Does intensive glycemic control in diabetic pregnancies result in normalization of other metabolic fuels?

Reece, E. Albert; Coustan, Donald R.; Sherwin, Robert S.; Tuck, Susan M.; Bates, Sue; O’Connor, Theresa; Tamborlane, William V.

doi:10.1016/0002-9378(91)90240-r

Cited by 16 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Analysis of studies in which the amino acid and lipid concentrations were measured in type 1 diabetic patients on conventional or intensive insulin treatment (25,26) suggests that the metabolic abnormalities of islet-transplanted patients with partial function are comparable with those of (25)(26)(27). However, in the latter group, metabolic control was obtained at the expense of a high prevalence of hypoglycemia (27), whereas no hypoglycemic episode was seen in islet-transplanted patients.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Effects of Restoring Partial β-Cell Function After Islet Allotransplantation in Type 1 Diabetic Patients

et al. 2001

View full text Add to dashboard Cite

Successful intraportal islet transplantation normalizes glucose metabolism in diabetic humans. To date, full function is not routinely achieved after islet transplantation in humans, with most grafts being characterized by only partial function. Moreover, the duration of full function is variable and cannot be sufficiently predicted with available methods. In contrast, most grafts retain partial function for a long time. We hypothesized that partial function can restore normal protein and lipid metabolism in diabetic individuals. We studied 45 diabetic patients after islet transplantation. Labeled glucose and leucine were infused to assess whole-body glucose and protein turnover in 1) 6 type 1 diabetic patients with full function after intraportal islet transplantation (FF group; C-peptide > 0.6 nmol/l; daily insulin dosage 0.03 ± 0.02 U · kg -1 body wt · day -1 ; fasting plasma glucose < 7.7 mmol/l; HbA 1c ≤ 6.5%), 2) 17 patients with partial function (PF group; C-peptide > 0.16 nmol/l; insulin dosage < 0.4 U · kg -1 body wt · day -1 ), 3) 9 patients with no function (NF group; C-peptide < 0.16 nmol/l; insulin dosage > 0.4 U · kg -1 body wt · day -1 ), and 4) 6 patients with chronic uveitis as control subjects (CU group). Hepatic albumin synthesis was assessed in an additional five PF and five healthy volunteers by means of a primed-continuous infusion of [3,3,3-2 H 3 ]leucine. The insulin requirement was 97% lower than pretransplant levels for the FF group and 57% lower than pretransplant levels for the PF group. In the basal state, the PF group had a plasma glucose concentration slightly higher than that of the FF (P = 0.249) and CU groups (P = 0.08), but was improved with respect to the NF group (P < 0.01). Plasma leucine (101.1 ± 5.9 µmol/l) and branched-chain amino acids (337.6 ± 16.6 µmol/l) were similar in the PF, FF, and CU groups, and significantly lower than in the NF group (P < 0.01). During insulin infusion, the metabolic clearance rate of glucose was defective in the NF group versus in the other groups (P < 0.01). Both the basal and insulin-stimulated proteolytic and proteosynthetic rates were comparable in the PF, FF, and CU groups, but significantly higher in the NF group (P = 0.05). In addition, the PF group had a normal hepatic albumin synthesis. Plasma free fatty acid concentrations in the PF and FF groups were similar to those of the CU group, but the NF group showed a reduced insulin-dependent suppression during the clamp. We concluded that the restoration of ~60% of endogenous insulin secretion is capable of normalizing the alterations of protein and lipid metabolism in type 1 diabetic kidney recipients, notwithstanding chronic immunosuppressive therapy. The results of the present study indicate that "success" of islet transplantation may be best defined by a number of metabolic criteria, not just glucose concentration/metabolism alone. Diabetes 50:277-282, 2001

show abstract

Section: Discussionmentioning

confidence: 99%

Metabolic Effects of Restoring Partial β-Cell Function After Islet Allotransplantation in Type 1 Diabetic Patients

et al. 2001

View full text Add to dashboard Cite

show abstract

“…We know that maternal glucose is one of the most important factors of influence (1,2), and Reece et al (3) showed that normoglycemia in pregnancy is associated with normal levels of other nutrients, such as amino acids and lipids. For this reason, glycemia is the single maternal metabolic parameter routinely assessed in diabetic pregnancies.…”

Section: Diabetes Care 24:1319 -1323 2001mentioning

confidence: 99%

Third-Trimester Maternal Glucose Levels From Diurnal Profiles in Nondiabetic Pregnancies

et al. 2001

View full text Add to dashboard Cite

OBJECTIVE -To assess the 24-h glucose levels in a group of nondiabetic, nonobese pregnant women and to verify the presence of correlations between maternal glucose levels and sonographic parameters of fetal growth. RESEARCH DESIGN AND METHODS -A total of 66Caucasian nonobese pregnant women with normal glucose challenge tests (GCT) enrolled in the study; from this population, we selected 51 women who delivered term (from 37 to 42 weeks completed) live-born infants without evidence of congenital malformations. The women were requested to have three main meals and to perform daily glucose profiles fortnightly from 28 -38 weeks without modifying their lifestyle or following any dietary restriction. All subjects were taught how to monitor their blood glucose by using a reflectance meter. Fetal biometry was evaluated by ultrasound scan according to standard methodology at 22, 28, 32, and 36 weeks of pregnancy.RESULTS -The overall daily mean glucose level during the third trimester was 74.7 Ϯ 5.2 mg/dl. Daily mean glucose values increased between 28 (71.9 Ϯ 5.7 mg/dl) and 38 (78.3 Ϯ 5.4 mg/dl) weeks of pregnancy. We found a significant positive correlation at 28 weeks between 1-h postprandial glucose values and fetal abdominal circumference (AC). At 32 weeks, we documented positive correlations between fetal AC and maternal blood glucose levels 1 h after breakfast, 1 and 2 h after lunch, and 1 and 2 h after dinner. At 36 weeks, there was a positive correlation between fetal AC and 1-and 2-h postprandial blood glucose levels. In addition, there was a negative correlation between head-abdominal circumference ratio and 1-h postprandial blood glucose values.CONCLUSIONS -This longitudinal study first provides a contribution toward the definition of normoglycemia in nondiabetic, nonobese pregnant women; moreover, it reveals significant correlations of postprandial blood glucose levels with the growth of insulin-sensitive fetal tissues and, in particular, between 1-h postprandial blood glucose values and fetal AC. Diabetes Care 24:1319 -1323, 2001T he complex phenomenon of fetal growth has been thoroughly investigated over past decades (1) but still remains to be fully understood. We know that maternal glucose is one of the most important factors of influence (1,2), and Reece et al. (3) showed that normoglycemia in pregnancy is associated with normal levels of other nutrients, such as amino acids and lipids. For this reason, glycemia is the single maternal metabolic parameter routinely assessed in diabetic pregnancies. Indeed, the criteria for metabolic control and therapeutic strategies of diabetes in pregnancy are based almost exclusively on maternal glucose levels (2). Although there is overwhelming evidence that good perinatal outcomes can be achieved in diabetic pregnancies only with the normalization of maternal glucose values (4 -6), there is no clear definition of normoglycemia in nondiabetic pregnancies. In fact, a very limited number of studies have been performed thus far in the attempt to define maternal glucose l...

show abstract

“…They also observed an increase in ALA concentration, as well as an increased rate of metabolism of these amino acids. Reece et al [40], however, obtained different results. Research on diabetic pregnant women treated with insulin injections (multiple injections or infusion pump) showed that in correctly balanced diabetes the ALA concentration and branched-chain amino acids is the same as in the normoglycaemic group.…”

Section: Discussionmentioning

confidence: 95%

Study on free amino acid concentrations in umbilical cord blood plasma of newborns from normoglycaemic and gestational diabetes-complicated pregnancies

Hawryluk¹,

Grafka²,

Gęca³

et al. 2016

J Pre Clin Clin Res.

View full text Add to dashboard Cite

Introduction and objective. Gestational diabetes mellitus is a common disease among pregnant women. The aim of the study was to compare plasma concentrations of 24 amino acids in umbilical cord blood in newborns from normoglycaemic pregnancies versus those complicated by gestational diabetes. The relationship between birth weight and length of newborns and placental concentrations of individual amino acids were also assessed. Material and methods. The study comprised 76 pregnant women at the gestational age of 37 weeks and more. The control group consisted of 31 women whose 75-g glucose load test excluded gestational diabetes mellitus. The study group encompassed 45 women with diagnosed gestational diabetes mellitus. The placental plasma concentrations of 24 amino acids were determined using ion-exchange chromatography with an automated amino acid analyser. Results. The concentrations of cysteic acid, aspartic acid, threonine, glutamic acid, cystine, and alpha-aminobutyric acid in umbilical cord blood plasma were higher in the group complicated by gestational diabetes compared to normoglycemic pregnancies; otherwise, concentrations of glutamine, alanine, valine, phenylalanine, lysine and, arginine were lower in the group complicated by gestational diabetes than in the normoglycaemic group. Conclusions. The results show that despite optimal control of carbohydrate metabolism during gestational diabetes mellitus, there are many abnormalities in the amino acids metabolism. This suggests that research on the effects of amino acids concentration in umbilical cord blood on the foetal development in gestational diabetes-complicated pregnancies should be continued.

show abstract

Does intensive glycemic control in diabetic pregnancies result in normalization of other metabolic fuels?

Cited by 16 publications

References 15 publications

Metabolic Effects of Restoring Partial β-Cell Function After Islet Allotransplantation in Type 1 Diabetic Patients

Metabolic Effects of Restoring Partial β-Cell Function After Islet Allotransplantation in Type 1 Diabetic Patients

Third-Trimester Maternal Glucose Levels From Diurnal Profiles in Nondiabetic Pregnancies

Study on free amino acid concentrations in umbilical cord blood plasma of newborns from normoglycaemic and gestational diabetes-complicated pregnancies

Contact Info

Product

Resources

About