Other Monogenic Forms of Diabetes
A number of other monogenic forms of early onset diabetes have been reported. These diabetes syndromes can be classified into three main types, that is, congenital pancreatic islet cell dysfunction, congenital insulin resistance, and early autoimmune destruction of pancreatic islet see Table 4 . Monogenic Forms of Congenital Diabetes 1. Transient neonatal diabetes mellitus TNDM is a rare type of diabetes incidence of 1 in 1 million neonates that presents soon after birth, resolves by 18 months,...
The Energy Cost of Pregnancy in Gestational Diabetes Mellitus
In common with others, Okereke et al. 11 observed an increase in BMR from the prepregnant state to late pregnancy in obese women with normal glucose tolerance NGT and obese women with gestational diabetes mellitus GDM . There were no significant differences in basal energy expenditure between NGT and GDM obese women 11 . Obese GDM women had total energy expenditure similar to that of obese NGT women 11 . Similar observations were made for lean GDM and NGT women 18 . GDM women had oxygen...
Celiac Medical Centers in the USA
Celiac Center at Beth Israel Deaconess Medical Center, Boston, MA - http www.bidmc.harvard.edu celiaccenter Celiac Disease Center at Columbia University, New York, New York - http www.celiacdiseasecenter. columbia.edu CF-HOME.htm Celiac Disease Clinic Mayo Clinic, Rochester, MN - html Celiac Center, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA -http www.uihealthcare.com Celiac Clinic, Digestive Center of Excellence, University of Virginia Health...
Sexual Disorders Among Women with Type Diabetes Mellitus 1
The study by Doruk et al. 38 showed a SD prevalence of 42 within the DM2 women. Low sexual desire was reported in 82 of the DM2 women, whereas 68 complained of low arousal, 38 of reduced lubrication, 38 of orgasm difficulties, 46 of coital pain, and 50 of sexual dissatisfaction. Troubles in sexual arousal, lubrication, and orgasmic function were significantly more prevalent among DM2 subjects than among the healthy controls 23, 38 . Erol et al. 40 assessed the SF profile in 72 premenopausal DM2...
Complications Of Preeclampsia
Preeclampsia may cause both acute complications to the mother and neonate, as well as long-term complications for the mother. Usually maternal and perinatal outcomes are more favorable in women with mild preeclampsia that develops after 36 weeks of gestation 116-118 . Women who develop preeclampsia prior to 33 weeks who have preexisting medical conditions or who live in developing countries have increased maternal and neonatal morbidity and mortality. Immediate complications for the mother...
Short and LongTerm Consequences of Fetal Complications
Fetal complications associated with the presence of gestational diabetes in the mother include macrosomia, neonatal hypoglycemia, perinatal mortality, congenital malformations in the case of undiagnosed preexisting DM , hyperbilirubinemia, polycythemia, hypocalcemia, and respiratory distress syndrome, and associated complications of labor and delivery are the most frequent and serious types of morbidity. Macrosomia, defined as birth weight gt 4,000 g, occurs in 20-30 of infants whose mothers...
Gestational Diabetes Mellitus
Gestational diabetes mellitus GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy 146 . GDM complicates 4 of all pregnancies in the USA and represents nearly 90 of all pregnancies complicated by diabetes 146 . The heritability of GDM has been demonstrated, suggesting genetic predisposition, although it is unlikely that GDM represents a single disease 312-315 . According to the definition of GDM, if a diabetes case is found during pregnancy,...
Diabetic Nephropathy and Superimposed Preeclampsia
Women with diabetes and microalbuminuria or nephropathy are at an increased risk for preeclampsia compared to women with diabetes and no renal disease. In a Danish study 110 of 203 women with type 1 diabetes, 85 had normal albumin excretion, 11 had microalbuminuria, and 5 had diabetic nephropathy. Of those with normal albumin excretion 6 developed preeclampsia, and there was pre-term delivery in 35 . In those with microalbuminuria, 42 developed preeclampsia and 62 with preterm delivery, and in...
Management of GDM Based on Maternal Glucose Control Combined with Fetal Growth
The group of Buchanan and Kjos from Los Angeles picked up Weiss' concept of a fetal-based GDM management and investigated if the fetal AC in the third trimester could serve as a noninvasive method to target GDM pregnancies that need intensive treatment. This fetal-growth based strategy uses the diabetes-specific growth pattern of accelerated growth of the abdomen. This is mainly due to increased subcutaneous fat, which determines 63 of the variation of the fetal AC 24 . While the measurement of...
The Weiss Concept Management of Diabetes Based on Maternal Glucose Combined
Taking into account all these uncertainties, Weiss had already begun, in the eighties, to implement the first fetal-based strategy of GDM management to target women who would benefit from intensive treatment. Tight glucose control with intensified insulin therapy was limited to pregnancies with fetal hyperinsulinism diagnosed by determination of amniotic fluid insulin 21 , which reflects urinary excretion of fetal insulin 22 . On the basis of his data it was found that only about 20 of the...
Predicting Preeclampsia
As the only current treatment for preeclampsia is delivery, a good screening test would be helpful to identify women at risk, diagnose them early, and to provide them with appropriate management that might lead to improved maternal and perinatal outcomes. Women with known risk factors should be assessed early in pregnancy by a physician who is experienced in the management of preeclampsia. Both human and animal data described earlier in Circulating Angiogenic Factors suggest that ang-iogenic...
summary and conclusions
There are many differences between the sexes in the susceptibility and development of chronic metabolic diseases and CvDs. Fundamental differences between males and females primarily involve hormones, which define the secondary sex characteristics at puberty, regulate fertility, metabolism, and behavior, and play an important role in regulating many functions of different nonreproductive tissues. Changes in the androgen balance have been found to be associated with a series of chronic metabolic...
Diabetes Mellitus Conclusion
There are scarce data on the epidemiology and health and socioeconomic consequences of gestational diabetes and diabetes in the third world. One of the main reasons for this is that these diseases have not received adequate attention in terms of health planning and allocation of financial resources in many of the poor and transitional countries. It is essential that the health planners in the third world make diabetes diagnosis and treatment a health care priority. Guidelines for managing...
Contributors
Patricia Aguirre, PhD Institute of High Social Studies, Universidad Nacional de San Martin, Buenos Aires, Argentina Allison L. CohEN, MD Joslin Diabetes Center, One Joslin Place, Boston, MA Dana Dabelea, MD, PhD Dept. of Preventive Medicine and Biometrics, Denver, CO Assiamira Ferrara, MD, PhD Division of Research, Kaiser Permanente, Oakland, CA Dilys Freeman, PhD Reproductive and Maternal Medicine, University of Glasgow, Royal Infirmary, Glasgow UK CAThERiNE Kim, MD, MPH Depts. of Medicine and...
Circulating Angiogenic Factors
Soluble fms-like Tyrosine Kinase-1 sFlt-1 Fig. 1 The search for circulating factors that mediate the generalized maternal endothelial function has been the focus of much research, and recent studies have demonstrated an increase in placental expression and secretion of soluble fms-like tyrosine kinase 1 sFLT-1 or sVEGFR-1 , which is a naturally occurring circulating vascular endothelial growth factor VEGF antagonist. VEGF has several receptors, including Flt1 VEGFR1 and Flk1 VEGFR2 , and sFlt1...
Optimal Timing and Frequency
For most patients with DM1 SMBG before and after meals and exercise will provide useful information for adjusting insulin and carbohydrate intake. The ADA suggests that there are no data to support that postmeal glucose monitoring has a specific role in preconception diabetes care beyond what is needed to achieve the target for A1C 30 . However, there is increasing evidence that elevated PPG levels exert a more deleterious effect than elevation of fasting plasma glucose 49 . Many studies...
SUMMARY Hnb
Preeclampsia is a leading cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Recent knowledge elucidating the pathogenesis of preeclampsia may be useful in the development of diagnostic tests for preeclampsia as well therapeutics to treat preeclampsia in the future. Acknowledgments A.L.C. is funded by the Clinical Investigator Training Program Beth Israel Deaconess Medical Center -Harvard MIT Health Sciences and Technology, in collaboration with Pfizer Inc., and Merck amp...
Risk Factors for Maternal Postpartum Diabetes Among Women with GDM
Glucose intolerance during the index GDM pregnancy, reflected by the glucose values on the 50-g glucose challenge screening test as well as the diagnostic prenatal OGTT, is associated with postpartum hyperglycemia and diabetes 88-93 . Because of variation in diagnostic testing procedures for GDM, as well as the continuous relationship between glucose values and future risk, no single glucose value consistently identifies women at risk for future diabetes 88 . As discussed earlier in the...
The ILRA Locus
Vella et al. identified a novel DM1 locus, interleukin-2 receptor alpha IL2RA , by multilocus association test, based on a candidate gene approach 10 . Our study confirmed this DM1 association 96 . An association between Graves' disease and IL2RA was also found 97 . The DM1 association was initially mapped to an LD block encompassing the IL2RA gene 5' side and promoter region 96 . IL2RA encodes the a chain of the IL2 receptor complex IL2Ra, also known as CD25 . Interleukin-2 IL2 is a powerful...
preconception counseling
All women of reproductive age with diabetes should receive preconception counseling, as reviewed in Chap. 15. Both preconception counseling and prenatal care entail a team approach including an obstetrician, endocrinologist, nurse educator, dietitian, and social worker. Education should focus on the rationale for good blood glucose control, blood glucose goals for preconception and pregnancy, MNT, exercise, insulin, and effects of diabetes on pregnancy and of pregnancy on diabetes with an...
The HLA Locus
The major genetic susceptibility of DM1 is from the HLA locus. The HLA genes locate at Chr6p21.3 Fig. 2 . The HLA class I and class II genes encode cell-surface antigen-presenting proteins. Antigens presented by HLA class I proteins are from inside the cell, while antigens presented by HLA class II proteins are from the cell surroundings. The two classes of HLA play essential roles in infectious diseases, autoimmune diseases, graft vs. host disease GvHD and cancer, by presenting native or...
Diabetes And Eating Disorders Epidemiology And Clinical Features
There has been controversy in the literature about the association of eating disorders and DM1 50 . However, the evidence from methodologically rigorous studies and from a meta-analytic review 51 supports the view that there is an increased risk for both subthreshold and full-syndrome eating disorders in girls and women with DM1. In studies using a diagnostic interview, the prevalence of full-syndrome eating disorders in girls and women with DM1 ranged from 0 to 11 , and the prevalence of...
Laparoscopic Ovarian Drilling
Surgical ovarian wedge resection was the first surgical treatment for anovulatory PCOS but fell out of favor due to the risk of postsurgical adhesion formation 95-97 . Alternatively, LOD involves cautery of the ovarian surface using electrocoagulation or laser, which can be done on an outpatient basis, results in fewer postoperative adhesions, and requires no ongoing monitoring 98-100 . It has been used as an alternate therapy in patients who do not conceive with clomiphene or gonadotropin...
Agathocles Tsatsoulis
The Clinical and Molecular Phenotype of PCOS Evidence for the Developmental Origins of PCOS Potential Origin of Prenatal Androgen Excess in Humans Plausible Biological Mechanisms Conclusions and Future Implications References Polycystic ovary syndrome PCOS is a common endocrine metabolic disorder in women, characterized by hyperandrogenism, chronic anovulation, and or polycystic ovaries in association with android fat distribution and insulin resistance hyperinsulinism. The etiology of PCOS...
Early Pregnancy Loss
Early pregnancy loss EPL is defined as miscarriage of a clinically recognized pregnancy during the first trimester 39 . While EPL occurs in 10-15 of normal women 116 , rates in women with PCOS are as high as 30-50 117 . Because of the prevalence of infertility in patients with PCOS, many women require fertility treatments which in themselves increase the prevalence of miscarriage 118 . However, several studies in women undergoing fertility treatment with IVF have demonstrated that women with...
Renato Pasquali and Alessandra Gambineri
The Biology of Sex Difference in Health and Disease Insulin Resistance in The General Female Population The Metabolic Syndrome, Cardiovascular Risk Factors and Cardiovascular Events in Women How the Definition of the Metabolic Syndrome Overlaps that of Insulin Resistance Diabetes and Cardiovascular Risk Factors in Women The Paradigm of PCOS Androgens and Risk for CvD and Diabetes in the Female Population Lessons From the PCOS Paradigm Summary and Conclusions References There are many...
Coc
COCs contain a wide variety of progestin formulations and doses. Most progestins are testosterone derivatives and have varying degrees of androgenic effects, e.g., decreasing sex-binding globulin, increasing insulin resistance, and adverse changes in serum lipids 3 . Newer formulations of oral progestins desogestrel, gestodene or older lower dose potency norethindrone formulations minimize androgenic side effects and, therefore, generally are preferable. Their net effect is estrogen-dominant...
Diagnosis of Preeclampsia
Although preeclampsia is usually diagnosed clinically based on clinical criteria as outlined by ACOG, the diagnosis can be a challenge in some patients in differentiating preeclampsia from progestational diabetes, gestational hypertension, and or chronic hypertension. In this regard, it has been recently reported in a small pilot study 99 that both sFltl and sEng may be useful in differentiating preeclampsia from other hypertensive disorders in pregnancy. This study found that the sensitivity...
Gonadotropin Therapy
A second-line option for infertility treatment is direct gonadotropin therapy with either FSH or human menopausal gonadotropin hMG . Because of the increased number of FSH-responsive follicles in polycystic ovaries, patients with PCOS are more at risk for OHSS and multiple gestations 82-84 . A low-dose, step-up protocol has been developed, which yields an increased pregnancy rate while reducing the incidence of OHSS and multiple gestations 83, 85, 86 . Treatment consists of employing a low...
Clinical Health Care Concerns
The hypothesis of fuel-mediated teratogenesis suggests that excess fetal growth caused by maternal fuel abnormalities results in adult disease in the offspring, and so interventions to reduce the transmission of obesity, cardiovascular disease and type 2 diabetes would logically focus on normalizing maternal metabolism and fuel delivery to the infant. There is evidence that hyperglycemia increases fetal growth and also may induce other metabolic changes that are associated with adult chronic...
Platelet And Coagulation Abnormalities In Diabetes
Micro- and macrovascular complications in DM2 are associated with platelet dysfunction and imbalance between coagulation and fibrinolysis, which in turn contribute to the generation of a prothrombotic state. Platelet Dysfunction in Diabetes Source 2 Increased platelet adhesiveness Increased platelet aggregation Decreased platelet survival Increased platelet generation of vasoconstrictor prostanoids Reduced platelet generation of prostacyclin and other vasodilator prostanoids Altered platelet...
Coagulation Abnormalities in Diabetes Mellitus
Eighty percent of the premature deaths in DM2 patients are secondary to thrombotic events, with 75 of these cases occurring in the cardiovascular system 38 . Diabetic patients are prone to enhanced thrombosis and platelet aggregation adhesion, endothelial dysfunction, altered fibrinolysis, and lipid disorders 2 . Hemostasis is the process of blood clot formation at the site of vessel injury. The coagulation system involves a complex cascade of proteins, which, after activation, lead to thrombin...
the paradigm of pcos
PCOS is one of the most common causes of ovulatory infertility, affecting 4-7 of women. After the original description by Stein and Leventhal 76 , this syndrome has been defined in different ways over the last 15 years. In 1990 the National Institutes of Health NIH established very simple new diagnostic criteria, which were based on the presence of hyperandrogenism either clinical, such as hirsutism, etc., or biochemical and chronic oligo-anovulation, with the exclusion of other causes of blood...
Allison L Cohen and S Ananth Karumanchi
Epidemiology of Preeclampsia Pathophysiology of Preeclampsia Prediction and Diagnosis of Preeclampsia Complications of Preeclampsia Summary References Preeclampsia is a syndrome of new-onset hypertension and proteinuria after 20-weeks gestation in a previously normotensive woman. Preeclampsia is a leading cause of maternal, fetal, and neonatal morbidity and mortality throughout the world. There are multiple risk factors for preeclampsia, including pregestational diabetes and obesity. Women with...
Teleological Significance
The sex difference in body composition, with females having greater body fat accumulation than men, seems to transcend culture and time 101 . Moreover, such a marked sex dimorphism in body fat distribution is rather unique to the human species 1 . The evolutionary mechanisms underlying these dimorphisms and their teleological significance will be briefly discussed in this section. Hoyenga put forward a theory stating that through sexually dimorphic natural selection, females were placed under...
Gestational Diabetes
GDM is defined as diabetes or impaired glucose tolerance that develops during pregnancy 39 . It affects 4-7 of pregnant women 151, 152 and carries considerable perinatal risk including mac-rosomia, hypoglycemia, stillbirth, jaundice and respiratory distress syndrome 153 . A randomized controlled trial has shown that rates of serious perinatal complications were reduced, birth weight was lower, and macrosomia was less frequent in patients who were treated intensively for impaired glucose...
REFERENCES Mdz
1. Bachmann G. Female sexuality and sexual dysfunction are we stuck on the learning curve J Sex Med 2006 3 639-645 2. Hayes RD, Bennett CM, Fairley CK, Dennerstein L. What can prevalence studies tell us about female sexual difficulty and dysfunction J Sex Med 2006 3 589-595 3. Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet 2007 369 409-424 4. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States prevalence and predictors. JAMA 1999 281 537-544 5....
REFERENCES Gia
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision. Washington, DC American Psychiatric Association 2000 2. Garfinkel PE, Lin E, Goering P, et al. Bulimia nervosa in a Canadian community sample prevalence and comparison of subgroups. Am J Psychiatry 1995 152 1052-8 3. Gartner AF, Marcus RN, Halmi K, Loranger AW. DSM-III-R personality disorders in patients with eating disorders. Am J Psychiatry 1989 146 1585-91 4. Keel PK, Mitchell...
Maternal Endothelial Dysfunction
All of the clinical features of preeclampsia can be explained as a maternal response to generalized endothelial dysfunction 29, 30 , and women with underlying vascular disease may be at higher risk of developing preeclampsia due to preexisting endothelial dysfunction 31 . Increased vascular permeability results in proteinuria and edema disturbed endothelial control of vascular tone leads to hypertension, and abnormal endothelial expression of procoagulants leads to coagulopathy. In the kidney,...
INTRODUCTION Kde
Polycystic ovary syndrome PCOS affects 5-10 of women of reproductive age 1, 2 . It is characterized by hyperandrogenism, often presenting as hirsutism, alopecia or acne, and chronic oligo- or anovulation, which typically presents as oligomenorrhea or amenorrhea and infertility 3 . In addition, hyperinsulinemic insulin resistance is intrinsic to the syndrome, increasing the risk of type 2 diabetes mellitus 4 , metabolic syndrome and cardiovascular risk 5 . From Diabetes in Women Pathophysiology...
Screening And Diagnosis Of Cad
No specific guidelines are available for screening of CVD or CAD in women with diabetes. If patients are symptomatic further testing is likely to be undertaken without delay. However, guidelines on screening asymptomatic individuals are not clearly defined. Recently the American Diabetes Association released a new expert panel recommendation regarding screening for CAD in diabetic patients based on recent evidence that did not support their previous recommendation of screening asymptomatic...
screening for gestational diabetes in third world countries do we need ethnic
Defining the performance characteristics of screening strategies for GDM is complicated by the lack of a universally accepted gold standard for the diagnosis of GDM. As can be seen from Table 4, studies that have been carried out in developing countries have used differing screening and diagnostic criteria, mirroring the same lack of consensus in the developed world. More work needs to be done to address a cost-effective diagnostic strategy for GDM that takes into account fetal outcomes rather...
Fibrinolytic System in Diabetes Mellitus Plasminogen Activator Inhibitor
PAI-1, one of the inhibitors of the fibrinolytic system, is synthesized by hepatocytes, fibroblasts, adipocytes, and ECs and is stored within the platelet granules. Elevated PAI-1 levels have been noted in patients with CAD and are strongly correlated with components of cardiometabolic syndrome CMS such as BMI, blood pressure, and triglycerides 2, 27 . Festa et al. examined the relationship between new-onset diabetes and dynamic changes of PAI-1 and fibrinogen 39, 40 . In nondiabetic, healthy...
Hormonal Contraception
Hormonal contraception contains either a progestin compound alone or in conjunction with estrogen. They can be administered orally, intramuscularly, transdermally, and transvaginally. Some IUDs also contain progestin. Estrogen does not affect glucose tolerance 5 , but progestins do increase insulin resistance and decrease glucose tolerance in a dose and potency fashion 6-8 . Estrogen slightly increases blood pressure 9 by increasing angiotensin production while progestins have no effect....
References
1. Pond CM 1992 An evolutionary and functional view of mammalian adipose tissue. Proc Nutr Soc 51 367-377 2. Vague J 1947 La diff renciation sexuelle, facteur d terminant des formes de l'ob sit . Presse Med 30 339-340 3. Vague J 1956 The degree of masculine differentiation of obesities a factor determining predisposition to diabetes, atherosclerosis, gout and uric calculous disease. Am J Clin Nutr 4 20-34 4. Kissebah AH, Krakower GR 1994 Regional adiposity and morbidity. Physiol Rev 74 761-811...
Risk Factors for Preeclampsia
There are multiple risk factors for preeclampsia Table 5 12 . First pregnancy is associated with an increase risk in preeclampsia, though it is not clear why this is such an important factor RR 2.91, 95 CI 1.28-6.61 13 . There are some data suggesting that the risk increases in women who have had limited sperm exposure with the same partner prior to conception 14-16 , though this theory has been challenged. A past history of preeclampsia is a very strong risk factor for preeclampsia in a future...
Export Taxes Or Sliding Scale Duties Or Retentions
Approximately 50 world economies, mostly those of countries that specialize in exports of primary products, tax their exports on a sliding scale basis in order to recapture a part of the income derived from their natural resources. Examples of this are coffee in Colombia, grains in Argentina, or uncut diamonds in South Africa. In the absence of state-run companies for trade of grains, like the Australian and Canadian Wheat Boards AWB and CWB , sliding scale duties are a source for the State to...
Antithrombin III Protein C and Protein S
Antithrombin III inhibits the activity of multiple serine proteases of the coagulation pathway. Levels of antithrombin III have been shown to be diminished in patients with diabetes 38 . Protein C and Protein S levels have been known to be decreased in patients with diabetes, predisposing them to thrombosis 2, 3 . Lp a is a modified form of LDL in which a large glycoprotein, apolipoprotein a , is covalently bound to apo B by a disulfide bridge. It is structurally similar to human plasminogen....
Prenatal Androgenization and PCOS
The developmental origins hypothesis of PCOS emerged following astute clinical observations in women with congenital virilizing disorders and was further substantiated by experimental animal research. Examples of prenatally androgenized humans are women with classical congenital adrenal hyperplasia from 21-hydroxylase deficiency and rare cases of women with congenital adrenal virilizing tumors 25, 26 . These women are exposed to excess adrenal androgens during intrauterine life and, despite the...
The Metabolic Syndrome in PCOS
Due to the high prevalence of insulin resistance in PCOS, some recent studies used the NCEP ATP III criteria to assess the prevalence of the metabolic syndrome in PCOS women. Glueck et al. 95 studied 138 PCOS patients and found a prevalence rate of 46 , whereas, more recently, Apridonidze et al. 82 found a prevalence of 43 by retrospectively reviewing the medical charts of 106 PCOS women attending the Endocrine Clinic of Richmond, Virginia. Both these studies, therefore, described a prevalence...