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Aims: In this study, we assessed changes in prevalence of gestational diabetes mellitus (GDM) in a region with diverse cultural backgrounds in Australia under the new World Health Organization (WHO) diagnostic criteria, with reference to the woman's ethnicity, age and pre-pregnant body mass index (BMI).Methods: We recorded results of all 75-gram oral glucose tolerance tests (OGTTs) performed on pregnant women between February and December 2015 together with their demographic details, and determined the prevalence of GDM based on the old Australian Diabetes in Pregnancy Society (ADIPS) and the new WHO criteria respectively.Results: Over that period, 2140 OGTTs were performed in 1725 pregnant women. The prevalence of GDM was 14.8% (255/1725 women) under old ADIPS criteria, but went up to 29.6% (510/1725) when using WHO criteria. An increase in prevalence was observed in all ethnic groups. Women from East/South-East Asia had the lowest increment (from 19.2 to 22.3%) while those from South Asia had the highest (from 22.0 to 44.4%). Prevalence of GDM was 45.9% amongst women with BMI>30kg/m2. For women from South Asia with BMI>30kg/m2, 70.0% would have GDM. Birth outcomes were similar between women who would have GDM under WHO but not the old ADIPS criteria (untreated), and those who were treated for GDM under old criteria.Conclusion: In parts of Australia, adoption of WHO diagnostic criteria could result in doubling of the prevalence of GDM, depending on the women's demographic characteristics. Women from South Asia or those with obesity should be targeted for pre-pregnant lifestyle intervention. [ABSTRACT FROM AUTHOR]

Aims: The oral glucose tolerance test (OGTT) is routinely performed in most pregnancies; however, there are few studies which document the experience of taking this test. We assessed the experience of pregnant women during an OGTT.Methods: This cross-sectional study included 152 women (24-32 weeks' gestation) and assessed their knowledge, anxiety (Spielberg anxiety inventory test-STAI), and physical pain (0-10 visual analog scale) during the OGTT. The Friedman test was used to compare pain scores over time.Results: 61 (40%) participants did not know why they were doing the OGTT and 73 (48%) women had high state-anxiety levels (STAI ≥ 41 points, 20-80 scale). Participants had mild to moderate pain scores immediately after the first and second blood draws (3.9 ± 2.7 and 3.8 ± 2.3, respectively) that decreased significantly after the third blood draw (2.8 ± 2.4, P < 0.001). Nearly half (n = 71, 47%) of the participants were very or extremely bothered with having to drink the glucose solution.Conclusions: The OGTT was associated with high levels of anxiety and mild to moderate physical pain. Ingestion of the glucose solution was perceived as the most difficult part of the test. Good strategies can help to mitigate some of these negative experiences while undergoing an OGTT. [ABSTRACT FROM AUTHOR]

Aims: Accelerated atherosclerosis is the major cause of mortality in diabetic patients and increased oxidative stress probably plays an important role in its development. The aim of our study was to evaluate the relationship between thioredoxin-interacting protein (TXNIP) as an oxidative stress parameter and carotid artery intima-media thickness (CIMT) as an indicator of atherosclerosis in patients with early-state diabetes and impaired glucose tolerance.Methods: The study was a retrospective analysis of 90 patients with impaired glucose regulation (IGR), 80 patients with early Type 2 diabetes mellitus (T2DM), and 80 subjects with normal glucose tolerance (NGT) as the control group. It was conducted at the endocrine out-patient clinic and hospital department of Cangzhou Central Hospital (Cangzhou, China) from June 2012 to Oct. 2013. Plasma TXNIP was measured to evaluate the level of oxidative stress. CIMT was assessed by carotid artery ultrasonography. Soluble vascular cell adhesion molecule-1 (sVCAM-1), a risk indicator for endothelial dysfunction, was also measured.Results: Compared to the NGT control, patients with IGR showed significantly higher plasma levels of TXNIP (P<0.05). Compared to the IGR group, patients with T2DM also had significantly higher plasma levels of TXNIP (P<0.05). CIMT was significantly higher in the subjects with abnormal glucose metabolism than in the NGT group (P<0.05). CIMT showed positive correlations with both TXNIP and sVCAM-1 levels (r = 0.56 and r = 0.49, respectively, both P<0.01).Conclusions: The present study showed that plasma levels of TXNIP may be a useful predictor of subclinical atherosclerosis in Type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To compare the associations of three glucose measures with coronary heart disease (CHD) and total mortality and to examine how these associations changed over time. Methods: Prospective study of 1774 adults (median age 68 years, 56% female). Fasting plasma glucose (FPG), 2h post-challenge glucose (2hPG), and glycohemoglobin (GHb) were obtained in 1984–1987. Mortality data was obtained for all participants. Multivariable Cox models examined the association of baseline glucose measures with mortality during sequential periods of follow-up (0–6, 7–12, and 13–18 years), adjusting for age, sex, blood pressure, LDL-cholesterol, smoking, exercise, and aspirin use. Results: 854 (48%) participants died during follow-up. In adjusted models, only GHb was associated with total mortality over the entire 18 years (p =0.007). In analyses of mortality in successive six year time intervals, the association of GHb and total mortality was only significant in years 0–6. For each 1% increase in GHb, the hazard ratio for death in years 0–6 was 1.14 (95% CI 1.01–1.30, p =0.04) and the hazard ratio for CHD death was 1.26 (95% CI 1.03–1.55, p =0.02). Stratification by sex and exclusion of participants with diabetes did not change our results. Conclusions: Higher levels of GHb were associated with increased total and CHD mortality within the first six years independent of cardiac risk factors. Though further research is needed, this supports the hypothesis that early glycemic control may affect mortality outcomes. [Copyright &y& Elsevier]

This prospective study was carried out to determine the prevalence of gestational diabetes mellitus (GDM) in Kashmiri women and to assess the effect of various demographic factors. Two thousand pregnant women (divided into groups A and B, being the first and last 1000 consecutive women) attending various antenatal clinics in six districts of Kashmir valley were screened for GDM by 1 h 50 g oral glucose challenge test. Four hundred and fourteen (20.8%) women (216 from group A and 198 from group B) had an abnormal screening test and proceeded to oral glucose tolerance testing. Women from group A had a 3 h 100 gram oral glucose tolerance test (OGTT) and GDM was as classified by Carpenter and Coustan. A 2 h 75 g OGTT was performed on group B subjects and WHO criteria applied for diagnosis of GDM. The overall prevalence of GDM was 3.8% (3.1% in group A versus 4.4% in group B—P-value 0.071). GDM prevalence steadily increased with age (from 1.7% in women below 25 years to 18% in women 35 years or older). GDM occurred more frequently in women who were residing in urban areas, had borne three or more children, had history of abortion(s) or GDM during previous pregnancies, had given birth to a macrosomic baby, or had a family history of diabetes mellitus. Women with obesity, hypertension, osmotic symptoms, proteinuria or hydramnios had a higher prevalence of GDM. [Copyright &y& Elsevier]

Aims: To explore the glucose-overload hypothesis of artefactual gestational diabetes (GDM) diagnosis in shorter women during oral glucose tolerance testing (OGTT), by investigating associations between height and maternal glycemia; and GDM and pregnancy complications in height-groups.Methods: Women from GUSTO (n = 1100, 2009-2010) and NUH (n = 4068, 2017-2018) cohorts underwent a mid-gestation two and three time-point 75 g 2-hour OGTT, respectively. GDM-related complications (hypertensive disorders of pregnancy, preterm delivery, emergency cesarean section, neonatal intensive care unit admission, macrosomia, birthweight) were compared within shorter and taller groups, dichotomized by ethnic-specific median height.Results: Using WHO-1999 criteria, 18.8% (GUSTO) to 22.9% (NUH) of women were diagnosed with GDM-1999; and by WHO-2013 criteria, 21.9% (NUH) had GDM-2013. Each 5-cm height increment was inversely associated with GDM-1999 (adjusted odds ratio [aOR, 95% CI] = 0.81 [0.76-0.87], 2-h glycemia (adjusted β [aβ, 95% CI] = -0.171 mmol/L [-0.208, -0.135]) and 1-h glycemia (aβ = -0.160 mmol/L [-0.207, -0.112]). The inverse association between height and 2-h glycemia was most marked in "Other" ethnicities (Eurasians/Caucasians/mixed/other Asians) and Indians, followed by Chinese, then Malays. Compared with non-GDM, GDM-1999 was associated with preterm delivery (aOR = 1.76 [1.19-2.61]) and higher birthweight (aβ = 57.16 g [20.95, 93.38]) only among taller but not shorter women.Conclusions: Only taller women had an increased odds of GDM-related pregnancy complications. An artefactual GDM diagnosis due to glucose-overload among shorter women is plausible. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The 50g-glucose challenge test (GCT) is commonly used for screening of gestational diabetes (GDM) in low risk pregnant women. If elevated, glucose tolerance test is performed to confirm the diagnosis. In this study, we evaluated whether GCT alone is sufficient to diagnose GDM when the GCT result is very elevated. Research design and methods: Using a database of 62877 pregnancies over 10 years, the positive predictive value (PPV) of GCT for GDM was assessed using different GCT cut-off values. Results: At a glucose cut-off value of 11mmol/l, the PPV for GDM was 85.3%, based on the subsequent GTT. This increased to 95.3% when the cut-off was 12mmol/l. Furthermore, the PPV was consistently higher when GCT was performed in the morning. Conclusion: We concluded that the diagnosis of GDM can be made when the glucose level following GCT is very elevated, and GTT need not to be performed for confirmation of GDM. The timing of GCT also affected PPV for GDM, and has implications on the diagnostic value of the test. [Copyright &y& Elsevier]

Abstract: Screening for gestational diabetes mellitus (GDM) with a 50g glucose challenge has become standard practice in obstetrics. However, there are little data comparing the recommended cut-off points of 130 or 140mg/dl in Asian populations. To determine the optimal threshold for the screening test in an Iranian population, we examined data from 412 pregnant women who underwent both the screening glucose challenge and diagnostic glucose tolerance tests, between the 24th and 28th week''s gestation. Receiver operator curve characteristics suggested that 140mg/dl was the optimal threshold for the screening test for GDM in our population. Whilst a 130mg/dl cut-off point increases the sensitivity of the test, the cost implications may be prohibitive in developing countries. [Copyright &y& Elsevier]

Our aim was to evaluate attendance for postpartum glucose testing among women attending five antenatal centres with a diagnosis of GDM in the preceding pregnancy. A central, regional coordinator who made verbal and written contact with each individual facilitated a favourable recall rate of 75%. [ABSTRACT FROM AUTHOR]