Lower Plasma Ghrelin Levels are Found in Women with Diabetes-Complicated Pregnancies.

OBJECTIVE: To evaluate the associations of glycemic control and gestational age with ghrelin and proinsulin levels in cord blood and mothers' peripheral blood during pregnancy. METHODS: This is a cross-sectional comparative study of twenty-four pregnant women with gestational diabetes (GD), 18 with type 2 diabetes mellitus (T2DM), and 36 without diabetes, as well as their neonates. Levels of proinsulin, ghrelin, and glycated hemoglobin A1c (HbA1c) were measured from maternal blood during the last week before caesarian delivery and in neonatal umbilical cord blood samples. RESULTS: Mothers with GD and T2DM had significantly lower ghrelin levels compared to the healthy mothers (p<0.001). Maternal proinsulin was lower in women with GD than in women without diabetes (p<0.001). Proinsulin was significantly elevated in the neonates of women with GD and in women with HbA1c ≥6.5% (p<0.001). However, maternal ghrelin levels were higher (p=0.031) and neonate proinsulin levels lower in the pre-term offspring of mothers with GD (p=0.033). There was a negative correlation between HbA1c levels and birth weight (r=-0.407, p<0.001). CONCLUSION: Ghrelin levels were lower in pregnant women with diabetes, although pre-term birth appeared to reverse this trend in GD. Proinsulin levels were also low in pregnant women with diabetes and even lower in pre-term vs. at-term births. Both ghrelin and proinsulin levels were lower in pregnant women with diabetes and HbA1c of <6.5%. Thus, ghrelin participates in the adaptation to the caloric imbalance of diabetic pregnancy and may play a similar role in pregnancy-related complications, since high ghrelin concentrations may be necessary for normal fetal development.

Association between carotid intima-media thickness, buccodental status, and glycemic control in pediatric type 1 diabetes.

OBJECTIVE: To evaluate the association between carotid intima-media thickness, buccodental status, and glycemic control in patients with type 1 diabetes. METHODS: Cross-sectional study with consecutive cases attended in an outpatient clinic (n = 69). Medical and clinical dental history, HbA1c, lipid profile, treatment period, and daily insulin dosage were recorded. Sociodemographic data and anthropometrical measurements were obtained by standardized questionnaire. Doppler real-time ultrasound was performed by a single experienced vascular radiologist blinded to the study. Assessment of buccodental status was done by the Maxillofacial Unit of the Pediatrics Hospital, and an oral scrape culture was collected. RESULTS: The mean age was 11.7 ± 3.0 years, with diabetes 5.1 ± 3.3 years. Mean HbA1c was 8.5 ± 1.7%. Primary teeth were present in 52.2% and bacterial plaque in 94.2%. Buccodental conditions featured caries (63.8%), gingivitis (84%), and enamel demineralization (26.1%): white spot lesions (18.8%) and cavitated lesions (7.3%). Bacteria associated with caries were found in 44.1%. Patients in the highest HbA1c tertile (>8.5%) had greater frequency of buccodental conditions and were positive for Streptococcus mutans and Candida albicans; also, cIMT increased and vessel compliance decreased compared to those in the lowest tertile (<7.0%) (p < 0.05). CONCLUSIONS: More buccodental conditions and carotid intima-media thickness increase appeared in the patients with HbA1c level > 8.5%, suggesting onset of atherosclerosis. The correlation between buccodental status and HbA1c values may indicate the connection between inflammatory states of atherosclerosis and type 1 diabetes.

Carotid intima-media thickness in pediatric type 1 diabetic patients.

OBJECTIVE: To compare the carotid artery intima-media thickness in Hispanic pediatric type 1 diabetic patients against that in healthy control subjects matched for age, sex, height, and BMI. RESEARCH DESIGN AND METHODS: The evaluation consisted of anthropometric measurements, biochemical parameters, and a carotid Doppler and real-time ultrasound, in which carotid artery intima-media thickness (cIMT), peak systolic velocity, and end diastolic velocity were measured using standardized procedures. RESULTS: A total of 52 diabetic patients and 47 control subjects were included. No significant differences existed in the characteristics between case and control subjects (mean age 11.8 +/- 3.1 vs. 11.8 +/- 2.8 years, weight 42.2 +/- 15.3 vs. 44.2 +/- 14.4 kg, height 1.45 +/- 0.15 vs. 1.47 +/- 0.15 m, BMI 19.3 +/- 3.2 vs. 19.9 +/- 4.4 kg/m2, systolic blood pressure 99.1 +/- 9.9 vs. 99.6 +/- 9 mmHg, and diastolic blood pressure 63 +/- 6.4 vs. 62.0 +/- 5.7 mmHg, respectively). The mean duration of diabetes was 4.8 +/- 3.2 years (range 6-144 months), and the mean A1C was 8.6 +/- 1.6%. A significantly higher cIMT was found in the patients with type 1 diabetes (0.463 +/- 0.04 vs. 0.441 +/- 0.04 mm; P = 0.001). In contrast, both peak systolic velocity (107.1 +/- 22.8 vs. 119.3 +/- 19.2, P < 0.005) and end diastolic velocity (28.4 +/- 6.0 vs. 33.0 +/- 7.0, P < 0.001) were higher in the control subjects. CONCLUSIONS: Type 1 diabetes is associated with higher cIMT and decreased flow velocities in a Hispanic pediatric population.