Rola insuliny i wybranych adipocytokin u pacjentek z zespołem policystycznych jajników (PCOS)

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. It is manifested by hyperandrogenism, polycystic ovaries on ultrasound, oligomenorrhoea and anovulation. PCOS patients are more vulnerable to metabolic disorders: insulin resistance, obesity, endothelium dysfunction, atherosclerosis, and activation of proinflammatory factors. This association shows that PCOS might be an ovarian manifestation of a metabolic syndrome. Insulin resistance is also strongly correlated with reproductive failure. Approximately 100 factors, secreted in adipose tissue, are responsible for its regulation. Adipocytokines have been found to play an important role in regulating insulin sensitivity. Abnormal levels of adipokines are detected in patients with insulin resistance. Studies indicate that these factors, and their different activity in PCOS women, may affect changes observed in their metabolism and, especially, may participate in the development of insulin resistance. There are several adipokines whose role has been thoroughly investigated and many that we still know very little about, for example apelin and visfatin. Counseling PCOS patients about the possibility of developing metabolic syndrome, diabetes mellitus, and cardiovascular diseases should be a standard of care.Zespół policystycznych jajników (PCOS) jest najczęstszą endokrynopatią wśród kobiet w wieku rozrodczym. Manifestuje się hiperandrogenizmem, obrazem policystycznych jajników w ultrasonografii, zaburzeniami miesiączkowania o typie rzadkich miesiączek lub zaburzeniami owulacji. Pacjentki z PCOS są bardziej narażone na zaburzenia metaboliczne: insulinooporność, otyłość, nieprawidłowości endothelium, miażdżycę i aktywację czynników prozapalnych. Te zależności mogą świadczyć o tym, że PCOS może być jajnikową postacią zespołu metabolicznego. Insulinooporność silnie koreluje również z zaburzeniami rozrodu. Istnieje około 100 czynników produkowanych przez tkankę tłuszczową, odpowiedzialnych za funkcje regulacyjne. Adipocytokiny są ważnymi czynnikami regulującymi wrażliwość organizmu na insulinę. U pacjentek z insulinoopornością zauważalne są nieprawidłowe poziomy adipocytokin. Badania pokazują, że te czynniki i ich odmienna aktywność u kobiet z PCOS, może mieć wpływ na zmiany w ich metabolizmie, a w szczególności w rozwoju insulinooporności. Istnieje wiele adipokin, których rola jest dobrze poznana, lecz nadal rola wielu z nich jest niedostatecznie zbadana: między innymi apeliny i wisfatyny. Ocena czynników ryzyka zaburzeń metabolicznych, cukrzycy oraz choroby sercowo-naczyniowej powinna być standardem u kobiet z PCOS

Objectives and methods of the ORCHESTRA FOUNDATION Registry study: a multicenter observational study of the use of insulin pump therapy in pregnant women with type 1 diabetes mellitus in Poland.

Background. The ORCHESTRA FOUNDATION Registry study was a prospective, multicenter, observational, post-market study investigating the use of an insulin pump with or without continuous glucose monitoring (CGM) [i.e., sensor-augmented pump (SAP) or sensor-integrated insulin pump (SIP)]; before, during, and after pregnancy, in women with type 1 diabetes mellitus (T1DM). Methods. Study participants enrolled in 24 centers, in Poland, and contributed intake and follow-up data for up to 22 months (i.e., up to 12 months pre-conception, throughout pregnancy, and 6 weeks after delivery). Participants who were already pregnant were enrolled up to the 16th week of pregnancy. Investigated outcomes included HbA1c before and during pregnancy, and serious adverse events (e.g., severe hypoglycemia, diabetic ketoacidosis, miscarriage, and hospitalization due to any bleeding or any symptoms suggesting premature delivery). Routine clinical data including maternal weight, body mass index, and daily insulin use were also recorded. The insulin delivery devices used in the study were the MiniMed™ Paradigm™ REAL-Time insulin pump with CGM (via the MiniMed Sof-sensor™ sensor) or without CGM, and the MiniMed Paradigm Veo™ with CGM (via the Enlite™ sensor). Results. Study enrollment began in May 2013 and the last patient completed the study in August 2017. Conclusions. The ORCHESTRA FOUNDATION Registry study provides an opportunity to assess the effects of automated insulin delivery in pregnant women with T1DM using insulin pumps with or without continuous glucose monitoring.Background. The ORCHESTRA FOUNDATION Registry study was a prospective, multicenter, observational, post-market study investigating the use of an insulin pump with or without continuous glucose monitoring (CGM) [i.e., sensor-augmented pump (SAP) or sensor-integrated insulin pump (SIP)]; before, during, and after pregnancy, in women with type 1 diabetes mellitus (T1DM). Methods. Study participants enrolled in 24 centers, in Poland, and contributed intake and follow-up data for up to 22 months (i.e., up to 12 months pre-conception, throughout pregnancy, and 6 weeks after delivery). Participants who were already pregnant were enrolled up to the 16th week of pregnancy. Investigated outcomes included HbA1c before and during pregnancy, and serious adverse events (e.g., severe hypoglycemia, diabetic ketoacidosis, miscarriage, and hospitalization due to any bleeding or any symptoms suggesting premature delivery). Routine clinical data including maternal weight, body mass index, and daily insulin use were also recorded. The insulin delivery devices used in the study were the MiniMed™ Paradigm™ REAL-Time insulin pump with CGM (via the MiniMed Sof-sensor™ sensor) or without CGM, and the MiniMed Paradigm Veo™ with CGM (via the Enlite™ sensor). Results. Study enrollment began in May 2013 and the last patient completed the study in August 2017. Conclusions. The ORCHESTRA FOUNDATION Registry study provides an opportunity to assess the effects of automated insulin delivery in pregnant women with T1DM using insulin pumps with or without continuous glucose monitoring

Cele i metody Rejestru Klinicznego Fundacji ORKIESTRA : wieloośrodkowe badanie obserwacyjne dotyczące stosowania terapii z użyciem pompy insulinowej u kobiet w ciąży z cukrzycą typu 1 w Polsce

Background. The ORCHESTRA FOUNDATION Registry study was a prospective, multicenter, observational, post-market study investigating the use of an insulin pump with or without continuous glucose monitoring (CGM) [i.e., sensor-augmented pump (SAP) or sensor-integrated insulin pump (SIP)]; before, during, and after pregnancy, in women with type 1 diabetes mellitus (T1DM). Methods. Study participants enrolled in 24 centers, in Poland, and contributed intake and follow-up data for up to 22 months (i.e., up to 12 months pre-conception, throughout pregnancy, and 6 weeks after delivery). Participants who were already pregnant were enrolled up to the 16th week of pregnancy. Investigated outcomes included HbA1c before and during pregnancy, and serious adverse events (e.g., severe hypoglycemia, diabetic ketoacidosis, miscarriage, and hospitalization due to any bleeding or any symptoms suggesting premature delivery). Routine clinical data including maternal weight, body mass index, and daily insulin use were also recorded. The insulin delivery devices used in the study were the MiniMed™ Paradigm™ REAL-Time insulin pump with CGM (via the MiniMed Sof-sensor™ sensor) or without CGM, and the MiniMed Paradigm Veo™ with CGM (via the Enlite™ sensor). Results. Study enrollment began in May 2013 and the last patient completed the study in August 2017. Conclusions. The ORCHESTRA FOUNDATION Registry study provides an opportunity to assess the effects of automated insulin delivery in pregnant women with T1DM using insulin pumps with or without continuous glucose monitoring

Influence of pregnancy planning on obstetrical results in women with pregestational diabetes mellitus

Abstract Objective: The aim of the study was to compare obstetric results in two groups of pregnant women (patients that had and had not planned their pregnancy) suffering from pregestational diabetes mellitus (PGDM). Material and methods: 400 women with PGDM were divided into two subgroups: planned pregnancy (P) (N=200) and unplanned pregnancy (NP) (N=200). The study was based on retrospective analysis of data collected at the Department of Obstetrics and Women Diseases, University of Medical Sciences, Poznan, from patients who delivered between 1995-2006. In both groups obstetrical complications and selected neonatal parameters were analyzed. Results: Statistically important differences in obstetric results between the two analyzed subgroups of patients were observed. P-group was metabolically better controlled, both upon admission to our department and in the third trimester. The mean daily insulin requirement among P-group patients was smaller than among pregnant NP-women upon admission to our department. P-patients suffered from miscarriages and stillbirths less frequently. Neonates born to P-mothers had higher gestational age at delivery and their Apgar score and cord blood results were significantly better. Conclusions: Our results confirmed that patients with PGDM who plan their pregnancies achieve significantly better obstetric results compared with unplanned pregnancy group. Pregnancy planning should become a standard of obstetric and diabetic care in this group of patients

Czy istnieje związek między rozwojem zespołu metabolicznego u kobiet z zespołem policystycznych jajników, a polimorfizmem C677T genu reduktazy metylenotetrahydrofolianowej?

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is characterized by anovulation, polycystic ovaries, hyperandrogenism leading to infertility, dermatological and psychological problems, as well as the risk of developing Metabolic Syndrome (MetS) and cardiovascular disease (CVD). The exact cause of PCOS remains unclear. Various biochemical and genetic markers have been implicated in predisposition to PCOS, but no single variant has been associated with the syndrome. Some authors connect hyperhomocysteinemia (HHcy) with MetS and its components. The MTHFR gene C677T polymorphism is a common genetic abnormality leading to hyperhomocysteinemia. Objectives: The aim of the study was to confirm the existence of a possible correlation between metabolic disturbances in PCOS and the MTHFR C677T polymorphism. Material and methods: A total of 98 patients diagnosed with PCOS according to the Rotterdam criteria and 101 age-matched healthy controls were included in the study. Genotyping of MTHFR C677T was performed by the real time PCR method. Results: Statistically significant differences were observed between those two groups with regard to body mass index (BMI), waist circumference (WC), hip circumference (HC), fasting insulin, total cholesterol (TC), and triglycerides (TG). No significant differences in the prevalence of the genotypes of the MTHFR C677T gene polymorphism were found between the PCOS group and controls. Despite the lack of significant differences, we observed a tendency for a higher prevalence of the TT genotype in the PCOS group (p = 0.06). No statistically significant differences were observed between the PCOS group and the control group in terms of the presence of the MetS components and the predisposition to develop MetS. Conclusions: Our study did not confirm an association between the MTHFR C677T gene polymorphism and the development of MetS in PCOS. Further studies with larger sample size might be useful to determine this association.Wstęp: Zespól policystycznych jajników ( PCOS) jest najczęstszym zaburzeniem endokrynologicznym u kobiet w wieku rozrodczym, charakteryzującym się brakiem owulacji, jajnikami policystycznymi oraz hiperandrogenizmem, które prowadzą do niepłodności, problemów dermatologicznych i psychologicznych oraz zwiększają ryzyko rozwoju zespołu metabolicznego i choroby sercowo-naczyniowej. Przebadano wiele biochemicznych i genetycznych markerów, które mogłyby mieć wpływ na rozwój PCOS, jednak jak do tej pory nie udało się wskazać jednego pewnego czynnika. Istnieją badania łączące hiperhomocysteinemię z zespołem metabolicznym i jego składowymi. Częstym zaburzeniem genetycznym prowadzącym do hiperhomocysteinemi jest polimorfizm C677T genu reduktazy metylenotetrahydrofolianowej (MTHFR). Cel: Celem badania było zweryfikowanie związku zaburzeń metabolicznych w zespole policystycznych jajników z polimorfizmem genu C677T MTHFR. Materiał i metody: 98 pacjentek ze zdiagnozowanym PCOS na podstawie kryteriów Rotterdamskich zostało porównane ze 101 pacjentkami z grupy kontrolnej dobranej zgodnie wiekowo. Metoda real-time PCR została użyta do wykonania oznaczeń genetycznych. Wyniki: Istotne statystycznie różnice między grupami zauważono w Body Mass Index (BMI), obwodzie talii, obwodzie bioder, poziomie insuliny na czczo, cholesterolu całkowitego, trójglicerydów. Nie zauważono istotnych statystycznie różnic w występowaniu genotypów polimorfizmu C677T genu MTHFR między grupą badaną, a kontrolną. Zaobserwowano jedynie tendencję do częstszego występowania genotypu TT w grupie kobiet z PCOS (p = 0,06). Nie zauważono różnic statystycznych między częstością występowania składowych zespołu metabolicznego oraz w rozwoju pełnoobjawowego zespołu metabolicznego między tymi grupami. Wnioski: Nasze badanie nie potwierdziło związku polimorfizmu genu C677T MTHFR z rozwojem zespołu metabolicznego w PCOS. Dalsze badania na większej grupie pacjentek mogłyby być pomocne w ocenie tego związku

The influence of low-dose oral contraceptive pill on clinical and metabolic parameters in young women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, oligo/anovulation and is associated with risk factors for cardiovascular diseases, such as insulin resistance and central adiposity. The aim of the study was to evaluation of influence of the oral contraceptive pill on the endocrinologic and metabolic parameters in women with PCOS. Material & methods: Forty nine PCOS women (aged 23,9±3,5 [mean±SD]) without any other diseases were included into the study. Oral contraceptives (0,02mg ethynylestradiol +0,15 mg desogestrel) were administered for 6 months. Hormonal and biochemical analyses were performed with specific assays at the beginning and after 6 month-therapy. BMI, insulin sensitivity index (ISI) and QUICKI were calculated. Statistical analysis was performed using Results: All patients completed 6-month therapy and no severe side effects were reported during the study. A significant reduction in testosterone (T) concentrations was observed (

Cele i metody Rejestru Klinicznego Fundacji ORKIESTRA: wieloośrodkowe badanie obserwacyjne dotyczące stosowania terapii z użyciem pompy insulinowej u kobiet w ciąży z cukrzycą typu 1 w Polsce

Wstęp. Rejestr Kliniczny Fundacji ORKIESTRA był badaniem prospektywnym, wieloośrodkowym, obserwacyjnym, postmarketingowym, w którym badano stosowanie pompy insulinowej z systemem ciągłego monitorowania glikemii (CGM) lub bez CGM [tj. pompy wzbogaconej o system ciągłego monitorowania glikemii (SAP) lub pompy zintegrowanej z systemem ciągłego monitorowania glikemii (SIP)] u kobiet z cukrzycą typu 1 (T1DM). Materiał i metody. Rekrutacja kobiet do badania była prowadzona w 24 ośrodkach w Polsce, w których zbierano dane dotyczące dawkowania insuliny i obserwacji przez okres do 22 miesięcy (tj. do 12 miesięcy przed koncepcją, w trakcie ciąży i 6 tygodni po porodzie). Kobiety, które były już w ciąży, zostały włączone do 16. tygodnia ciąży. Badane wyniki obejmowały stężenie HbA1c przed ciążą i w czasie ciąży oraz poważne działania niepożądane (np. ciężka hipoglikemia, kwasica ketonowa, poronienie i hospitalizacja z powodu jakichkolwiek krwawień lub objawów sugerujących przedwczesny poród). Rejestrowano także rutynowe dane kliniczne, takie jak masa ciała kobiet ciężarnych, wskaźnik masy ciała (BMI) oraz dzienne zużycie insuliny. Urządzenia podające insulinę wykorzystane w badaniu to pompa insulinowa MiniMed™ Paradigm™ REAL-Time z funkcją ciągłego monitorowania glikemii (CGM) (za pomocą sensora MiniMed Sof-sensor™) lub bez CGM oraz MiniMed Paradigm Veo™ z funkcją CGM (za pomocą sensora Enlite™). Wyniki. Rekrutację do badania rozpoczęto w maju 2013 roku, a ostatnia pacjentka ukończyła badanie w sierpniu 2017 roku. Wnioski. Rejestr Kliniczny Fundacji ORKIESTRA pozwoli ocenić wyniki zautomatyzowanej podaży insuliny u kobiet w ciąży z T1DM przy użyciu pomp insulinowych z funkcją ciągłego monitorowania glikemii lub bez takiej funkcji

Objectives and methods of the ORCHESTRA FOUNDATION Registry study : a multicenter observational study of the use of insulin pump therapy in pregnant women with type 1 diabetes mellitus in Poland

Wstęp. Rejestr Kliniczny Fundacji ORKIESTRA był badaniem prospektywnym, wieloośrodkowym, obserwacyjnym, postmarketingowym, w którym badano stosowanie pompy insulinowej z systemem ciągłego monitorowania glikemii (CGM) lub bez CGM [tj. pompy wzbogaconej o system ciągłego monitorowania glikemii (SAP) lub pompy zintegrowanej z systemem ciągłego monitorowania glikemii (SIP)] u kobiet z cukrzycą typu 1 (T1DM). Materiał i metody. Rekrutacja kobiet do badania była prowadzona w 24 ośrodkach w Polsce, w których zbierano dane dotyczące dawkowania insuliny i obserwacji przez okres do 22 miesięcy (tj. do 12 miesięcy przed koncepcją, w trakcie ciąży i 6 tygodni po porodzie). Kobiety, które były już w ciąży, zostały włączone do 16. tygodnia ciąży. Badane wyniki obejmowały stężenie HbA1c przed ciążą i w czasie ciąży oraz poważne działania niepożądane (np. ciężka hipoglikemia, kwasica ketonowa, poronienie i hospitalizacja z powodu jakichkolwiek krwawień lub objawów sugerujących przedwczesny poród). Rejestrowano także rutynowe dane kliniczne, takie jak masa ciała kobiet ciężarnych, wskaźnik masy ciała (BMI) oraz dzienne zużycie insuliny. Urządzenia podające insulinę wykorzystane w badaniu to pompa insulinowa MiniMed™ Paradigm™ REAL-Time z funkcją ciągłego monitorowania glikemii (CGM) (za pomocą sensora MiniMed Sof-sensor™) lub bez CGM oraz MiniMed Paradigm Veo™ z funkcją CGM (za pomocą sensora Enlite™). Wyniki. Rekrutację do badania rozpoczęto w maju 2013 roku, a ostatnia pacjentka ukończyła badanie w sierpniu 2017 roku. Wnioski. Rejestr Kliniczny Fundacji ORKIESTRA pozwoli ocenić wyniki zautomatyzowanej podaży insuliny u kobiet w ciąży z T1DM przy użyciu pomp insulinowych z funkcją ciągłego monitorowania glikemii lub bez takiej funkcji.Background. The ORCHESTRA FOUNDATION Registry study was a prospective, multicenter, observational, post-market study investigating the use of an insulin pump with or without continuous glucose monitoring (CGM) [i.e., sensor-augmented pump (SAP) or sensor-integrated insulin pump (SIP)]; before, during, and after pregnancy, in women with type 1 diabetes mellitus (T1DM). Methods. Study participants enrolled in 24 centers, in Poland, and contributed intake and follow-up data for up to 22 months (i.e., up to 12 months pre-conception, throughout pregnancy, and 6 weeks after delivery). Participants who were already pregnant were enrolled up to the 16th week of pregnancy. Investigated outcomes included HbA1c before and during pregnancy, and serious adverse events (e.g., severe hypoglycemia, diabetic ketoacidosis, miscarriage, and hospitalization due to any bleeding or any symptoms suggesting premature delivery). Routine clinical data including maternal weight, body mass index, and daily insulin use were also recorded. The insulin delivery devices used in the study were the MiniMed™ Paradigm™ REAL-Time insulin pump with CGM (via the MiniMed Sof-sensor™ sensor) or without CGM, and the MiniMed Paradigm Veo™ with CGM (via the Enlite™ sensor). Results. Study enrollment began in May 2013 and the last patient completed the study in August 2017. Conclusions. The ORCHESTRA FOUNDATION Registry study provides an opportunity to assess the effects of automated insulin delivery in pregnant women with T1DM using insulin pumps with or without continuous glucose monitoring

Perinatal outcome among women undergoing in vitro fertilization procedures complicated by ovarian hyperstimulation syndrome

Objectives: The aim of the study was to assess the outcome of pregnancies after in vitro fertilization protocol (IVF), that were complicated by the ovarian hyperstimulation syndrome (OHSS). Material and methods: We examined 26 women undergoing IVF due to OHSS. Patients were divided into two groups: with early OHSS and late OHSS. All women were screened for age, Body Mass Index (BMI), number of embryos transferred, OHSS symptoms and duration of hospitalization. Pregnancy outcome was assessed by rate of miscarriages, premature deliveries and multiple gestations. We assessed also the delivery mode, birth weight of all newborns and obstetric complications. Results: Early OHSS occurred in 10 patients and late OHSS complicated the pregnancies of 16 women. 94,1% of the late OHSS cases occurred in cycles with pregnancy. The miscarriage rate was 26,9%. 38,5% of all births were premature and 26,9% of the newborns had low birth weight. Multiple pregnancies were confirmed in 46,2% of the patients, triplets mainly in women with late OHSS. No fetal anomalies were diagnosed. The most common antenatal complications were: diabetes mellitus, cholestasis and intrauterine infection. The rate of the cesarean sections was 73,8%. Conclusions: OHSS is a risk factor for miscarriage, preterm delivery, multiple gestation, obstetric complications and cesarean section. Late OHSS may be closely associated with the conception cycles

Mid-trimester ultrasound parameters for predicting birth weight in low risk pregnancies vs high-risk pregnancies complicated with pre-gestational diabetes mellitus

Objectives: The aim of the study was to assess the utility of mid-trimester ultrasound parameters in predicting birth weight in low-risk pregnancy and high-risk pregnancy complicated with pregestational diabetes mellitus. Material and methods: A study group comprised 97 healthy women and 160 women with pregestational diabetes (PGDM, type 1), all in singleton pregnancy. Ultrasound examination was performed between weeks 11 and 14, and in weeks 20 and 30 of gestation, based on recommendations of the Polish Society of Gynecologists and Obstetricians, Ultrasonography Division. We also checked uterine artery blood flow parameters. Results: There is a correlation between the birth weight and ultrasound-ascertained parameters, including those characterising uterine artery blood flow and foetal biometry [abdominal circumference (AC), femoral length (FL), biparietal dimension (BPD)].The biparietal dimension (BPD), head circumference (HC) abdominal circumference (AC) and pre-existing diabetes are the ultrasound predictors of LGA. The presence of an early-diastolic uterine artery blood flow waveform notching, as well as the uterine artery pulsatility index (UAPI), femoral length (FL) and hypertension in pregnancy are the ultrasound predictors of SGA. In the subset of women with pre-gestational diabetes (PGDM), there is a negative correlation between the birth weight and the uterine artery pulsatility index and early-diastolic uterine artery blood flow waveform notching. In women with pre-gestational diabetes mellitus (PGDM), femoral length (FL) is a significant predictor of LGA and in case of SGA significant predictors are uterine artery pulsatility index, artery blood flow waveform notching and femoral length (FL). Conclusions: Midtrimester ultrasound parameters with confirmed usefulness in the prediction of birth weight in low-risk pregnancy and high-risk pregnancy complicated with pregestational diabetes mellitus include: uterine artery PI, early-diastolic uterine artery blood flow waveform notching and foetal biometry