Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case–Control Study

Wang, Ning; Peng, Yang; Wang, Lu; Song, Lin; Sun, Bo; Wei, Junxiang; Wang, Ting; Mi, Yang; Cui, Wei

doi:10.2147/dmso.s295071

Cited by 10 publications

(13 citation statements)

References 43 publications

(57 reference statements)

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“…Next, we will continue to pay attention to such RCTs, and conduct further subgroup analyses of different GDM diagnoses. Finally, in combination with our previous studies (26,27,39), GDM subtypes should be considered as an important confounding factor that could affect the clinical efficacy of these oral hypoglycemic agents.…”

Section: Limitationmentioning

confidence: 78%

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Wang

Jing

Guo

et al. 2022

Front. Public Health

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ObjectiveTo compare the efficacy and safety of metformin, glyburide, and insulin for GDM, we conducted a subgroup analysis of outcomes for women with GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.MethodsWe searched the NCBI, Embase, and Web of Science databases from inception to March 2022. Randomized controlled trials (RCTs) that compared the outcomes of hypoglycemic agents in women with GDM were included. Bayesian network analysis was employed.ResultsA total of 29 RCTs were included. Metformin was estimated to lead to a slight improvement in total gestational weight gain (WMD – 1.24 kg, 95% CI −2.38, −0.09), a risk of unmet treatment target in the sensitivity analysis (OR 34.50, 95% CI 1.18–791.37) than insulin. The estimated effect of metformin showed improvements in birth weight than insulin (WMD – 102.58 g, 95% CI −180.45 to −25.49) and glyburide (WMD – 137.84 g, 95% CI −255.31 to −25.45), for hypoglycemia within 1 h of birth than insulin (OR 0.65, 95% CI 0.47 to 0.84). The improvement in the estimated effect of metformin for hypoglycemia within 1 h of birth still existed when compared with glyburide (OR 0.41, 95% CI 0.26 to 0.66), whether in the IADPSG group (OR 0.33, 95% CI 0.12 to 0.92) or not (OR 0.43, 95% CI 0.20 to 0.98).ConclusionMetformin is beneficial for GDM women to control total GWG compared with insulin, regulate fetal birth weight more than insulin and glyburide, and increase the risk of unmet treatment targets compared with insulin. Compared to metformin, glyburide is associated with neonatal hypoglycemia.

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Section: Limitationmentioning

confidence: 78%

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Wang

Jing

Guo

et al. 2022

Front. Public Health

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“…GDM women with insulin secretion defect were defined if the Stumvoll I index was under the 25 th percentile of the range in the NGT group. Due to the limited number of participants in this study, we used the indexes of the women in the NGT group of our previous study ( 5 ) to calculate the normal range, since participants in both studies came from the same population over the same time periods. Therefore, we divided GDM women into the two subgroups: GDM with a primary defect of insulin-sensitivity (GDM-resistance, n = 17), GDM with a primary defect of insulin-secretion (GDM-dysfunction, n = 9).…”

Section: Methodsmentioning

confidence: 99%

“…Women with GDM can be divided into subtypes based on insulin secretion and sensitivity heterogeneity ( 4 ). In clinical studies, we found differences in the risk factors of GDM subtypes ( 5 ), and having large-for-gestational-age infants is associated with specific GDM subtypes ( 6 ).…”

Section: Introductionmentioning

confidence: 93%

Association of Elevated Plasma FGF21 and Activated FGF21 Signaling in Visceral White Adipose Tissue and Improved Insulin Sensitivity in Gestational Diabetes Mellitus Subtype: A Case-Control Study

et al. 2021

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ObjectiveTo study the discrepancy of the insulin sensitivity alteration pattern, circulating fibroblast growth factor (FGF21) levels and FGF21 signaling in visceral white adipose tissue (vWAT) of gestational diabetes mellitus (GDM) subtypes.Methods26 GDM women with either a predominant of insulin-secretion defect (GDM-dysfunction, n = 9) or insulin-sensitivity defect (GDM-resistance, n = 17) and 13 normal glucose tolerance (NGT) women scheduled for caesarean-section at term were studied. Blood and vWAT samples were collected at delivery.ResultsThe insulin sensitivity was improved from the 2nd trimester to delivery in the GDM-resistance group. Elevated circulating FGF21 concentration at delivery, increased FGF receptor 1c and decreased klotho beta gene expression, enhanced ERK1/2 phosphorylation, and increased GLUT1, IR-B, PPAR-γ gene expression in vWAT were found in the GDM-resistance group as compared with the NGT group. The circulating FGF21 concentration was negatively correlated with fasting blood glucose (r = -0.574, P < 0.001), and associated with the GDM-resistance group (r = 0.574, P < 0.001) in pregnant women at delivery. However, we observed no insulin sensitivity alteration in GDM-dysfunction and NGT groups during pregnancy. No differences of plasma FGF21 level and FGF21 signaling in vWAT at delivery were found between women in the GDM-dysfunction and the NGT group.ConclusionsWomen with GDM heterogeneity exhibited different insulin sensitivity alteration patterns. The improvement of insulin sensitivity may relate to the elevated circulating FGF21 concentration and activated FGF21 signaling in vWAT at delivery in the GDM-resistance group.

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“…Several lines of evidence indicate the different metabolic profiles existing in patients with GDM with the three physiologic subtypes. Obesity-related factors, including pre-pregnancy overweight and elevated gestational weight gain in the first trimester, are specific to the insulin-resistance subtype ( 66 ). Layton et al.…”

Section: Metabolic Profiles Of Women With Gestational Diabetes Mellit...mentioning

confidence: 99%

Perspectives from metabolomics in the early diagnosis and prognosis of gestational diabetes mellitus

Zhang

Yang²

2022

Front. Endocrinol.

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Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders in pregnant women. The early detection of GDM provides an opportunity for the effective treatment of hyperglycemia in pregnancy, thus decreasing the risk of adverse perinatal outcomes for mothers and newborns. Metabolomics, an emerging technique, offers a novel point of view in understanding the onset and development of diseases and has been repeatedly used in various gestational periods in recent studies of GDM. Moreover, metabolomics provides varied opportunities in the different diagnoses of GDM from prediabetes or predisposition to diabetes, the diagnosis of GDM at a gestational age several weeks earlier than that used in the traditional method, and the assessment of prognosis considering the physiologic subtypes of GDM and clinical indexes. Longitudinal metabolomics truly facilitates the dynamic monitoring of metabolic alterations over the course of pregnancy. Herein, we review recent advancements in metabolomics and summarize evidence from studies on the application of metabolomics in GDM, highlighting the aspects of the diagnosis and differential diagnoses of GDM in an early stage. We also discuss future study directions concerning the physiologic subtypes, prognosis, and limitations of metabolomics.

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Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case–Control Study

Cited by 10 publications

References 43 publications

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Efficacy and safety of hypoglycemic agents on gestational diabetes mellitus in women: A Bayesian network analysis of randomized controlled trials

Association of Elevated Plasma FGF21 and Activated FGF21 Signaling in Visceral White Adipose Tissue and Improved Insulin Sensitivity in Gestational Diabetes Mellitus Subtype: A Case-Control Study

Perspectives from metabolomics in the early diagnosis and prognosis of gestational diabetes mellitus

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