Porównanie skuteczności, tolerancji i bezpieczeństwa diety wysoko- i niskowęglowodanowej u kobiet z cukrzycą ciążową

Introduction: Nutrition therapy is an integral part of the management of gestational diabetes mellitus (GDM). Most women with GDM are treated by nutritional management alone. The goal of our study was to compare low and high carbohydrate diets in their effectiveness, safety and tolerability in women with GDM. Material and methods: The study group consisted of 30 Caucasian women newly diagnosed with GDM, with a mean age of 28.7 &plusmn; 3.7 years and pregnancy duration of 29.2 &plusmn; 5.4 weeks. The patients were randomised into two groups: those on a low and those on a high carbohydrate diet (45% vs. 65% respectively of energy supply coming from carbohydrates). The presence of urine ketones was controlled every day. After two weeks daily glucose profiles and compliance with the recommended diets were analysed. Results: Glucose concentration before implementation of the diet regimen did not differ between groups. No changes in fasting blood glucose were noticed in the group that had followed a low carbohydrate diet, although a significant decrease in glucose concentration was observed after breakfast (102 &plusmn; 16 vs. 94 &plusmn; 11 mg/dl), lunch (105 &plusmn; 12 vs. 99 &plusmn; 9 mg/dl) and dinner (112 &plusmn; 16 vs. 103 &plusmn; 13 mg/dl) (p < 0.05). In the high carbohydrate diet group fasting and after-breakfast glucose concentration did not change. A significant decrease in glycaemia was noticed after lunch (106 &plusmn; 15 vs. 96 &plusmn; 7 mg/dl) and dinner (107 &plusmn; 12 vs. 97 &plusmn; 7 mg/dl) (p < 0.05). Ketonuria was not observed in either group. Obstetrical outcomes did not differ between groups. Conclusions: Both high and low carbohydrate diets are effective and safe. A diet with carbohydrate limitation should be recommended to women who experience the highest glycaemia levels after breakfast. (Pol J Endocrinol 2007; 58 (4): 314-319)Wstęp: Stosowanie odpowiedniej diety jest podstawą leczenia cukrzycy ciążowej (GDM, gestational diabetes mellitus). U większości kobiet dieta jest jedyną formą leczenia. Celem pracy było zbadanie skuteczności i bezpieczeństwa dwóch rodzajów diety: wysoko- i niskowęglowodanowej w grupie kobiet z cukrzycą ciążową. Materiał i metody: Badaniem objęto 30 kobiet z cukrzycą ciążową w wieku 28,7 &plusmn; 3,7 lat, w 29,2 &plusmn; 5,4 tygodniu ciąży. Pacjentki zrandomizowano do dwóch grup: diety wysoko- i niskowęglowodanowej zawierającej odpowiednio 65% i 45% dziennej podaży energii z węglowodanów. Po 2 tygodniach stosowania diety oceniono zmianę wartości glikemii, występowanie ketonurii oraz tolerancję zaleconej diety.Wyniki: U pacjentek stosujących dietę niskowęglowodanową zaobserwowano istotne obniżenie wartości glikemii poposiłkowych - po śniadaniu (102 &plusmn; 16 vs. 94 &plusmn; 11 mg/dl), obiedzie (105 &plusmn; 12 vs. 99 &plusmn; 9 mg/dl) i kolacji (112 &plusmn; 16 vs. 103 &plusmn; 13 mg/dl) w stosunku do wartości przed rozpoczęciem leczenia (p < 0,05). W grupie wysokowęglanowej zaobserwowano istotny statystycznie spadek wartości glikemii po obiedzie (106 &plusmn; 15 vs. 96 &plusmn; 7 mg/dl) i po kolacji (107 &plusmn; 12 vs. 97 &plusmn; 7 mg/dl) w stosunku do wartości przed rozpoczęciem leczenia (p < 0,05), jednak bez zmian w glikemii po śniadaniu (94 &plusmn; 17 vs. 89 &plusmn; 17 mg/dl). W żadnej z grup nie zaobserwowano obniżenia glikemii na czczo. U żadnej pacjentki nie stwierdzono epizodów ketonurii. Wyniki położnicze nie różniły się w grupach. Wnioski: Diety wysoko- i niskowęglowodanowe okazały się tak samo skuteczne i bezpieczne w stosowaniu u kobiet z cukrzycą ciążową. Dietę niskowęglowodanową powinno zalecać się kobietom, u których najwyższy wzrost wartości glikemii obserwuje się po śniadaniu

Role of Collectins and Complement Protein C1q in pregnancy and parturition

Collectins such as surfactant proteins SP-A, SP-D, and mannan-binding lectin (MBL), as well as complement protein C1q are evolutionarily conserved innate immune molecules. They are known to opsonize a range of microbial pathogens (bacteria, fungi, virus, and parasites) and trigger effector clearance mechanisms involving phagocytosis and/or complement activation. Collectins and C1q have also attracted attention in studies involving pregnancy as they are expressed in the female reproductive tissues during pregnancy; a unique state of immune suppression with increased susceptibility to infectious diseases. Recent studies are beginning to unravel their functional significance in implantation, placentation, pregnancy maintenance and parturition in normal and adverse pregnancies. Collectins and C1q, expressed in gestational tissues during pregnancy, might alter the status of mother’s immune response to the allogenic fetus and the microenvironment, thereby serving as important regulators of fetus-mother interaction. Here, we discuss the functional roles that have been assigned to SPA, SP-D, MBL and C1q in pregnancy and parturition

Bromocriptine &#8212; an old drug in a new formulation for the effective treatment of type 2 diabetes

Quick-release bromocriptine mesylate was approved by the Food and Drug Administration (FDA) in May 2009, for the treatment of type 2 diabetes (T2DM). The quick-release formulation of bromocriptine (bromocriptine- QR; Cycloset) represents a novel therapeutic option in T2DM by targeting centrally mediated pathways of glucose metabolism, effecting in reducing plasma glucose, triglycerides, free fatty acid (FFA) levels and eventually cardiovascular events. Randomized controlled trials have shown that bromocriptine- QR lowers glycated hemoglobin by 0.4&#8211; &#8211;0.8% either as monotherapy or in combination with other anti-diabetes medications. Bromocriptine-QR mechanism of action, unique formulation, clinical efficacy and safety, proves it to be a great alternative to current treatments for type 2 diabetes. (Diabet. Prakt. 2011; 12, 5: 175&#8211;179)Quick-release bromocriptine mesylate was approved by the Food and Drug Administration (FDA) in May 2009, for the treatment of type 2 diabetes (T2DM). The quick-release formulation of bromocriptine (bromocriptine- QR; Cycloset) represents a novel therapeutic option in T2DM by targeting centrally mediated pathways of glucose metabolism, effecting in reducing plasma glucose, triglycerides, free fatty acid (FFA) levels and eventually cardiovascular events. Randomized controlled trials have shown that bromocriptine- QR lowers glycated hemoglobin by 0.4&#8211; &#8211;0.8% either as monotherapy or in combination with other anti-diabetes medications. Bromocriptine-QR mechanism of action, unique formulation, clinical efficacy and safety, proves it to be a great alternative to current treatments for type 2 diabetes. (Diabet. Prakt. 2011; 12, 5: 175&#8211;179

Effect of transdermal hormone therapy on platelet haemostasis in menopausal women

Introduction Despite the undeniably positive effect on the quality of life of menopausal women, menopausal hormone therapy (HT) also has negative side-effects, which include, among others, thromboembolic complications. Objective.To assess the effect of a popular type of this therapy – transdermal HT on platelet hemostasis, which plays a significant role in intravascular coagulation. Material and Methods The study group consisted of 92 postmenopausal women: 1) group G1 (n=30), treated with transdermal HT (17β-estradiol 50 μg/day plus NETA 170 μg/day); 2) group G2 (n=31), treated with the above transdermal HT and low dosage of acetylsalicylic acid (ASA); 3) control group P (n=31). All the women qualified for the study had two or more risk factors for arterial thrombosis, such as: smoking, hypertension, visceral obesity, hypercholesterolaemia, hypertriglyceridaemia, elevated levels of PAI-1, and increased fibrinogen, increased activity of coagulation factor VII. Results After three months of therapy, in the G1 group there was a decrease in platelet count (p = 0.004) and a decrease in GP IIb/IIIa – a platelet receptor for fibrinogen (p = 0.022). In the G2 group, no changes in the tested parameters were observed. Conclusions 1) Transdermal HT in the form of combined, estrogen-progestogen patches favourably modifies platelets haemostasis, reversing the adverse effects that occur after menopause. 2) The use of low ASA doses as a thromboprophylaxis in short-term transdermal HT is not necessary

Effect of transdermal hormone therapy on platelet haemostasis in menopausal women

[b]Introduction[/b]. Despite the undeniably positive effect on the quality of life of menopausal women, menopausal hormone therapy (HT) also has negative side-effects, which include, among others, thromboembolic complications. [b]objective[/b]. To assess the effect of a popular type of this therapy – transdermal HT on platelet hemostasis, which plays a significant role in intravascular coagulation. [b]Materials and method[/b]. The study group consisted of 92 postmenopausal women: 1) group G1 (n=30), treated with transdermal HT (17β-estradiol 50 μg/day plus NETA 170 μg/day); 2) group G2 (n=31), treated with the above transdermal HT and low dosage of acetylsalicylic acid (ASA); 3) control group P (n=31). All the women qualified for the study had two or more risk factors for arterial thrombosis, such as: smoking, hypertension, visceral obesity, hypercholesterolaemia, hypertriglyceridaemia, elevated levels of PAI-1, and increased fibrinogen, increased activity of coagulation factor VII. Results. After three months of therapy, in the G1 group there was a decrease in platelet count (p = 0.004) and a decrease in GP IIb/IIIa – a platelet receptor for fibrinogen (p = 0.022). In the G2 group, no changes in the tested parameters were observed. conclusions. 1) Transdermal HT in the form of combined, estrogen-progestogen patches favourably modifies platelets haemostasis, reversing the adverse effects that occur after menopause. 2) The use of low ASA doses as a thromboprophylaxis in short-term transdermal HT is not necessary

Advanced glycation end products upregulate angiogenic and pro-inflammatory cytokine production in human monocyte/macrophages.

Glucose can react non-enzymatically with amino groups of, for example, proteins, to yield derivatives termed advanced glycation end products (AGE), which contribute to many chronic progressive diseases associated with microvascular complications. The study aimed to determine the effect of AGE-modified albumin on THP-1 cells and human monocyte-derived macrophages. Bovine serum albumin (BSA) or human serum albumin (HSA), modified by glucose-derived AGE, was prepared by incubation with glucose for differing periods of time. Alternatively, BSA was incubated with sodium cyanoborohydride and glyoxylic acid to produce N(epsilon)-(carboxymethyl)lysine-modified BSA (CML-BSA). Stimulation for 24h of THP-1 cells with BSA, incubated for 6-8 weeks with glucose, induced significant VEGF release. Human monocyte-derived macrophages stimulated with extensively glycated HSA also showed significant VEGF release, as well as upregulation of IL-8 production, incubation for 6h with extensively glycated HSA increased release of TNFalpha and expression of tissue factor. Finally, addition of CML-BSA resulted in significant induction of TNFalpha and VEGF release. We demonstrate that a range of different methods of glycation of BSA and HSA, including CML-BSA, resulted in the induction of VEGF, TNFalpha, IL-8 and expression of tissue factor, according to length of stimulation and different glycation products used, suggesting that AGE-induced activation of macrophages may contribute to vascular complications by regulation of angiogenic, inflammatory and pro-coagulant processes