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Association of hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

World Journal of Diabetes 2019年第5期10卷 304-310页

作者： ananth u nayak Arun M A Vijay Radha Indusekhar Sushuma Kalidindi Venkata M Katreddy Lakshminarayanan Varadhan Combined Antenatal Diabetes Clinic University Hospital of North Midlands NHS Trust

BACKGROuND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is the recommended screening test in the united Kingdom as per National Institute for Health and Care Excellence(NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is *** To determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth *** All deliveries between 2009 and 2013 at the local maternity unit of the university hospital were reviewed. Of the total number of 24,154 women without preexisting diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study(n =3537). Blood samples for fasting plasma glucose(FPG), 2-hour plasma glucose(2-h PG) and HbA1 c had been obtained. Birth weight was categorised as low(≤ 2500 g), normal or Macrosomia(≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ~2 test and comparison between group means was by one-way *** Amongst the study cohort(3537 deliveries), 96(2.7%) women had babies with LBW(< 2500 g). Women who delivered a LBW baby had significantly lower FPG(4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies(8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L,whereas maternal age, 2-h PG ≥ 7.8 mm

关键词： Hypoglycemia Glucose tolerance test Low birth weight Pregnancy

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Hemoglobin A1c in early postpartum screening of women with gestational diabetes

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World Journal of Diabetes 2013年第3期4卷 76-81页

作者： Mahesh V Katreddy Joseph M Pappachan Sarah E Taylor Radha Indusekhar ananth u nayak Alan M Nevill the combined Antenatal Diabetes Clinic University Hospital of North Staffordshire NHS TrustStoke on Trent ST4 6QGUnited Kingdom Department of Endocrinology University Hospital of North Staffordshire NHS TrustStoke-on-Trent ST4 6QGUnited Kingdom Research Institute in Health Care Sciences University of WolverhamptonWolverhampton WV1 1LYUnited Kingdom

AIM:To assess the utility of hemoglobin A1c(HbA1c) in the early postpartum screening of women with gestational diabetes mellitus(GDM).METHODS:Over a 3 years period,HbA1c estimations were undertaken in addition to and simultaneously with the traditional oral glucose tolerance test(OGTT),in 203 women with GDM as a part of early postpartum screening for dysglycaemia,at 6 wk *** Health Organization criteria was used for diagnosing diabetes:fasting blood glucose(FBG) ≥ 7.0 mmol/Land/or 2-h postprandial blood glucose(PPBG) ≥ 11.1 mmol/L and/or HbA1c ≥ 48 mmol/mol;and impaired glycaemiastate:impaired fasting glucose 6.1-6.9 mmol/L and/or impaired glucose tolerance 7.8-11.0 mmol/L and/or HbA1c:42-47 mmol/***:Mean FBG,2-h PPBG and HbA1c were 4.9 ± 0.7 mmol/L,5.6 ± 2.0 mmol/L and 38 ± 5 mmol/mol ***,2-h PPBG and HbA1c detected 6(3%),7(3.5%) and 11(5.4%) cases of diabetes respectively,and 11(5.4%),25(12.3%) and 23(11.3%) cases of pre-diabetes state ***1c values ≥ 48 mmol/mol(≥ 6.5%) showed a diagnostic sensitivity of 71.4% and specificity of 98.5% for diabetes in comparison to OGTT in receiver operating characteristics curve *** HbA1c cut-off 44 mmol/mol,sensitivity and specificity were 100% and 92.3% respectively [area under the curve:0.98(95%CI:0.96-1.00)].Sensitivity and specificity for detecting high risk "impaired glycaemia" state [HbA1c 42 mmol/mol(6.0%)] were 28% and 80%,***:HbA1c level ≥ 48 mmol/mol(≥ 6.5%) has reasonable sensitivity and high specificity in comparison to OGTT for early postpartum screening of diabetes in *** 6 th week postpartum screening,if FBG is normal and HbA1c < 44 mmol/mol OGTT is not recommended.

关键词： Postpartum screening Glycated haemoglobin Gestational diabetes mellitus Impaired glycaemia

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Challenges of emerging adulthood-transition from paediatric to adult diabetes

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World Journal of Diabetes 2014年第5期5卷 630-635页

作者： Gurmit Gill ananth u nayak Julie Wilkins Jo Hankey Parakkal Raffeeq George I Varughese Lakshminarayanan Varadhan Department of Diabetes and Endocrinology university Hospital of North Staffordshire NHS Trust Stoke on Trent ST46QG united Kingdom Department of Paediatrics university Hospital of North Staffordshire NHS Trust Stoke on Trent ST46QG united Kingdom

Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi- disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.

关键词： Transition Adolescent Young adult Diabetes

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