diabetes are associated with a different cardiovascular profile.

OBJECTIVE: The purpose of this study was to investigate the association of cardiovascular risk factors to impaired glucose tolerance (IGT) and to impaired fasting glucose (IFG) in women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We studied 838 women with prior GDM. Postpartum glucose tolerance status was classified as normal, IFG, IGT, IFG plus IGT, and diabetes according to the World Health Organization criteria. Postpartum BMI, waist circumference, blood pressure, triglyceride, cholesterol, and HDL cholesterol were assessed. RESULTS: BMI and blood pressure were significantly higher in women with IFG than in women with normal glucose status. BMI and waist circumference were significantly higher in women with IFG plus IGT than in women with normal glucose status. No differences were observed between women with IGT and normal glucose status. The prevalence of hypertension and obesity was significantly increased in IFG compared with normal glucose status. The prevalence of obesity and abnormal lipids was significantly increased in IFG plus IGT compared with normal glucose status. IGT showed no increased prevalence of cardiovascular risk factors. CONCLUSIONS: Traditional cardiovascular risk factors have a stronger association with isolated IFG than with isolated IGT in women with prior GDM.

Influencia del control metabólico preconcepcional en la evolución de la gestación de la paciente diabética / Role of glycosylated hemoglobin of preconception stage in diabetic pregnancy outcome

FUNDAMENTO: En la paciente diabética es preciso un control metabólico estricto en los momentos previos a la concepción y en las primeras semanas del embarazo para disminuir la morbilidad maternofetal. En nuestro estudio tratamos de comprobar si dicho control se relaciona o no con la aparición de abortos y de complicaciones neonatales. PACIENTES Y MÉTODO: Se examina a 69 pacientes diabéticas, 62 diabéticas tipo 1 y 7 diabéticas tipo 2, sometidas a control preconcepcional en la unidad de diabetes y embarazo en el período 1992-1998. Se llevó a cabo control metabólico en el período preconcepcional y a lo largo de la gestación. Se analiza la relación entre los parámetros de control metabólico en el período preconcepcional inmediato y la evolución de la gestación. RESULTADOS: Un total de 50 mujeres (72,6 por ciento; intervalo de confianza [IC] del 95 por ciento: 62-83 por ciento) finalizaron el control preconcepcional con embarazo. De estas pacientes, 8 (16 por ciento; IC del 95 por ciento: 5,5-27 por ciento) abortaron. No hubo diferencias entre las pacientes que abortaron y las que no, en relación con la hemoglobina glucosilada (HbA1c) con que terminaron el control preconcepcional, edad, tiempo de evolución de la diabetes y edad al diagnóstico, presencia de anticuerpos antitiroideos o de vasculopatía. En los 41 embarazos con feto único, hubo macrosomía en un 36,6 por ciento (IC del 95 por ciento: 21,2-52 por ciento), hipoglucemia neonatal en un 19,5 por ciento (IC del 95 por ciento: 6,9-32 por ciento) y malformaciones graves en un caso (2,4 por ciento; IC del 95 por ciento 2-7,4 por ciento). La HbA1c media (desviación estándar) de las 41 pacientes embarazadas con feto único al inicio del período preconcepcional fue del 7,6 (1,3) (IC del 95 por ciento: 7,1-7,9 por ciento) y al final de dicho período del 6,5 por ciento (0,7) (IC del 95 por ciento: 6,3-6,7 por ciento) (p < 0,0001). La HbA1c con que finalizaron el control preconcepcional fue del 6,8 por ciento (0,7) (IC del 95 por ciento: 6,5-7,2 por ciento) para el grupo con macrosomía frente al 6,3 por ciento (0,7) (IC del 95 por ciento: 6-6,6 por ciento) para el grupo sin macrosomía (p = 0,019). Dicha HbA1c evidenció una correlación lineal con el peso del recién nacido (r = 0,432; p = 0,014), el índice ponderal fetal (r = 0,450; p = 0,009), y con una puntuación de morbilidad (r = 0,458; p = 0,007). CONCLUSIÓN: Un mejor control metabólico en el período preconcepcional puede contribuir a disminuir la incidencia de macrosomía y de morbilidad neonatal (AU)