Objective To evaluate the association of hepatic steatosis index (HSI) in the first trimester and the risk of gestational diabetes mellitus (GDM) as well as large for gestational age (LGA) infant in Chinese women. Methods A total of 1082 pregnant women were included in this study. Maternal basic laboratory data, including ALT, AST, FBG, insulin, TG, and HDL-C, were tested during 6–12 weeks of gestation and anthropometric characteristics were monitored during gestation. A 75-g oral glucose tolerance test (OGTT) was conducted at 24–28 weeks of gestation. HSI, nonalcoholic fatty liver disease (NAFLD) liver fat score, triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) and triglyceride-glucose (TyG) index were calculated. Odds ratio with 95% confidence interval for subsequent risk of GDM and LGA by HSI quartiles were assessed by binary logistic regression model. The predictive ability of HSI for GDM and LGA was evaluated by the receiver operating characteristic (ROC) curve analysis and was compared with other indices. Results The incidence of GDM and LGA were 22.09% (239/1082) and 10.53% (87/826). HSI was higher in GDM group than in NGT group (median, interquartile range: 30.67, 27.20–35.10 vs 27.98, 25.70–30.82, P <0.001). Incidence of GDM was gradually increased with increasing HSI values. Women in the highest HSI quartile had significantly higher risk of LGA delivery than those in the lowest HSI quartile ( P <0.05). The area under the ROC curves of HSI for GDM and LGA were higher than other indices, reaching 0.646 (95%CI: 0.605–0.686) and 0.600 (95%CI: 0.541–0.660), respectively. Conclusion Higher HSI was independently associated with higher risk of GDM and LGA in Chinese women. HSI in the first trimester can predict the risk of GDM and LGA.
Objective To assess the association between insulin resistance and gestational diabetes mellitus (GDM) in early pregnancy and find a simple surrogate index of the homeostasis model assessment of insulin resistance (HOMA‐IR). Methods A total of 700 pregnant women were included in this prospective, double‐center, observational cohort study. The glucose and lipid metabolic characterization was performed at 6–12 weeks of pregnancy. All participants underwent a 75‐g oral glucose tolerance test at 24–28 weeks of pregnancy. Linear regression analysis was applied to find a novel surrogate index of HOMA‐IR. Binary logistic analysis was applied to estimate possible associations of different indices with GDM and insulin resistance. Results GDM was diagnosed in 145 of 700 women with singleton pregnancies (20.7%). HOMA‐IR was higher in the GDM group than in the normal glucose tolerance (NGT) group and was an individual risk factor for GDM (adjusted risk ratio RR 1.371, 95% confidence interval [CI] 1.129–1.665, P < 0.001). TyHGB index as the surrogate index of HOMA‐IR was represented as TG/HDL‐C + 0.7*FBG (mmol/L) +0.1*preBMI (kg/m2)(where TG/HDL‐C is triglyceride/high‐density lipoprotein cholesterol; FBG is fasting blood glucose, and preBMI is the pre‐pregnancy body mass index [calculated as weight in kilograms divided by the square of height in meters]). The cut‐off point of the TyHGB index was 6.0 (area under the curve 0.827, 95% CI 0.794–0.861, P < 0.001) for mild insulin resistance. Conclusion Increased HOMA‐IR in early pregnancy was a risk factor of GDM. TyHGB index could be a surrogate index of HOMA‐IR and had a predictive value for GDM.
Aim To investigate the influence of sodium/glucose cotransporter‐2 inhibitors (SGLT‐2i) on renal function during the course of its administration, particularly in the initial weeks. Materials and Methods Randomized controlled trials (RCTs) related to SGLT‐2i were searched in databases (MEDLINE, EMBASE, and Cochrane Central Register) from the database's inception to August 31, 2021. All RCTs reported the kidney outcomes of SGLT2i versus active or placebo control were included, regardless of the presence of diabetes in the patients and the baseline estimated glomerular filtration rate (eGFR). The Cochrane Collaboration risk of bias tool was used to assess the quality of the included studies. All outcome comparisons were performed using the RevMan 5.4 software. Results Eleven RCTs with 58 534 participants reporting prespecified renal outcomes were identified. There was no heterogeneity in the baseline eGFR and urine albumin‐to‐creatinine ratio in the included studies. In the initial 2–4 weeks, there was an acute decline of eGFR in the SGLT‐2i group compared with placebo group (weighted mean difference [WMD] −3.35 ml/min/1.73 m 2 ; 95% CI, −3.81 to −2.90; I 2 = 35%, p = .15); When compared to baseline eGFR in the SGLT‐2i group, the WMD was −4.02 ml/min/1.73 m 2 (95% confidence interval [CI], −3.61 to −4.44; I 2 = 0%, p = .45). The renoprotective effect gradually appeared, and the decline rate of eGFR in the SGLT‐2i group was sustained slower than placebo. However, the statistically significant benefit of SGLT‐2i did not appear until the 104th week (the second year) (WMD 0.35 ml/min/1.73 m 2 , 95% CI, 0.04 to 0.66; I 2 = 45%, p = .08). Subgroup analysis showed SGLT‐2i had a similar benefit on renal function regardless of baseline eGFR values. Conclusion SGLT‐2i consistently slowed the deterioration of eGFR since the early stage of administration, even in patients with chronic kidney disease. However, there was an acute decline in eGFR in the initial 2–4 weeks; afterwards the renoprotective effect of SGLT‐2i gradually appeared and remained stable in the next few years.
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