Endocrine Abstracts

Introduction: Pregnant women with pre-existing diabetes are at greater risk of perinatal morbidity and diabetic complications. Glycemic control is the greatest impotance for both mothers and infants due to the risk of congenital anomalies, perinatal mortality and significant morbidity in the short and long term. Continuous glucose monitoring system (CGMS) is a novel tool to assess 24-h glucose fluctuations. In pregestational diabetes, CGMS may have an important role for excellent glucose control and treatment adjustments in conjunction with other glycemic status markers. Aim of this study was to assess relationship between these glycemic markers and CGMS parameters and their correlations with adipocytokine visfatin, 8-isoprostane, a marker of oxidative stress, and endogenous NOS inhibitor - asymmetric dimethylarginine (ADMA).

Material and methods: Twenty pregnant women (mean age 32.2±5) with pregestational diabetes mellitus (14 with type 1DM, 6 with type 2 DM with history of diabetes for 9.5 years) who admitted to our gestational diabetes mellitus outpatient clinics, were included in this study. All patients used insulin during pregnancy. CGMS profiles for >5 day in the 32 week of gestation were compared with glycemic markers- HbA1c and 1,5-anhydro-D-glucitol (1,5-AG). Visfatin, 8-isoprostane and ADMA levels were determined by ELISA.

Results: Seven of patient were primipar and 6 of them give more than 3 births. BMI before pregnancy was 25.8±3.3 kg/m², weight gain during pregnancy was 12.3±5.1 kg. Mean values of HbA1c, 1,5-AG were 6.5±0.6 and 0.5±03 ng/ml respectively. The number of glycemic excursions were 16.2±7.3 which was consist of high (11.6±6) and low excurtions (4.5±3.5). Mean absolute difference percentage (MAD%) was 12.5±6.6. Mean levels of visfatin, 8-isoprostane and ADMA were 6.4±3.8 ng/ml, 463.4±120 ng/L and 0.53±0.06 μmol/l respectively. HbA1c, fructosamine and ADMA levels were not associated with glycemic markers or other cytokine levels. Visfatin levels were correlated with 1,5 AG (r=0.979, P=0.000). 8-isoprostane levels were inversely related to the lowest value in CGMS data (r=−0.649, P=0.002). There were no significant interactions between cytokines and MAD%, glycemic excurtions in CGMS.

Conclusion: Including 1,5-AG, glycemic markers do not reflect glycemic variability. CGMS can be used to assess hypoglycaemia and glucose variability in conjunction with HbA1c. It is also important for treatment adjustment in all patients with type1 diabetes and patients with type 2 diabetes treated with insulin therapy.