В связи с ростом заболеваемости сахарным диабетом (СД) в последние годы увеличилось число женщин репродуктивного возраста, страдающих этим заболеванием. Более 40 лет известно о негативном влиянии гипергликемии на рост и формирование плода, течение и исходы беременности [1-4]. Как хроническая, так и эпизодическая гипергликемия у матери приводит к формированию гиперинсулинемии у плода-основной причины формирования диабетической фетопатии. Для улучшения течения и исхода беременности у женщин с СД необходимо дости-жение содержания глюкозы в крови, соответствующего физиологической беременности. С целью уточнения гликемического профиля при физиологической беременности был проведен метаанализ, включающий 12 крупных исследований профиля глюкозы при физиологической беременности [5]. По результатам анализа, максимальная концентрация глюкозы после приема пищи во время беременности наступает на 69,4±23,9-й минуте. Средний уровень гликемии натощак составил 3,9±0,4 ммоль/л, через 1 ч после приема пищи-6,1±0,7 ммоль/л, через 2 ч
The main ideas about the pathogenesis of ovarian dysfunction in women with diabetes mellitus (DM) type 1 are presented. The role of increased opioid and dopaminergic tone in the pathogenesis of reducing the synthesis of the gonadotropin-releasing hormone by the hypothalamus in women with type 1 diabetes was analyzed. Presented the data of relationship between ovarian hormonal insufficiency in women with type 1 diabetes with possible damage of positive feedback mechanism of the ovaries and the pituitary gland, which intactness is necessary for the maturation of the dominant follicle and ovulation. The results of studies, suggested that the high doses of exogenously administered insulin in type 1 DM lead to stimulation of androgen synthesis in teca cells and ovarian stroma and the development of ovarian hyperandrogenemia, as well as polycystic ovary syndrome, are reduced. In addition to exogenous hyperinsulinemia, in the pathogenesis of ovarian dysfunction, the value of the deficiency of endogenous insulin, leading to a violation of steroidogenesis in the tissues of the ovary and anovulation, is proved. The role of insulin deficiency and hyperglycemia in the development of metabolic stress lead to ovarian dysfunction in patients with type 1 diabetes was analyzed.
The article describes the principles of using the insulin pump therapy in patients with type 1 diabetes mellitus during pregnancy. There were obtained data about the state of the carbohydrate metabolism in pregnant women with type 1 diabetes using insulin pump therapy regimen (PI) and multiple daily insulin injections, the outcomes of pregnancy and labor.
Hypothesis/aims of study. Using early non-invasive markers of diabetic nephropathy (DN) in clinical practice is important to early start of nephroprotective therapy and leads to improving the quality of life, while decreasing disability and mortality of diabetic patients. The aim of the study was to estimate the potential of using serum cystatin C and glomerular filtration rate (GFR) calculated by CKD-EPIcys and CKD-EPIcr-cys equations for an early diagnosis of DN in type 1 diabetic (T1D) women who were planning pregnancy or were in the I trimester of pregnancy. Study design, materials, and methods. 47 T1D women were examined, of whom 25 individuals were pregnant and 22 ones were planning pregnancy. In all patients, glycated hemoglobin and serum cystatin C levels were determined, GFR was estimated by the creatinine clearance test, MDRD, CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, with diabetes training done. Results. The pregnant group and the planning pregnancy group were distinguished by glycated hemoglobin (p = 0.001), serum creatinine (p = 0.001), and GFR estimated by the creatinine clearance test (р = 0.017), CKD-EPIcr (р = 0.005), and CKD-EPIcr-cys (р = 0.046) equations. There was no difference in urinary creatinine, serum cystatin C, and GFR estimated by CKD-EPIcys equation and daily urinary protein excretion between the study groups. Most pregnant women (87.5%) were in stage C1 and only 12,5% in stage C2 as determined by estimated GFR using the CKD-EPIcr formula, which was significantly different compared to the planning pregnancy group, where the percentage of women in stages C1 and C2 was comparable (р = 0.002). In addition, most pregnant patients were in stage C1, while most of the patients planning pregnancy were referred to stage C2 by GFR estimated by CKD-EPIcysequation. Stage C3a was diagnosed in the both study groups only when CKD-EPIcys equation for GFR estimation was used. Most women from both groups were in stage C1 when GFR was estimated by the creatinine clearance test, the percentage ratio of patients in stages C1 and C2 in both groups being comparable. Conclusion. Our results demonstrated that serum cystatin C and GFR estimation by CKD-EPIcys equation could improve nephropathy diagnostic accuracy among T1D patients with a normal serum creatinine level and intact GFR based on creatinine level.
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