Impaired fasting glucose as a marker of heterogeneity of gestational diabetes mellitus. A study of 1025 women living in the region of Kuyavia and Pomerania in Poland

Introduction: Gestational diabetes mellitus (GDM) is a heterogeneous disease. We hypothesized that fasting hyperglycaemia, defined as impaired fasting glycaemia (IFG), is a marker of metabolic heterogeneity of GDM. The aim of this study was to compare selected metabolic parameters in two groups of women with GDM, one with normal fasting glycaemia (NFG GDM) and another with IFG, to test this hypothesis. Material and methods: Metabolic parameters of 1025 women with GDM (mean age 29 years): glucose and insulin at 0 OGTT, glucose at 2-h oral glucose tolerance test (OGTT), body mass index before pregnancy, parity, and gestational age at diagnosis of GDM were analyzed. Insulin resistance and &#946;-cell function were evaluated by HOMA indexes (HOMA-IR and HOMA-B) at the diagnosis of GDM. Results: The IFG GDM group (23%) consisted of isolated IFG (30%), IFG/IGT (60%), and IFG/DM (10%). The NFG GDM group (77%) consisted of isolated IGT (98%) and NFG/DM (2%). Women with IFG GDM were characterized by higher prepregnancy BMI, earlier diagnosis of GDM, higher HOMA-IR (p < 0.03), and lower HOMA-B (p < 0.01) compared to NFG GDM. In the IFGGDM group, DM was characterized by lower HOMA-B compared with isolated IFG and IFG/IGT. In the NFG GDM group, isolated IGT and DM were characterized by similar HOMA-IR and HOMA-B. Conclusions: Impaired fasting glucose distinguishes more severe metabolic phenotypes of GDM compared toGDM with normal fasting glucose concentrations.Wstęp: Cukrzyca ciężarnych (GDM, gestational diabetes mellitus) jest chorobą heterogenną. Autorzy przyjęli hipotezę, że hiperglikemia na czczo spełniająca kryterium nieprawidłowej glikemii (IFG, impaired fasting glycaemia) może być znacznikiem heterogenności GDM. Celem pracy było porównanie wybranych parametrów metabolicznych w dwóch grupach kobiet z GDM, jednej z prawidłową glikemią na czczo (NFG, normal fasting glycaemia) i drugiej z IFG dla sprawdzenia powyższej hipotezy. Materiał i metody: Porównano parametry metaboliczne 1025 kobiet z GDM (śr.wiek 29 lat): stężenie glukozy i insuliny na czczo, stężenie glukozy w 2-godzinnym doustnym teście tolerancji glukozy (OGTT, oral glucose tolerance test), wskaźnik masy ciała (BMI, body mass index) przed ciążą, ilość przebytych ciąż oraz tydzień rozpoznania GDM. Insulinooporność oraz czynność komórek b trzustki oceniono metodą HOMA (HOMA-IR i HOMA-B) przy rozpoznaniu GDM. Wyniki: Grupa IFG GDM (23%) składała się z podgrup z izolowaną IFG (30%), IFG/IGT (60%) oraz IFG/DM (10%). Grupa NFG GDM (77%) skladała się z podgrup z izolowaną IGT (98%) oraz z NFG/DM (2%). Grupa IFG GDM charakteryzowała się wyższym BMI przed ciążą, wcześniejszym rozpoznaniem GDM, większym wskaźnikiem HOMA-IR (p < 0,03) oraz mniejszym wskaźnikiem HOMA-B (p < 0,01) w porównaniu z grupą NFG GDM. W grupie IFG GDM podgrupa z DM charakteryzowała się mniejszym wskaznikiem HOMA-B w porównaniu z izolowaną IFG oraz IFG/IGT. W grupie NFG GDM w podgrupach z izolowaną IGT oraz IGT/DM wskaźniki HOMA-IR oraz HOMA-B nie różniły się istotnie. Wnioski: Występowanie nieprawidłowej glikemii na czczo u kobiet z GDM wyróżnia niekorzystny metabolicznie fenotyp w porównaniu z kobietami z prawidłową glikemią na czczo

Obesity, type 2 diabetes and hormone replacement therapy vs. colorectal tumors in the elderly

Aims. A prophylaxis program for the early detection of colorectal cancer carried out by our department since the year 2000 has been extended to include people aged 65 and older. The subjects were asked additional questions regarding their dietary habits and possible coexistence of type 2 diabetes, and women were asked about the use of hormone replacement therapy. A physical examination, including measurements of nutritional status, was conducted. The aim of the study was to assess the effect of overweight, obesity, type 2 diabetes and hormone replacement therapy on the incidence of cancers and adenomas detected by colonoscopy screening in people aged 65 and older.Methods. The study method was standard colonoscopy screening conducted in people aged 65 and older, in whom no clinical signs suggesting the presence of colorectal cancer were observed. The subjects examined provided their answers to a number of questions related to coexisting conditions and medicines taken, and women were asked about their use of hormone replacement therapy in the past. Every subject underwent a thorough physical examination that included basic anthropometric measurements.    Results. Subjects with obesity, type 2 diabetes, and women who had used hormone replacement therapy had a greater risk of developing colorectal cancer.             Conclusions. The increased risk of colorectal cancer in people with obesity and type 2 diabetes, as well as women undergoing hormone replacement therapy, may be associated with insulin-like growth factor 1 (IGF-1). This polypeptide shows a similarity to insulin, is an active compound in the process of carcinogenesis and plays a role in the regulation of cell growth, proliferation, differentiation and apoptosis. Elucidating the molecular mechanism of action of IGF-1 is important for identifying the causes of tumorigenesis and can also be of significance for the future development of effective methods of treating malignancies

Heterogeneity of insulin resistance level in gestational diabetes mellitus. Therapeutic implications

Objective: The evaluation of insulin resistance (IR) level in population of women with gestational diabetes(GDM) and its relation to treatment of GDM. Materials and methods: 657 GDM women, aged 17-45, treated between the years 2003 and 2005, in Bydgoszcz were studied. Age, pregravid body mass index(BMI), weight gain during pregnancy at the GDM diagnosis, week of GDM diagnosis, week of the beginning of insulin therapy and daily doses of insulin were assessed in the whole population. Daily doses of insulin were evaluated as minimal doses needed at the initial phase of GDM therapy and as maximal doses during gestation. IR was evaluated at the GDM diagnosis, with the use of homeostasis model assessment (HOMA-IR), based on fasting glucose and insulin concentration. Results: 47% women were classified as low HOMA-IR

Gestational Diabetes Mellitus Worsens the Profile of Cardiometabolic Risk Markers and Decrease Indexes of Beta-Cell Function Independently of Insulin Resistance in Nondiabetic Women with a Parental History of Type 2 Diabetes

Background. Women with a history of both parental type 2 diabetes (pt2DM) and previous gestational diabetes (pGDM) represent a group at high risk of cardiovascular events. We hypothesized that pGDM changes cardiometabolic risk markers levels as well as theirs associations with glucose indices in nondiabetic pt2DM women. Methods. Anthropometric parameters, glucose regulation (OGTT), insulin resistance (HOMA-IR), beta-cell function, lipid levels, parameters of endothelial dysfunction, and inflammation were evaluated in 55 women with pt2DM, 40 with both pt2DM and pGDM 2–24 months postpartum, and 35 controls. Results. Prediabetes was diagnosed more frequently in women with both pt2DM and pGDM in comparison with women with only pt2DM (10 versus 8, P=0.04). The pGDM group had higher LDL-cholesterol, sICAM-1, tPa Ag, fibrinogen, and lower beta-cell function after adjustment for HOMA-IR, in comparison with pt2DM group. In pt2DM group postchallenge glucose correlated independently with hsCRP and in pGDM group fasting glucose with HOMA-IR. Conclusions. pGDM exerts a combined effect on cardiometabolic risk markers in women with pt2DM. In these women higher LDL-cholesterol, fibrinogen, sICAM-1, tPa Ag levels and decreased beta cell function are associated with pGDM independently of HOMA-IR index value. Fasting glucose is an important cardiometabolic risk marker and is independently associated with HOMA-IR

Elevation of sE-Selectin Levels 2–24 Months following Gestational Diabetes Is Associated with Early Cardiometabolic Risk in Nondiabetic Women

Objective. We hypothesised that the endothelial dysfunction is associated with early glucose dysregulation and/or atherosclerosis risk factors in nondiabetic women with a previous history of gestational diabetes (pGDM). Material/Methods. Anthropometric parameters, glucose regulation (OGTT), insulin resistance (HOMA), lipids, biomarkers of endothelial dysfunction, and inflammation were evaluated in 85 women with pGDM and in 40 controls 2–24 months postpartum. Results. The pGDM group consisted of 67% normoglycemic women (pGDM-N) and 33% with prediabetic state (pGDM-P). The BMI, waist circumference, fasting and 2 h glucose (OGTT), soluble adhesion molecules, tissue plasminogen activator antigen, high sensitivity C-reactive protein, total-, LDL-cholesterol, and triglycerides/HDL-cholesterol ratio were higher in the pGDM women compared with the controls. After adjustment for BMI and fasting glucose, only higher triglycerides, higher TG/HDL and lower HDL-cholesterol were associated with pGDM. The pGDM-P differed from pGDM-N for only higher triglycerides and TG/HDL. The plasma level of sE-selectin was not independently associated with glucose concentration in pGDM group. sE-selectin level correlated with triglycerides, TG/HDL, plasminogen activator inhibitor-1 antigen, and sICAM-1. Conclusions. sE-selectin level correlated with components of metabolic syndrome, but only the atherogenic lipid profile was independently associated with a previous history of GDM in nondiabetic women 2–24 months postpartum

The Role of Hypoxia-Inducible Factor-1α, Glucose Transporter-1, (GLUT-1) and Carbon Anhydrase IX in Endometrial Cancer Patients

Hypoxia-inducible factor-1α (HIF-1α), glucose transporter-1 (GLUT-1), and carbon anhydrase IX (CAIX) are important molecules that allow adaptation to hypoxic environments. The aim of our study was to investigate the correlation between HIF-1α, GLUT-1, and CAIX protein level with the clinicopathological features of endometrial cancer patients. Materials and Methods. 92 endometrial cancer patients, aged 37–84, were enrolled to our study. In all patients clinical stage, histologic grade, myometrial invasion, lymph node, and distant metastases were determined. Moreover, the survival time was assessed. Immunohistochemical analyses were performed on archive formalin fixed paraffin embedded tissue sections. Results. High significant differences (P=0.0115) were reported between HIF-1α expression and the histologic subtype of cancer. Higher HIF-1α expression was associated with the higher risk of recurrence (P=0.0434). The results of GLUT-1 and CAIX expression did not reveal any significant differences between the proteins expression in the primary tumor and the clinicopathological features. Conclusion. The important role of HIF-1α in the group of patients with the high risk of recurrence and the negative histologic subtype of the tumor suggest that the expression of this factor might be useful in the panel of accessory pathomorphological tests and could be helpful in establishing more accurate prognosis in endometrial cancer patients

Stromal derived factor-1 (SDF-1) and its receptors CXCR4 and CXCR7 in endometrial cancer patients.

PURPOSE: One of the most important function of stromal derived factor-1 (SDF-1) and its receptors, is regulating the process of metastasis formation. The aim of our study was to investigate the correlation between SDF-1, CXCR4 and CXCR7 protein levels measured by immunohistochemistry with the clinicopathological features and the survival of endometrial cancer patients. MATERIALS AND METHODS: 92 patients aged 37-84 (mean 65.1±9.5) were enrolled to our study between January 2000 and December 2007. After the diagnosis of endometrial cancer, all women underwent total abdominal hysterectomy, with bilateral salpingoophorectomy and pelvic lymph node dissection. In all patients clinical stage (according to FIGO classification), histologic grade, myometrial invasion, lymph node and distant metastases were determined.Furthermore, the survival time was assessed. Immunohistochemical analyses of SDF-1, CXCR4 and CXCR7 were performed on archive formalin fixed paraffin embedded tissue sections. RESULTS: Statistically significant correlations (p<0.01) were reported between SDF-1 and the clinical stage of disease, lymph node metastases, distant metastases, deep myometrial invasion (≥50%), cervical involvement, involvement of adnexa. Statistically significant correlation (p<0.01) was found between SDF-1 expression and the risk of the recurrence. Higher SDF-1 expression was associated with a higher risk of recurrence (p = 0.0001). The results of CXCR4 and CXCR7 expression didn't reveal any significant differences(p>0.05) between the proteins expression in the primary tumor cells and the clinicopathological features. Moreover, the Kaplan-Meier analyses demonstrated a stepwise impairment of cancer overall survival (OS) with increasing SDF-1 expression. CONCLUSION: The important role of SDF-1 as a predictor of negative clinicopathological characteristics of a tumor suggests that the expression of this stromal factor should be included in the panel of accessory pathomorphological tests and could be helpful in establishing a more accurate prognosis in endometrial cancer patients

Inhibin A and Inhibin B concentrations in relation to FIGO stage.

<p>FIGO stage- the International Federation of Gynecology and Obstetrics stage; Q1: lower quartile; Q2: median; Q3: upper quartile.</p