An impaired secretion of GLP-1 and GIP does not seem to play a major role in the pathogenesis of GDM.

IntroductionPeroxisome proliferator-activated receptor γ (PPARγ) is a ligand-activated transcription factor of the nuclear receptor superfamily that is involved in lipid and carbohydrate metabolism as well as inflammation; thereby it participates in metabolic diseases including diabetes. Although PPARγ expression has been observed in different tissues of diabetic patients, its level in leukocytes from subjects affected by gestational diabetes mellitus (GDM) has not yet been reported. This study aimed to investigate leukocyte PPARG expression in GDM patients at 24–33 weeks of gestation and, in turn, to correlate these alterations with anthropometric and metabolic parameters of patients.Material and methodsLeukocytes were isolated from the blood of normal glucose tolerant (NGT; n = 34) and GDM (n = 77) pregnant women between 24 and 33 weeks of gestation. Leukocyte PPARG mRNA expression was determined by semi-quantitative polymerase chain reaction. Univariate correlation analysis was performed to investigate associations between PPARG expression and clinical characteristics of patients.ResultsLeukocyte PPARG mRNA level was significantly higher in GDM than NGT women (p < 0.05). In the whole study group, PPARG expression positively correlated with plasma glucose concentrations at 1 h (r = 0.222, p = 0.049) and 2 h (r = 0.315, p = 0.020) of 75 g oral glucose tolerance test (OGTT), and negatively correlated with plasma HDL cholesterol concentration (r = -0.351, p = 0.010).ConclusionsThe correlation between leukocyte PPARG overexpression and hyperglycaemia suggests that PPARG mRNA expression in these cells might be up-regulated in high-glucose conditions in GDM patients at 24–33 weeks of gestation.

Staged Diabetes Management (SDM) is a disease state management programme, that was developed by the International Diabetes Center, Minneapolis, USA. Its primary aim is to achieve near‐normal to normal blood glucose control in all patients with diabetes, using community involvement and simple, complete clinical pathways. SDM contains methods of diagnosis, an overview of therapy, practice guidelines, and specific detailed treatment protocols (decision paths) for type 1 and type 2 diabetes and gestational diabetes (GDM). Formal training in SDM was conducted for participating physicians and nurses, including an introduction to the philosophy and approach of SDM, provision of the materials and elucidation of the expected goals and results. After training and implementation, a series of trials were performed to determine the effectiveness of SDM in improving diabetes care in this region. The trial results evaluated the overall influence of SDM on such clinical parameters as HbA1c and fasting blood glucose, to assess the appropriateness of treatment modalities and timing of therapeutic choices, eg minimal delay to choice of appropriate stage. The introduction of the SDM programme led to significant reductions of HbA1c and fasting and postprandial blood sugar, without hypoglycaemia, in a representative group of people with type 1 diabetes. In patients with type 2 diabetes, significant reductions of HbA1c, fasting and postprandial blood glucose without hypoglycaemia or weight‐gain was achieved. To our knowledge, this is one of the first times that these goals have been achieved in people with type 1 diabetes, without hypoglycaemia, and in type 2 diabetes, without weight‐gain. Using SDM we achieved 100% screening of 500 women referred for evaluation of menopausal symptoms. Approximately 5% of peri‐ and post‐menopausal women were found to have frank diabetes (type 2) and an additional 8% had impaired glucose tolerance. Using the SDM programme, tight metabolic control in pregnant women with type 1 diabetes decreased the incidence of serious complications, eg urinary tract infections and pre‐eclampsia, particularly in the critical last few weeks before delivery. We found a decrease in the incidence of serious neonatal complications in the SDM group — lower levels of: neonatal death (none seen in the SDM group); fetal congenital malformations; hypoglycaemia and respiratory distress syndrome. With respect to GDM, screening of pregnant women and proper treatment using SDM resulted in lower pregnancy and neonatal complication rates as well as fewer Caesarean sections. The success of these early pilot studies has led to a training programme that aims to introduce SDM to up to 500 primary care providers per year throughout Poland. Once trained, a larger more definitive multi‐centre study of the effects of SDM will be needed to confirm the earlier findings.

Introduction: An increasing body of evidence has linked diabetes to inflammation. The phosphatidylinositol 3-kinase delta (PI3-K delta), a member of the PI3K class IA family, has been implicated in the regulation of inflammation since it is predominantly expressed in leukocytes. To date, no information has been available on the relationship of leukocyte PI3-K delta with gestational diabetes mellitus (GDM). Therefore, the aim of this study was to investigate changes in leukocyte PIK3CD mRNA expression in GDM women and, in turn, to correlate them with anthropometric and metabolic parameters of patients. Additionally, an association between leukocyte mRNA expression of PIK3CD and Sirtuin 1 (SIRT1) was determined. Material and methods: Blood samples from women with normal glucose tolerance (NGT; n = 43) and GDM (n = 132) at 24-33 weeks of gestation were collected. After isolating leukocytes from the blood, quantitative real time PCR (qRT-PCR) was performed to determine PIK3CD gene expression in these cells. Univariate regression analyses were used to assess an association of leukocyte PIK3CD mRNA level with clinical characteristics of patients as well as with leukocyte SIRT1 mRNA expression. Results: Leukocyte PIK3CD mRNA was increased by 1.98-fold in the GDM v. NGT subjects and inversely correlated with low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) in diabetic pregnancy. There were also significant positive correlations of leukocyte PIK3CD mRNA with plasma glucose concentration at 2h of 75 g oral glucose tolerance test (OGTT) and SIRT1 mRNA in the whole study population (both P < 0.05). Conclusions: GDM is accompanied by leukocyte PIK3CD overexpression associated with reduced plasma LDL-C and TC levels, as well as with hyperglycaemia and elevated leukocyte SIRT1 mRNA. (Endokrynol Pol 2014; 65 (1): 17-24)