Non–Glycemic-Dependent Reduction of Late Pregnancy A1C Levels in Women With Type 1 Diabetes

Herranz, Lucrecia; Saez-de-Ibarra, Lourdes; Grande, Cristina; Pallardo, Luís Felipe

doi:10.2337/dc06-2568

Cited by 24 publications

(15 citation statements)

References 13 publications

(10 reference statements)

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“…Maintenance of good glucose control in diabetic pregnancy is also essential to avoid adverse fetal outcomes, such as fetal growth acceleration (24,25). Glucose uptake, endogenous glucose production, and insulin requirements strongly vary throughout pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Absorption of Insulin Aspart as the Result of a Dispersed Injection Strategy Tested in a Randomized Trial in Type 1 Diabetic Patients

et al. 2013

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OBJECTIVEWe investigated the impact of two different injection strategies on the pharmacokinetics and pharmacodynamics of insulin aspart in vivo in an open-label, two-period crossover study and verified changes in the surface-to-volume ratio ex vivo.RESEARCH DESIGN AND METHODSBefore the clinical trial, insulin aspart was injected ex vivo into explanted human abdominal skin flaps. The surface-to-volume ratio of the subcutaneous insulin depot was assessed by microfocus computed tomography that compared 1 bolus of 18 IU with 9 dispersed boluses of 2 IU. These two injection strategies were then tested in vivo, in 12 C-peptide–negative type 1 diabetic patients in a euglycemic glucose clamp (glucose target 5.5 ± 1.1 mmol/L) for 8 h after the first insulin administration.RESULTSThe ex vivo experiment showed a 1.8-fold higher mean surface-to-volume ratio for the dispersed injection strategy. The maximum glucose infusion rates (GIR) were similar for the two strategies (10 ± 4 vs. 9 ± 4; P = 0.5); however, times to reach maximum GIR and 50% and 10% of the maximum GIR were significantly reduced by using the 9 × 2 IU strategy (68 ± 33 vs. 127 ± 93 min; P = 0.01; 38 ± 9 vs. 49 ± 16 min; P < 0.01; 23 ± 6 vs. 30 ± 10 min; P < 0.05). For 9 × 2 IU, the area under the GIR curve was greater during the first 60 min (219 ± 89 vs. 137 ± 75; P < 0.01) and halved until maximum GIR (242 ± 183 vs. 501 ± 396; P < 0.01); however, it was similar across the whole study period (1,361 ± 469 vs. 1,565 ± 527; P = 0.08).CONCLUSIONSA dispersed insulin injection strategy enhanced the effect of a fast-acting insulin analog. The increased surface-to-volume ratio of the subcutaneous insulin depot can facilitate insulin absorption into the vascular system.

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Section: Discussionmentioning

confidence: 99%

Enhanced Absorption of Insulin Aspart as the Result of a Dispersed Injection Strategy Tested in a Randomized Trial in Type 1 Diabetic Patients

et al. 2013

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“…Reasons for reluctance in adopting HbA 1c during pregnancy as a measure of maternal glycemic control include the scarcity of published reports that account for the effect of pregnancy-associated metabolic and hematologic changes on the interpretation of HbA 1c values in pregnant patients. (5, 6)…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin A1c and Postpartum Abnormal Glucose Tolerance Among Women With Gestational Diabetes Mellitus

Katon

Reiber

Williams

et al. 2012

Obstetrics & Gynecology

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Objective To analyze the association of hemoglobin A1c (HbA1c) at gestational diabetes mellitus (GDM) diagnosis with postpartum abnormal glucose in a cohort of women with GDM. Methods Women with singleton pregnancies managed for GDM at a large diabetes and pregnancy program located in Charlotte, North Carolina who completed a postpartum 2-hour oral glucose tolerance test were eligible for inclusion in this retrospective cohort study. Clinical information, including maternal HbA1c at diagnosis was abstracted from medical records. A parametric survival model was used to assess the association of HbA1c at GDM diagnosis with postpartum maternal abnormal glucose including impaired fasting glucose, impaired glucose tolerance, and any postpartum abnormal glucose. Results Of the 277 postpartum women with GDM 75 (32%) had impaired fasting glucose, 61 (28%) had impaired glucose tolerance, and 15 (9%) were diagnosed with type 2 diabetes after delivery. After adjustment for clinic, maternal age, parity, prepregnancy BMI 25 kg/m2 or higher, non-white race or ethnicity, and gestational week at first HbA1c we detected a trend of increased risk for impaired fasting glucose (p=0.01), impaired glucose tolerance (p=0.002), and any glucose abnormality (p <0.001) associated with increased quartile of HbA1c at GDM diagnosis. Conclusion HbA1c measured at GDM diagnosis may be a useful tool for identifying GDM patients at highest risk of developing postpartum abnormal glucose.

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“…Reprinted with permission from The American Diabetes Association predicted from the actual average glycaemia. This is well recognized to occur during the third trimester of pregnancy in women with type 1 diabetes [20], and there is evidence that diabetic persons with nephropathy have levels of A 1c differing from those would be predicted from the simultaneously measured serum fructosamine level [21]. Further studies are in progress of interrelationships between A 1c and erythrocyte survival, and between A 1c and the presence of renal and hepatic disease [22].…”

Section: Abbreviationsmentioning

confidence: 97%

The proposed terminology ‘A1c-derived average glucose’ is inherently imprecise and should not be adopted

et al. 2008

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The proposed use of a more precise standard for glycated (A 1c ) and non-glycated haemoglobin would lead to an A 1c value, when expressed as a percentage, that is lower than that currently in use. One approach advocated to address the potential confusion that would ensue is to replace 'HbA 1c ' with a new term, 'A 1c -derived average glucose.' We review evidence from several sources suggesting that A 1c is, in fact, inherently imprecise as a measure of average glucose, so that the proposed terminology should not be adopted.

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Non–Glycemic-Dependent Reduction of Late Pregnancy A1C Levels in Women With Type 1 Diabetes

Cited by 24 publications

References 13 publications

Enhanced Absorption of Insulin Aspart as the Result of a Dispersed Injection Strategy Tested in a Randomized Trial in Type 1 Diabetic Patients

Enhanced Absorption of Insulin Aspart as the Result of a Dispersed Injection Strategy Tested in a Randomized Trial in Type 1 Diabetic Patients

Hemoglobin A1c and Postpartum Abnormal Glucose Tolerance Among Women With Gestational Diabetes Mellitus

The proposed terminology ‘A1c-derived average glucose’ is inherently imprecise and should not be adopted

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