Olimpia Bitterman

Thyroid autoimmunity is very frequent in women of reproductive age and is associated with many adverse pregnancy outcomes; also, diabetes mellitus in pregnancy, of any type, is associated to many complications. In type 1 diabetes, the prevalence of thyroid autoimmunity is higher than in healthy population. Instead, the association of thyroid autoimmunity with other types of diabetes is less clear; however, there are some studies claiming that the prevalence is higher in gestational diabetes too. Poor data about type 2 diabetes in pregnancy are available. It is also unclear how diabetes and thyroid function influence each other and if levothyroxine therapy is necessary in pregnancy with positive autoimmunity but normal thyroid function. The aim of this article was to find in the literature studies on thyroid autoimmunity in different types of diabetes in pregnancy, in order to detect any difference in prevalence. Data were found through pubmed database from 1990 to 2013. Several studies found a higher prevalence of thyroid autoimmunity in GDM compared to healthy controls; therefore it would be appropriate to extend screening for thyroid diseases to women with GDM. More studies are needed on the possible requirement of therapy for thyroid autoimmunity when the function is normal.

Objective: evaluate the metabolic impact and metrics of the new hybrid closed loop insulin delivery system on the quality of life in patients with type 1 diabetes. Methods: Metrics obtained with CGM with >80% of CGM readings over a 4-week period in real life: Time in Range (TIR%) [target 70-180 mg/Dl (3.9-10mmol/L) ], Time Above Range (TAR%) [ (>180mg/dl (>10mmol/L) ], Time Below Range (TBR%) [<70mg/dl (3.9mmol/L) ], CV (<36%) referred to 30 consecutive days. Statistics ANOVA post-hoc Bonferroni/Tukey tests were used as appropriate. Results: Fifty-two type 1 diabetic patients (38F; 14M) on SAP therapy aged 45.5±12.0 yrs, BMI 27.7±15.5 kg/m2, duration of diabetes 24.6±13.4 yrs, were studied. In these patients, who were treated with total daily insulin (TDI) 0.55±0.16 UI/kg/day, basal 0.27±0.UI/kg/day, bolus 0.28±0.UI/kg/day, mean glucose was 158.6 mg/dl (8.8 mmol/L) (121-250) , TIR% 62.4±13.5%, TBR% 4.6±4.5%, TAR% 33.0±15.1%, CV% 36.1±5.2%. Only 19 of 52 patients reached TIR≥70%. A subgroup of 30 patients (21F; 9M) , mean age 44.2±12.2 yrs, BMI 29.2±19.7 kg/m2, duration of diabetes 24.2±13.6 yrs, HbA1c 7.7±1.4%, TDI 0.59±0.14 UI/kg/day, basal 0.30 UI/kg/day, bolus 0.29 UI/kg/die, shifted from SAP to HCL. CGM Metrics regarding our patient's glucose status at baseline and 1, 2, 3, 6 and 12 months after, showed that: mean sensor BG decreased from 158.6 mg/dl (8.8 mmol/L) at baseline to 144.3 mg/dl (8.2mmol/L, p<0.05) at the 2nd month, p<0.05. TIR% significantly increased from 62.4% (TBR 4.6%, TAR 33.0%, CV 36.1%) to 76% at the first month, to 76.5% (TBR 2.6%, TAR 20.9%, CV 33%) at the 3rd month, p<0.05. After 12 months (n=10) TIR% was 73.4±8.8%, TBR% 2.7±3.1%, TAR% 23.9±7.2%, CV% 35.5±5.2%, p<0.05. Conclusions: HCL improves glucose status increasing TIR% and reducing TAR%, TBR% and glycemic variability, improving the quality of life. Disclosure A.Convertino: None. C.Giuliani: None. O.Bitterman: None. A.Napoli: None.

Objective: evaluate the metabolic impact and metrics of the new hybrid closed loop insulin delivery system on the quality of life in patients with type 1 diabetes. Methods: Metrics obtained with CGM with >80% of CGM readings over a 4-week period in real life: Time in Range (TIR%) [target 70-180 mg/Dl (3.9-10mmol/L) ], Time Above Range (TAR%) [ (>180mg/dl (>10mmol/L) ], Time Below Range (TBR%) [<70mg/dl (3.9mmol/L) ], CV (<36%) referred to 30 consecutive days. Statistics ANOVA post-hoc Bonferroni/Tukey tests were used as appropriate. Results: Fifty-two type 1 diabetic patients (38F; 14M) on SAP therapy aged 45.5±12.0 yrs, BMI 27.7±15.5 kg/m2, duration of diabetes 24.6±13.4 yrs, were studied. In these patients, who were treated with total daily insulin (TDI) 0.55±0.16 UI/kg/day, basal 0.27±0.UI/kg/day, bolus 0.28±0.UI/kg/day, mean glucose was 158.6 mg/dl (8.8 mmol/L) (121-250) , TIR% 62.4±13.5%, TBR% 4.6±4.5%, TAR% 33.0±15.1%, CV% 36.1±5.2%. Only 19 of 52 patients reach...

The aim of this study was to assess carbohydrate (CHO)-to-insulin ratio (CHO/IR) values in pregnant women with type 1 diabetes and to describe differences in CHO/IR across each week of pregnancy. This was a multicenter, retrospective, observational study (2006-2012) of 101 white pregnant women with a mean age of 32 (range, 18-43) years who had type 1 diabetes and were under continuous subcutaneous insulin infusion (CSII) therapy. These patients had the following characteristics: type 1 diabetes duration was 1 year (range, 1-31 years), the pregestational glycosylated hemoglobin level was 6.9% (range, 6.8-12.1%), the median weight gain during pregnancy was 14 kg (-3; 25 kg), with delivery at 37 weeks (range, 30-40 weeks), and the child had a birth weight of 3.530 kg (range, 1.480-5.250 kg). The CHO/IR was measured by dividing the CHO (in g) of each meal by insulin unit injected to acquire and maintain the following glycemic targets: fasting <90 mg/dL and 1-h postprandial <130 mg...

Gestational diabetes mellitus (GDM) is a risk factor for GDM in next pregnancies.The aims of this observational study are to measure GDM recurrence rate in post index pregnancy of women with prior GDM and to compare maternal and neonatal outcomes and pancreatic beta cells function in two consecutive pregnancies. Methods: Longitudinal observational study in 68 women with GDM in index pregnancy (G1), followed by a post index pregnancy (G2) and normal glucose tolerance in-between [G1 vs. G2: age 32,1±4,6 vs. 35,5±4,7 years, BMI 24,5 (19,2-42,7) vs. 24,7 (17,5-42,2) kg/m2, ns]. GDM diagnosis according to IADPSG criteria. Statistics: SPSS. Results: significantly earlier first visit gestational age in G2 [17 (6-36) weeks] than in G1 [28,5 (8-35) weeks] (p<0,001). GDM recurrence rate was 85,3% (n58) 3,32±1,8 years after index pregnancy: of these women, n31 (45,6%) [36.5±4 years; BMI 24.7 (19.3-42.1) Kg/m2] developed GDM in early pregnancy (16-18 weeks), while n27 (39,7%) [35.66±4 years; BMI 25.26 (17.6-42.2) Kg/m2] at the end of second trimester (24-28 weeks). Women who reported a negative OGTT at both time-points (n10, 14,7%) [33.7±5.5 years; BMI 20.45 (17.5-25.4) Kg/m2;] showed a significantly lower BMI (p<0,0015) and a higher disposition index (p=0.07) than those with positive OGTT. In women who did not relapse GDM, no significant inter-pregnancy weight gain was observed and GDM diagnosis in G1 was performed by post-load OGTT points. Lower 24-28thOGTT post load blood glucose levels and AUCglucose were found in G2 (p<0,02, Wilcoxon). No pancreatic beta cells function deterioration was recorded in post index pregnancy. We found a lower rate of cumulative neonatal adverse outcomes in G2 (30,2% in G1 vs. 25,7% in G2, p<0,04) and a reduced maternal hypertension rate even though it did not reach the level of significance (4vs8). Conclusions: GDM relapsed in the majority of women with previous GDM with no weight gain between pregnancies and no pancreatic function deterioration. However, a normal OGTT in second pregnancy was found in normoweight women. Disclosure C. Giuliani: None. O. Bitterman: None. F. Amorosi: None. C. Festa: None. A. Napoli: None.

Copyright © 2011 Mario Brinciotti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Type 1 diabetic mothers ’ infants show a delay of visual evoked potential (VEP) significantly related to some parameters of poor metabolic control during pregnancy. In the present paper we analyzed the characteristics of VEPs and somatosensory evoked potentials (SEPs) recorded in 16 three-year-old type 1 diabetic mothers ’ children (DMC). Compared with controls (23 nondiabetic mothers ’ healthy matched children), DMC showed significantly delayed mean latency of VEP (P2) and SEP (P22). In 3 cases (19%), we found pathological responses (+3 SD from the mean value of controls) of VEPs and SEPs. At the age of 3 years, the offspring of type 1 diabetic mothers showed delay of cortical evoked responses in both visual and somatosensory syst...

Aim The primary aim of this study was to assess insulin requirements and carbohydrate to insulin ratio (CHO/IR) in normal weight, overweight, and obese pregnant women with type 1 diabetes across early, middle, and late pregnancy. Methods In this multicenter, retrospective, observational study we evaluated 86 of 101 pregnant Caucasian women with type 1 diabetes under pump treatment. The women were trained to calculate CHO/IR daily by dividing CHO grams of every single meal by insulin units injected. Since the purpose of the study was to identify the CHO/IR able to reach the glycemic target, we only selected the CHO/IR obtained when glycemic values were at target. Statistics: SPSS 20. Results We studied 45 normal weight, 31 overweight, and 10 obese women. Insulin requirements increased throughout pregnancy (p < 0.0001 and <0.001 respectively) in the normal and overweight women, while it remained unchanged in the obese women. Insulin requirements were different between groups whe...

Pregnancy induces a deep modification of women's gut microbiota composition. These changes may influence hormonal and metabolic factors, increasing insulin resistance and leading to hyperglycaemia in susceptible women. Data on 29 women in pregnancy showed insignificant reductions in the Bacteroidetes/Firmicutes ratio in women with (n.14) and without (n.15) gestational diabetes (GDM). Gut microbiota compositions at the genera and species level were further analysed in ten pregnant women with and ten without GDM (9 samples were excluded due to low DNA quality/quantity), showing differences in functionally specific patterns affecting host energy dietary polysaccharide metabolism pathways. According to our results, gut microbiome alteration may play a role in GDM pathogenesis through an increase of gut permeability and higher intestinal energetic balance.

To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI <  = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia p...

Background and Aim: There is no consensus on glycemic targets for the management of GDM. Since women with GDM managed with current glycemic targets show still worse pregnancy outcomes than women without it, we aim to identify which glycemic levels are associated to normal pregnancy outcomes with particular reference to Large for Gestational Age (LGA) rate. Methods: This is an observational study, involving women with GDM (IADPSG criteria) from 2016 to 2019. Glycemic values <90 mg/dl at fasting and <130 mg /dl 1h after a meal were "in target." Blood Glucose (BG) levels and clinical factors were related to LGA/GDM adverse outcomes through Data Analysis, Multiple Correspondence Analysis and conceptual maps. The RECPAM (RECursive Partitioning and Amalgamation) analysis was used to identify homogeneous and distinct groups of patients at risk for LGA/adverse outcome and to set the glycemic value cut-off discriminating for LGA/adverse outcome. Results: We analyzed 386 women...

Aims: A specific composition of gut microbiota can increase insulin resistance. The aim of this pilot study was to find differences between pregnant women with GDM and controls in terms of gut microbiota composition during the 3rd trimester. Methods: This study was carried out in 20 women, 10 with GDM (IADPSG criteria) (Age 36.2±4.4 years; BMI 24.6 (21.4-26.8)Kg/m2) and 10 controls (Age 32.0±2,7 years; BMI 22.1 (19-24.1)Kg/m2) at the 34-36th week of gestation, when fecal samples were collected. Exclusion criteria: antibiotics/probiotics/symbiotics/metformin use during gestation, GADAb+, twin pregnancy, IBD. Genera and species were detected by using a Next Generation Sequencing technology (Ion Torrent Personal Genome Machine). Statistics: SPSS. Results: the two groups were well matched a part from age (p=0.04). No difference in weight gain (GDM 12.2±4.9; Controls 12.4±5.1 Kg). With regard to the primary aim we found an higher Relative Abundance of Bacteroides caccae, massiliensis, th...

Gestational diabetes mellitus (GDM) is a risk factor for GDM in next pregnancies.The aims of this observational study are to measure GDM recurrence rate in post index pregnancy of women with prior GDM and to compare maternal and neonatal outcomes and pancreatic beta cells function in two consecutive pregnancies. Methods: Longitudinal observational study in 68 women with GDM in index pregnancy (G1), followed by a post index pregnancy (G2) and normal glucose tolerance in-between [G1 vs. G2: age 32,1±4,6 vs. 35,5±4,7 years, BMI 24,5 (19,2-42,7) vs. 24,7 (17,5-42,2) kg/m2, ns]. GDM diagnosis according to IADPSG criteria. Statistics: SPSS. Results: significantly earlier first visit gestational age in G2 [17 (6-36) weeks] than in G1 [28,5 (8-35) weeks] (p<0,001). GDM recurrence rate was 85,3% (n58) 3,32±1,8 years after index pregnancy: of these women, n31 (45,6%) [36.5±4 years; BMI 24.7 (19.3-42.1) Kg/m2] developed GDM in early pregnancy (16-18 weeks), while n27 (39,7%) [35.66±4 years;...

Il diabete monogenico da deficit di glucochinasi (MODY 2) spesso non viene diagnosticato oppure viene classificato come diabete tipo 2; quando l’iperglicemia viene riscontrata per la prima volta in gravidanza, esso può essere scambiato per diabete gestazionale (GDM). La prevalenza di MODY 2 tra le donne con GDM varia dallo 0 al 6%, in base ai criteri di selezione utilizzati per inviare le pazienti al test genetico. Infatti, non vi è ancora totale accordo su quali siano i criteri che permettano di individuare con il migliore rapporto costo-beneficio le pazienti a più alto rischio; i più utili sembrano essere il BMI e la glicemia a digiuno anche se, utilizzando diversi cut-off, specificità e sensibilità variano. La gestione del MODY 2 in gravidanza è ancora oggetto di dibattito. Il problema principale è che il genotipo fetale sembrerebbe influenzare la crescita fetale in risposta all’iperglicemia materna per cui, mentre i feti non portatori della mutazione materna rischierebbero le medesime complicanze di tutti i figli di madre diabetica (macrosomia, ipoglicemia neonatale, ecc.), i feti portatori della mutazione necessiterebbero di elevati valori di glicemia materna per avere un’adeguata secrezione insulinica e, quindi, una normale crescita. Di conseguenza, alcuni autori suggeriscono di sottoporre le donne MODY 2 in gravidanza a terapia insulinica solo se il feto non ha ereditato la mutazione; esistono altri studi in cui non si è osservata una differenza significativa riguardo il peso alla nascita dei neonati affetti in base alla terapia effettuata in gravidanza (dieta o insulina). Tuttavia, di solito il genotipo fetale non è noto fino alla nascita; pertanto, sarebbe necessario seguire la crescita fetale tramite ecografie seriate e iniziare la terapia insulinica solo in caso di eccessiva crescita, fin quando lo sviluppo di nuove metodiche diagnostiche non invasive, come l’estrazione del DNA fetale dal sangue materno, non permetterà una diagnosi precoce e, quindi, una più accurata gestione terapeutica. Infine, non vi è alcun dato su quali dovrebbero essere i target glicemici nelle gravidanze MODY 2 che, in base a quanto detto fino ad ora, potrebbero essere diversi in base al genotipo fetale.

The aim of this work was to evaluate the impact of diabetes on female sexuality and to highlight any differences between sexuality in the context of type 1 and type 2 diabetes mellitus (DM). The subjects selected were 49 women with type 1 DM, 24 women with type 2 DM, and 45 healthy women as controls. Each participant was given the nine-item Female Sexual Function Index questionnaire to complete. The metabolic profile was evaluated by body mass index and glycosylated hemoglobin assay. The prevalence of sexual dysfunction (total score ≤30) was significantly higher in the type 1 DM group (25/49, 51%; 95% confidence interval [CI] 18-31) than in the control group (4/45, 9%; 95% CI 3-5; P=0.00006); there were no significant variations in the type 2 DM group (4/24, 17%; 95% CI 3-4) versus the control group (P=0.630, not statistically significant). The mean total score was significantly lower in the type 1 DM group (30.2±6.9) versus the control group (36.5±4.9; P=0.0003), but there was no significant difference between the type 2 DM group and the control group (P=0.773). With regard to specific questionnaire items, the mean values for arousal, lubrication, dyspareunia, and orgasm were significantly lower only in the type 1 DM group versus the control group. The mean values for desire were reduced in type 1 and type 2 DM groups versus control group. Type 1 DM is associated with sexual dysfunction. This may be due to classic neurovascular complications or to the negative impact of the disease on psychosocial factors. Larger and ideally longitudinal studies are necessary to better understand the relationship between DM and sexual dysfunction.

This study monitored blood glucose profiles in normotolerant breastfeeding women, with and without previous gestational diabetes, in real life in order to identify normal blood glucose fluctuations during breastfeeding. Two groups were studied: (1) 18 women with recent gestational diabetes mellitus but normotolerant postpartum (pGDM-N group) and (2) 15 women normotolerant both during pregnancy and postpartum (pN-N group). All participants underwent continuous glucose monitoring during which they recorded their main daily activities and three standardized events: "suckling," "meal," and "meal and suckling." Other than these three events, these women were essentially on an "ad lib" diet. Data were expressed as median and SD values. Student's t test and Fisher's test were used to compare mean, variances, and percentages. Differences were significant with P<0.05. Clustering analysis was used to determine the normal range of glucose values. The two groups were matched for age, follow-up duration, and monitoring measurements but not for body mass index. Blood glucose levels and variances were higher in the pGDM-N group, particularly during daytime and the three standardized events, and were not related to body mass index. Suckling had no direct effect on glucose profile during both the non-fed and the fed state. Blood glucose levels that best represent the normal breastfeeding population were between 50 and 126 mg/dL (from 2.8 to 7.0 mmol/L). Three months after delivery, normotolerant women with recent gestational diabetes had higher daily blood glucose levels than women who were always normotolerant, with no direct effect of suckling. The blood glucose profiles of healthy subjects could be representative of the normal range of the population during breastfeeding.