Erratum to: A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG)

Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factor-based screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity

Fluxes of dissolved organic carbon in stand throughfall and percolation water in 12 boreal coniferous stands on mineral soils in Finland

Predictors for glucose intolerance postpartum were evaluated in women with gestational diabetes mellitus (GDM) based on the 2013 World Health Organization (WHO) criteria. 1841 women were tested for GDM in a prospective cohort study. A postpartum 75g oral glucose tolerance test (OGTT) was performed in women with GDM at 14 ± 4.1 weeks. Of all 231 mothers with GDM, 83.1% (192) had a postpartum OGTT of which 18.2% (35) had glucose intolerance. Women with glucose intolerance were more often of Asian origin [15.1% vs. 3.7%, OR 4.64 (1.26–17.12)], had more often a recurrent history of GDM [41.7% vs. 26.7%, OR 3.68 (1.37–9.87)], higher fasting glycaemia (FPG) [5.1 (4.5–5.3) vs. 4.6 (4.3–5.1) mmol/L, OR 1.05 (1.01–1.09)], higher HbA1c [33 (31–36) vs. 32 (30–33) mmol/mol, OR 4.89 (1.61–14.82)], and higher triglycerides [2.2 (1.9–2.8) vs. 2.0 (1.6–2.5) mmol/L, OR 1.00 (1.00–1.01)]. Sensitivity of glucose challenge test (GCT) ≥7.2 mmol/l for glucose intolerance postpartum was 80% (63.1%–91.6%). The area under the curve to predict glucose intolerance was 0.76 (0.65–0.87) for FPG, 0.54 (0.43–0.65) for HbA1c and 0.75 (0.64–0.86) for both combined. In conclusion, nearly one-fifth of women with GDM have glucose intolerance postpartum. A GCT ≥7.2 mmol/L identifies a high risk population for glucose intolerance postpartum

Normal glucose tolerant women with low glycemia during the oral glucose tolerance test have a higher risk to deliver a low birth weight infant

BackgroundData are limited on pregnancy outcomes of normal glucose tolerant (NGT) women with a low glycemic value measured during the 75g oral glucose tolerance test (OGTT). Our aim was to evaluate maternal characteristics and pregnancy outcomes of NGT women with low glycemia measured at fasting, 1-hour or 2-hour OGTT.MethodsThe Belgian Diabetes in Pregnancy-N study was a multicentric prospective cohort study with 1841 pregnant women receiving an OGTT to screen for gestational diabetes (GDM). We compared the characteristics and pregnancy outcomes in NGT women according to different groups [(<3.9mmol/L), (3.9-4.2mmol/L), (4.25-4.4mmol/L) and (>4.4mmol/L)] of lowest glycemia measured during the OGTT. Pregnancy outcomes were adjusted for confounding factors such as body mass index (BMI) and gestational weight gain.ResultsOf all NGT women, 10.7% (172) had low glycemia (<3.9 mmol/L) during the OGTT. Women in the lowest glycemic group (<3.9mmol/L) during the OGTT had compared to women in highest glycemic group (>4.4mmol/L, 29.9%, n=482), a better metabolic profile with a lower BMI, less insulin resistance and better beta-cell function. However, women in the lowest glycemic group had more often inadequate gestational weight gain [51.1% (67) vs. 29.5% (123); p<0.001]. Compared to the highest glycemia group, women in the lowest group had more often a birth weight <2.5Kg [adjusted OR 3.41, 95% CI (1.17-9.92); p=0.025].ConclusionWomen with a glycemic value <3.9 mmol/L during the OGTT have a higher risk for a neonate with birth weight < 2.5Kg, which remained significant after adjustment for BMI and gestational weight gain

Recent Advances in Gestational Diabetes Mellitus

The incidence of gestational diabetes mellitus (GDM) and overt diabetes in pregnancy is rising globally [...

Screening and Management of Gestational Diabetes Mellitus after Bariatric Surgery

Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. This is partly due to the increasing prevalence of obesity in women of childbearing age. Since bariatric surgery is currently the most successful way to achieve maintained weight loss, increasing numbers of obese women of childbearing age receive bariatric surgery. Bariatric surgery performed before pregnancy significantly reduces the risk to develop GDM but the risk is generally still higher compared to normal weight pregnant women. Women after bariatric surgery therefore still require screening for GDM. However, screening for GDM is challenging in pregnant women after bariatric surgery. The standard screening tests such as an oral glucose tolerance test are often not well tolerated and wide variations in glucose excursions make the diagnosis difficult. Capillary blood glucose measurements may currently be the most acceptable alternative for screening in pregnancy after bariatric surgery. In addition, pregnant women after bariatric surgery have an increased risk for small neonates and need careful nutritional and foetal monitoring. In this review, we address the risk to develop GDM after bariatric surgery, the challenges to screen for GDM and the management of women with GDM after bariatric surgery

Gestational diabetes: towards an uniform screening strategy

Since long there is lack of international uniformity in the approach to screening and diagnosis of gestational diabetes (GDM). Pregnant women are commonly screened for GDM by a 50g glucose challenge test (GCT) followed by a diagnostic oral glucose tolerance test (100g 3-h OGTT) using the Carpenter & Coustan criteria in late 2nd trimester (two-step screening strategy). Progressively more data emerge that show that the risk of adverse perinatal outcomes are also associated with degrees of hyperglycaemia less severe than overt diabetes during pregnancy. Since 2010 a one-step screening strategy with a 75g OGTT using more stringent criteria to diagnose GDM has been proposed by ‘The International Association of Diabetes and Pregnancy Study Groups’ (IADPSG). Internationally, the IADPSG recommendation for screening for GDM remains controversial since this will lead to an important increase in the number of women labeled and treated as GDM. Other important comments are the paucity of data on the cost-effectiveness of such screening strategy, the uncertainty on the clinical relevance of treatment of mild GDM and the uncertainty on the risk of women who have had mild GDM based on the IADPSG criteria to develop type 2 diabetes postpartum. Accurate data on the prevalence of GDM are lacking in Belgium and the current practice for screening for GDM varies across different centers. There is also no consensus on screening for GDM in Belgium. The discrepancy in recommendations is due to the lack of data based on research in our own population concerning the best screening strategy for pregestational diabetes in early pregnancy and the lack of data on the best screening strategy for GDM. To address these questions, we started a large Belgian prospective multi-centric cohort study on screening for GDM, the Belgian Diabetes in Pregnancy study (BEDIP-N study). The aim of the study is to recruit 2090 women before 14 weeks of pregnancy. The study is coordinated by UZ Leuven and 6 other centers also participate: Imelda Bonheiden, UZA, OLV-Aalst site Aalst, OLV-Aalst site Asse, St Jan kliniek Brussel and St Jan Brugge. The most important objectives of the study are to evaluate the prevalence of GDM and diabetes early in pregnancy, to evaluate the risk factors for GDM, to evaluate the prevalence of GDM later in pregnancy and to compare the different screening strategies for GDM (screening based on risk factors versus a two-step screening strategy with a GCT or a 1-step approach with a 75g OGTT). In the first trimester all women receive a fasting bloodtest to evaluate the fasting glycemia (FPG). If the FPG shows GDM (FPG=100-125mg/dl) or diabetes (FPG = 126mg/dl or more), women are treated according to normal routine and do not receive any further testing for GDM later in pregnancy. All women with a normal FPG in early pregnancy, undergo testing for GDM between 24-28 weeks with a GCT and 75g OGTT. Both women and health care professionals are blind for the result of the GCT and the diagnosis of GDM is based on the 75g OGTT using the IADPSG criteria. If women are diagnosed with GDM, they are treated according to normal routine. From all women, data on the follow up during pregnancy and pregnancy outcomes are collected. Women with GDM also receive a 75g OGTT three months after the delivery to timely detect (pre)diabetes.status: publishe

Sodium glucose transporter protein 2 inhibitors: focusing on the kidney to treat type 2 diabetes

Type 2 diabetes mellitus (T2DM) is increasing worldwide. Treatment of T2DM continues to present challenges, with a significant proportion of patients failing to achieve and maintain glycemic targets. Despite the availability of many oral antidiabetic agents, therapeutic efficacy is also offset by side effects such as weight gain and hypoglycemia. Therefore, the search for novel therapeutic agents with an improved benefit–risk profile continues. In the following review we focus on a novel class of oral antidiabetic drugs, the sodium glucose transporter protein 2 (SGLT2) inhibitors, which have unique characteristics. SGLT2 inhibitors focus on the kidney as a therapeutic target, where they inhibit the reabsorption of glucose in the proximal tubule, causing an increase in urinary glucose excretion. Doing this, they reduce plasma glucose independently of the β-cell function of the pancreas. SGLT2 inhibitors are effective at lowering hemoglobin A1c, but also induce weight loss and reduce blood pressure, with a low risk of hypoglycemia. In general, the SGLT2 inhibitors are well tolerated, with the most frequent adverse events being mild urinal and genital infections. Since their primary site of effect is the kidney, these drugs are less effective in patients with impaired kidney function but evidence is emerging that these drugs may also have a protective effect against diabetic nephropathy. This review focuses on the most extensively studied SGLT2 inhibitors dapagliflozin, canagliflozin and empagliflozin. Dapagliflozin and canagliflozin have already been approved for marketing by the US Food and Drug Administration. The European Medicines Agency has accepted all three drugs for marketing

ADA/EASD-consensus over glucoseverlagende therapie bij diabetes mellitus type 2: wat betekent dit voor België?

Op 5 oktober 2018 werd de nieuwe consensus over glucoseverlagende therapie bij diabetes mellitus type 2 (DM2) tussen de twee leidende diabetesverenigingen van de Verenigde Staten („American Diabetes Association” – ADA) en Europa („European Association for the Study of Diabetes” – EASD) gepubliceerd. De hoofdboodschappen zijn dat de aanpak van DM2 ingebed moet zijn in een globaal behandelplan waarin de patiënt centraal staat en deel uitmaakt van het team dat de beslissingen neemt. Een multifactoriële aanpak met aandacht voor andere risicofactoren dan glucose, leefstijlaanpassingen en het vermijden van klinische inertie zijn de basis van de therapie. De aanwezigheid van atherosclerotisch hartlijden, hartfalen of chronisch nierlijden drijft de keuze van de glucoseverlagende therapie bij DM2, waarbij „glucagon-like” peptide-1-receptoragonisten (GLP-1RA) en SGLT-2-inhibitoren (natriumglucose-cotransporter-2) dan te verkiezen zijn. Indien deze aandoeningen niet aanwezig zijn bij de patiënt, moet de clinicus zich in zijn keuze van glucoseverlagende therapie laten leiden door andere factoren, zoals het vermijden van hypoglykemie of gewichtstoename. Indien om kostredenen de nieuwere glucoseverlagende geneesmiddelen niet gebruikt kunnen worden, kan men oudere en goedkopere middelen gebruiken, maar met opnieuw educatie specifiek rond de bijwerkingen van deze producten en hoe deze vermeden kunnen worden. In de consensuspaper wordt gesuggereerd dat GLP-1RA verkozen moeten worden boven insuline wanneer men bij een DM2-patiënt een injectietherapie wil starten. Indien insuline gestart wordt, gebeurt dit het best als basale insuline.status: publishe

Insulin analogues in type 1 diabetes mellitus: getting better all the time

The treatment of type 1 diabetes mellitus consists of external replacement of the functions of β cells in an attempt to achieve blood levels of glucose as close to the normal range as possible. This approach means that glucose sensing needs to be replaced and levels of insulin need to mimic physiological insulin-action profiles, including basal coverage and changes around meals. Training and educating patients are crucial for the achievement of good glycaemic control, but having insulin preparations with action profiles that provide stable basal insulin coverage and appropriate mealtime insulin peaks helps people with type 1 diabetes mellitus to live active lives without sacrificing tight glycaemic control. Insulin analogues enable patients to achieve this goal, as some have fast action profiles, and some have very slow action profiles, which gives people with type 1 diabetes mellitus the tools to achieve dynamic insulin-action profiles that enable tight glycaemic control with a risk of hypoglycaemia that is lower than that with human short-acting and long-acting insulins. This Review discusses the established and novel insulin analogues that are used to treat patients with type 1 diabetes mellitus and provides insights into the future development of insulin analogues.status: publishe