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Objectives: The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance., Subjects and Methods: Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT)., Results: Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n=14), OGTT (n=93) or random glucose (n=1). Return was associated with lower parity rate (2 vs. 3, p<0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p=0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk-RR 2.41, p=0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p=0.045), insulin use during pregnancy (RR 2.37, p=0.014), and cesarean section (RR 2.61, p=0.015)., Conclusions: Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia.

Objectives: The aim of this study was to evaluate the rate of eGFR reporting in Southern Brazilian laboratories., Design and Methods: The eGFR automatic reporting, as assessed by Modification of Diet in Renal Disease (MDRD) and/or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-based equations, was evaluated in a representative cross-sectional sample. A standardized questionnaire to obtain this information was given out by mail or email., Results: Five-hundred fifty laboratories, evenly distributed in the different state regions, completed the questionnaire. The eGFR was automatically reported by 54 (9.8%) laboratories, and the MDRD was the most commonly used equation (94.5%). The Jaffe methods were the most employed technique (94%) to measure serum creatinine., Conclusion: The automatic eGFR reporting rate was unacceptably low, emphasizing the crucial role of educating medical teams and laboratories on the importance of having these tools available to optimize detection of renal disease and proper treatment., (© 2013.)

Objectives: The aim of this paper was to compare the agreement between creatinine measured by Jaffe and enzymatic methods and their putative influence on eGFR as calculated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation in healthy and diabetic individuals., Design and Methods: Cross-sectional study conducted in 123 adult southern Brazilians with GFR>60 mL/min/1.73 m² (53 patients with type 2 diabetes, 70 healthy volunteers). Mean age was 49±16 years (range of 19-86). Most were female (55%) and white (83%). Creatinine was measured by a traceable Jaffe method (Modular P, Roche Diagnostic) and by an enzymatic method (CREA plus, Roche/Hitachi 917). GFR was measured by the ⁵¹Cr-EDTA single-injection method., Results: Serum creatinine measured by the Jaffe and enzymatic methods was similar in healthy subjects (0.79±0.16 vs. 0.79±0.15 mg/dL, respectively, P=0.76), and diabetic patients (0.96±0.22 vs. 0.92±0.29 mg/dL, respectively, P=0.17). However, the correlation between the two methods was higher in the healthy group (r=0.90 vs. 0.76, P<0.001). The difference between Jaffe creatinine and enzymatic creatinine was <10% in 63% of cases in the healthy group and 40% of cases in the diabetes group (P=0.018). In the subset of patients with diabetes, eGFR based on enzymatic assay results showed better agreement with measured GFR than did eGFR based on Jaffe results., Conclusion: Jaffe and enzymatic creatinine methods show adequate agreement in healthy subjects, but in the presence of diabetes, the enzymatic method performed slightly better., (Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the influence of age of onset and duration of diabetes on the positivity of glutamic acid decarboxylase antibody (GADA) in South-Brazilian type 1 diabetes mellitus (DM) patients., Methods: GADA was evaluated in 92 patients with type 1 diabetes, in 147 gestational DM patients, and in 59 subjects with normal glucose tolerance., Results: Type 1 patients with positive GADA (N = 44, 48%) were older at the onset of diabetes (22 ± 9 versus 18 ± 10 y, P = 0.043) and had a shorter DM duration (12 ± 8 versus 19 ± 9 y, P < 0.001), as compared with negative GADA patients. A logistic regression with antibody positivity as the dependent variable and diabetes duration as the independent variable, showed that the shorter diabetes duration was related to the presence of the antibody with an odds ratio (OR) = 5.6; (CI 95% = 2.1-14.6); P < 0.001. Another model, with age at diagnosis as the independent variable, did not show any association with antibody positivity. However, analysing only men, a shorter DM duration (OR = 6.5; CI = 1.7-24.0; P = 0.006), and also a higher age at diagnosis (OR = 5.5; CI = 1.5-21.0; P = 0.01) were significantly related to the antibody positivity. The performance of GADA was similar in up to 15 y of duration of DM (P = 0.78), but significantly diminished with higher duration (P = 0.001)., Conclusion: GADA testing is a helpful tool in the diagnosis of type 1 DM starting in young adults and older individuals. Even though the positivity rate declines along the course of disease, it still provides useful information up to 15 y after the diabetes diagnosis.

Background: Glomerular filtration rate (GFR) is the best index of renal function, but age, gender and ethnicity can putatively affect its values. The aim of this study was to establish reference values for GFR in healthy Brazilian subjects while taking these factors into account., Methods: In this cross-sectional study, GFR was measured by the 51Cr-EDTA single-injection method. GFR reference values were developed according to CLSI Guidelines for Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory (CLSI C28 protocol)., Results: The age range of the 285 healthy individuals was 19 to 70  years, 57% were females, and GFR was 106 ± 18 mL/min/1.73 m(2). There was no difference between male and female GFRs (108 ± 18 vs. 104 ± 18 mL/min/1.73 m(2) respectively, P = 0.134), and reference values were therefore developed from the pooled sample. GFR values were lower in subjects aged ≥45 years as compared with those younger than 45 years (98 ± 15 vs.112 ± 18 mL/min/1.73 m(2), P < 0.001). Based on mean ± 2 SD, GFR reference values were 76 to 148 mL/min/1.73 m(2) for subjects younger than 45 years and 68 to 128 mL/min/1.73 m(2) for individuals older than 45 years, irrespective of gender., Conclusion: The age-adjusted reference intervals reported may be reliably adopted to evaluate kidney function, since they are based on recommended standards.

Background: The prevalence of chronic complications in type 2 diabetes mellitus (DM) is higher in black patients. The reason for this finding is still unknown. The objective of this study was to analyze the micro and macrovascular risk factor profile of type 2 DM patients without advanced diabetic nephropathy according to ethnicity., Methods: A cross-sectional multicentric regional study was conducted evaluating 780 patients. All patients were submitted to clinical and laboratory evaluation. Ethnicity was self-reported as white (n = 585) or black (n = 195)., Results: Black patients had lower triglycerides [115 (35-892) vs. 152 (34-1236) mg/dl; P <0.001] and higher HDL-cholesterol levels than whites (48.3 +/- 13.5 vs. 44.8 +/- 12.1 mg/dl; P = 0.002).White and black patients did not differ regarding fasting plasma glucose, A1c test, total and LDL cholesterol, blood pressure levels, insulin and HOMA-IR. There were no differences between groups regarding medication in use (statin: 18.5 vs. 19.3%, P = 1.000; fibrates: 1.5 vs. 0.7%, P = 0.680; angiotensin converting enzyme inhibitors: 39.5 vs. 43.8%, P = 0.375; acetylsalicylic acid: 29.9 vs. 27.7%, P = 0.673)., Conclusions: There were no differences in the prevalence of the classic micro and macrovascular risk factors between ethnic groups. The study of non-conventional risk factors and genetic factors is essential to understand determinants of the worst outcomes presented by the African-Brazilian population.

Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes mellitus characterized by autosomal dominant inheritance, early age of onset, and pancreatic beta cell dysfunction. Heterozygous mutations in at least seven genes can cause MODY. In the present study we investigated the relative prevalence of GCK (glucokinase) and HNF1alpha (hepatocyte nuclear factor 1alpha) mutations, the more frequent causes of MODY, in 13 South-Brazilian families with multiple cases of diabetes consistent with MODY. Heterozygous variants in GCK and HNF1alpha genes were observed respectively in one (7.7%), and six (46.2%) families. The six HNF1alpha variants are likely to cause diabetes in the families where they were observed. However, we could not ascertain whether the GCK Gly117Ser variant found in one family is a causal mutation. In conclusion, we have confirmed in a South-Brazilian population that HNF1alpha mutations are a common cause of monogenic diabetes in adults selected with strict clinical diagnostic criteria.