| [BACKGROUND]There is unique characteristics of glucose metabolism in Pregnant women.In the first trimester, due to the physiologic increase of maternal in parent substance or fetus and other factors,it mainly manifest the fasting hypoglycaemia and is easy to cause hypoglycaemia and ketosis. However, in the second trimester and the third trimester, on account of the raise of hormone secretion with anagonism insulin, it exist Insulin resistance(IR). When the organism can not produce enough insulin to compensate for the decreased insulin sensitivity, it Is easy to develop gestational diabetes mellitus(GDM) or aggravate the original diabetes. GDM is one of the most common medical complications during pregnancy, it often result in serious perinatal complications, such as large for date infant, pre-eclampsia, gestational hypertension, preterm delivery, shoulder dystocia, birth trauma, cesarean section, neonatal hypoglycemia, neonatal hyperbilirubinemia and so on, even may cause Pregnant women and there offspring metabolic disorder in long term. Therefore, it is very important for managing blood sugar during pregnancy.But currently, it is chaotic on the diagnosis of GDM at home and abroad,and lack of the comprehensive information on blood glucose in pregnant women with normal glucose tolerance. Blood glucose monitoring is the one of methods in diabetes treatment, but the traditional detection of fingertip blood and venous blood glucose only reflect instantaneous blood glucose values, it can not reflect the characteristics and regular of linear glucose.Continuous glucose monitoring syste (CGMS) is the most advanced technology of blood glucose monitoring in currently,it could obtain a signal from the probe every 10 seconds, and save the average of the signal every 5 minutes, a total of 288 blood glucose values can be recorded a day and continuous monitor patients' blood glucose levels for 72 hours.The CGMS could discover the hyperglycemia and hypoglycaemiaevents whith coulid not found by traditional blood glucose monitoring.,Providing a comprehensive and regular blood sugar information.HAPO study testified that following the rising of the blood glucose levels,the risk of the large for gestation ageinfat,the rate of cesarean section,neonatal hypoglycemia,hyperinsulinemia would increase,even the blood glucose levels in the normal range. Therefore, to find out the whole glucose spectrum of pregnant women with normal glucose tolerance,and comparing with the normal non-pregnant women. It's specificity of glucose spectrum may be the reason to bring about gestation combine the unusual goycometabllism. Besides, the former differences of glucose between the GDM and normal human was based on the information of the normal non-pregnant women,it was unreasonable. This study's main line was set up the preliminary glucose spectrum of second trimester of pregnancy women with normal glucose tolerance, analysising the differences between pregnancy women with normal glucose tolerance and normal non-pregnant women. Besides, comparing the differences of glucose profiles among GDM,pregnancy women with overt diabetes and pregnancy women with normal glucose tolerance. To provide the partial clinical data for managing the glucose of gestational period.Thus,this study preliminary analyze the characteristics of linear glucose profiles in pregnant women with different glucose tolerance status by CGMS in the second trimester and the third trimester.Then calculated the CGMS parameters and mean amplitude of glycemic excursion (MAGE), discussing the feature of prandial and postprandial blood sugan.Chapter 1 Preliminary analysis about glucose profile of normal sugar tolerance in the second and third trimester[Objectives]To observe the feature about glucose profile of normal sugar tolerance in the second and third trimester, analysising it's differences of glucose spectrum between coeval normal non-pregnant women.[Methods]4,Resaerch subjects:To collect 40 pregnant women and normal non-pregnant women. Subjects were divided into two groups:normal women (NGR) and Pregnancy women with normal glucose tolerance (NGRG). (1),Normal women were from 18 to 35, Han nationality, normal 75g OGTT(fasting plasmaglucose, FPG <5.6mmol/l,1 hour after oral glucose<7.8 mmol/l), HbA1c<5.7%,BMI<25 kg/m2.(2),The group of NGRG were from 18 to 35, gestational weeks from 24～34, Han nationality, received obstetrics checks in NanFang hospital from 2010.3～2011.3.They acceptted 75 g oral glucose tolerance test(OGTT) during 24～28 gestational weeks. Diagnostic criteria adopted in 2010 the American Diabetes Association (ADA) published standards:blood glucose cutoff value including fasting, 1 hour after oral glucose,2 hour after oral glucose,were 5.3mmol/l,10.0 mmol/l, 8.6 mmol/1 separately. Pregnant women whose blood glucose values were lower than the cutoff value mentioned above are pregnant women with normal glucose tolerance. Pregnant women with normal glucose tolerance must include conditions as follow:values of triglyceride and total cholesterol are lower than 3 times the upper limit of normal, single fetus, the first production, the normal fetal position, gestational age consistent with gestational weeks, systolic blood pressure <140mmHg, diastolic blood pressure <90mmHg. During research, the actual number of subjects enrolled in group NGR were 11, the actual number of subjects enrolled in group NGRG were37.5,Registrate general clinical data and Informe things:To inform the nature, purpose and possible side of this study to women who were chose into groups according to the above exclusion and enrollment criteria. Registrate general information as follow:name, sex, age, height, gestational age, with or without family history, blood pressure, weight, height, weight before pregnancy and pregnant, BMI pre-pregnancy and pregnant (according to the formula:body mass index (BMI)= weight (kg)/height (m2).3,Collect samples:All subjects were fasting at more than 8 hours before the test, detection of early morning blood specimens from elbow HbAlc, blood, liver and kidney function, blood lipids and glucose.4,According to CGMS practice embed sensor feeler at the lower edge of the upper arm deltoid for 3 days. Determining fingertip capillary blood glucose 4 times a day,and imput -ting to CGMS for correction,imputting the event flag when had meal. Statistical analysis:Statistical analyses were performed using the SPSS 13.0 software package. The data was expressed as the mean±S.D. The data witch conformed to gaussiandistribution was evaluated by Independent-Samples T Test. Statistical significance of differences among groups was evaluated by Repeted Measures ANOVA and one-way ANOVA,multiple comparisons were carried out using the Least-significant Difference (LSD) method. Welch method was used when equal variances not assumed, and multiple comparisons was analyzed by Dunnett's T3 method when P values less than 0.05.P<0.05 was considered as significant.The correlation of interstitial glucose levels of CGMS and finger capillary vessel glucose levels was evaluated by Pearson correlation analysis.[Results]1,General clinical dataThere were no significant differences in age. the systolic pressure,the diastolic pressure,ALT,AST,HDL-C,LDL in two groups, respectively (t=-0.275, P=0.785; t=-0.163, P=0.871; t=-0.855, P=0.397; t=-1.267, P=0.211; t=-1.437, P=0.157); There were significant differences in HbAlc,the mean present BMI,CR,BUN,CR,BUN,TC in two groups (t=2.330, P=0.024; t=-2.720, P=0.009; t=-5.262, P=0.000; t=-2.811, P=0.016; t=-2.891, P=0.006; t=-2.892, P=0.006).The mean gestational weeks is 27.57±2.06 weeks.the mean height is 161.66±2.06cm,the mean BMI of pre-pregnancy is 20.35±2.17kg/m2 in group NGRG.2,There was no hypoglycemia event in group NGR. There were four pregnancy women occurred hypoglycemia event in group NGRG(<2.8mmol/), one occurred during 11 o'clock to 15 o'clock,three occurred during before dawn 0 o'clock to 7 o'clock, centralizing 3 o'clock to 5 o'clock.3,There were 378 monitor value in two groups.Pearson correlation analysis showed that interstitial glucose levels and finger capillary vessel glucose levels was significant positive correlation (r=0.827,P=0.000)4. The parameters of CGMS:(1). There were no significant differences in MBG,SD,LAGE,MAGE,NGE,MODD(t=0.140,P=0.890; t=-0.900,P=0.373; t=-1.139. P=0.261; t=-1.412. P=0.165; t=0.671,P=0.506; t=-0.397,P=0.693). (2),There were no significant differences in 0.5h mean blood glucose before three meal in two groups (t=1.230,P=0.225; t=0.190,P=0.850; t=1.153,P=0.255). There were no significant differences in 0.5h mean blood glucose before three meal in group NGRG(F=0.770, P=0.467); (3),There were no significant differences in 1h mean blood glucose after three meal in two groups(t=0.106,P=0.916; t=-0.240,P=0.812; t=0.935,P=0.355). There were no significant differences in 1h mean blood glucose after three meal in group NGRG (F=0.853, P=0.416). (4),There were no significant differences in PPG of three meals in two groups (t=-1.009,P=0.318; t=-1.276,P=0.208; t=-0.336,P=0.739). There were no significant differences in PPG of three meals in group NGRG (F=0.258, P=0.708); (5),There were no significant differences in the time to peak of three meals in two groups (t=-1.277. P=0.208; t=-1.032,P=0.307; t=-0.405,P=0.687).The time to peak of breakfast eatbest was faster than lunch's and dinner's (P=0.001,P=0.000); (6),There were significant differences in Postprandial blood glucose increment of breakfast in two groups (t=-2.100,P=0.041). There were no significant differences in Postprandial blood glucose increment of three meals in group NGRG (F=2.290,P=0.117). (7),There were no significant differences in the mean blood glucose in night (t=0.515,P=0.609). (8),During the monitor period, the highest glucose value in group NGR was 9.7mmol/l, the minimum glucose value in group NGR was 2.9mmol/l. The highest glucose value in group NGRG was 12.4mmol/l, the minimum glucose value in group NGRG was 2.2mmol/l(smaller than the measurable range of CGMS). There were significant differences in the highest glucose value and the minimum glucose value in two groups (t=2.299,P=0.026; t=-3.327,P=0.002).[Conclusions]1,CGMS could provide integritive glucose profiles information, interstitial glucose levels and finger capillary vessel glucose levels had good positive correlation.2,The MAGE of pregnant women with normal glucose tolerance status was smaller than normal non-pregnant women. 3,During the monitor period, the highest glucose value of pregnancy women with normal glucose tolerance was higher than normal non-pregnant women, the minimum glucose value of pregnancy women with normal glucose tolerance was lower than normal non-pregnant women.4,The time to peak of breakfast eatbest of women with normal glucose tolerance was faster than lunch's and dinner's.Chapter 2 Analysis of glucose profile in pregnant women with different glucose tolerance status[Objectives]To analysis the variability of glucose profile of different glucose tolerance in the second and third trimester.[Method]1,Method and group:subjects were divided into three groups:(1),Pregnancy women with normal glucose tolerance (NGRG),GDM,overt diabetes (DM). (2),The inclusion criteria of Pregnancy women with normal glucose tolerance was just the same as those of the chapter 1. (3),Using "two-step way" to Sugar Screening,if the 1 hour after oral glucose>7.8 mmol/l,then undergo a 75-g OGTT 3 days later at 24-28 weeks of gestation. The diagnosis of GDM is made when any ofthe following plasma glucose values are exceeded:fasting,1-h, and 2-h plasma glucose after oral glucose were 5.3mmol/l,10.0mmol/l,8.6mmol/l. (4),When FPG≥7.0mmol/l or HbAlc>6.5%,1-h random plasma glucose≥11.1mmol/l and with classic symptoms of hyperglycemia or hyperglycemic crisis, the diagnosis of overt diabetes was made. During research, the actual number of subjects enrolled in group NGRG were37, the actual number of subjects enrolled in group GDM were32, the actual number of subjects enrolled in group DM were 8.2,Collect samples were just the same as those of the chapter 1.3,Statistical analysis:were just the same as those of the chapter 1.[Results]1,General clinical dataThere were no significant differences in gestational weeks,the systolic pressure,the diastolic pressure,ALT,AST,CR,BUN,TC,HDL-C,LDL in four group, respectively (F=2.732, P=0.072; F=1.671, P=0.195; F=2.079, P=0.132; F=0.741, P=0.480; F=2.883, P=0.074; F=2.767, P=0.069; F=1.697, P=0.339; F=0.074, P=0.929; F=1.877, P=0.160; F=1.551, P=0.219; F=2.735, P=0.072).The age in group GDM and group DM were larger than group NGRG, respectively (P=0.000, P=0.046); HbAlc of group GDM and group DM were larger than group NGRG, respectively (P=0.000, P=0.001); HbAlc of group DM werelarger than group GDM (P=0.013); the present BMI of group GDM were larger than group NGRG (P=0.014); TG of group GDM and grup DM were larger than group NGRG, respectively (P=0.016, P=0.000), TG of group GDM was larger than group DM (P=0.002)2,The parameters of CGMS in three groups:(1),There were four pregnancy women occurred hypoglycemia event(<2.8mmol/), one occurred during 11 o'clock to 15 o'clock,three occurred during before dawn 0 o'clock to 7 o'clock, centralizing during 3 o'clock to 5 o'clock. There were five pregnancy women occurred hypoglycemia event in group GDM, it centralized during 3 o'clock to 5 o'clock. There were one pregnancy women occurred hypoglycemia event in group DM,it centralized during 5 o'clock to 6 o'clock.(2),There were 952 monitor value in three groups.Pearson correlation analysis showed that interstitial glucose levels and finger capillary vessel glucose levels was significant positive correlation (r=0.901,P=0.000) (3),MBG of group DM was higher than group NGRG,group GDM, respectively (P=0.002,P=0.003), the rest were no significant difference (P=0.385).(4),SD of group DM were higher than group NGR,group GDM, respectively (P=0.000,P=0.000), the rest were no significant difference (P=0.210)(5),LAGE of group DM were higher than group NGRG and group GDM, respectively (P=0.000,P=0.000), the rest were no significant difference (P=0.213)(6),MAGE of group GDM,group DM were higher than group NGRG, respectively (P=0.023, P=0.000), MAGE of group DM was higher than group GDM (P=0.001)(7),NGE:There were no significant difference in four groups (F=0.391, P=0.677)(8),MODD of group DM was higher than group NGRG andgroupGDM, respectively (P=0.00,P=0.003), there were no significant difference in others (P=0.793)3,the characteristic of three meal in three group:(1),the 0.5h mean blood glucose before three meals:①,breakfast:group DM were higher than group NGRG and group GDM, respectively (P=0.000,P=0.000)②,luch:group DM were higher than group NGRG and group GDM, respectively (P=0.000,P=0.000)③,dinner:group DM were higher than group NGRG and group GDM, respectively (P=0.008,P=0.038) (2),The 1h mean blood glucose after three meals:①,breakfast:group GDM,group DM were higher than group NGRG, respectively (P=0.001,P=0.001).②,luch:group DM was higher than group NGRG and group GDM (P=0.017, P=0.041)③,dinner:group DM was higher than group NGRG and group GDM, respectively (P=0.000,P=0.002)(3),The PPG after three meals:C①,breakfast:group GDM,group DM was higher than group NGRG, respectively (P=0.000,P=0.001)②,luch:group DM was higher than group NGRG and group GDM (P=0.019,P=0.040)③,dinner:group GDM,group DM were higher than group NGRG, respectively (P=0.039, P=0.000). Group DM was higher thangroup GDM (P=0.000)(4),There were no significant differences in the time to peak after three meals in three groups (F=2.862, P=0.064; F=0.332, P=0.719; F=0.583, P=0.561)(5),The postprandial blood glucose increment of three meals:①,breakfast:group GDM,group DM were larger than group NGRG, respectively (P=0.000,P=0.001)②luch:There were no significant differences in postprandial blood glucose increment of lunch in three groups (F= 1.603, P=0.208)③,dinner:group DM were larger than NGRG组and group GDM, respectively (P=0.000,P=0.001)4. The characteristic of three meal in each group:(1),Group GDM:There were no significant differences in 0.5h mean blood glucose before three meal (F=1.437,P=0.246). There were significant differences beteewn the 1h mean blood glucose after breakfast and lunch,dinner (P=0.000, P=0.000). There were no significant differences beteewn the 1h mean blood glucose after lunch and dinner (P=0.527).There were significant differences in PPG among breakfast and lunch,diner (P=0.000,P=0.004),others had no significant differences (P=0.116). There were significant differences in the time to peak of breakfast and dinner (P=0.000), others had no significant differences (P=0.088,P=0.676).There were no significant differences in Postprandial blood glucose increment of three meals (F=2.787,P=0.070).(2),Group DM:There were no significant differences in 0.5h mean blood glucose before three meal (F=3.749,P=0.050). There were significant differences among the 1h mean blood glucose after breakfast and lunch,dinner (P=0.004,P=0.009), others had no significant differences (P=0.328). There were significant differences in PPG of breakfast and lunch,dinner (P=0.023,P=0.008), others had no significant differences (P=0.818). There were significant differences in the time to peak after breakfast and dinner (P=0.002), There were significant differences in the time to peak after lunch and dinner (P=0.011). There were significant differences in Postprandial blood glucose increment after breakfast and lunch (P=0.009), others had no significant differences (P=0.061)[Conclusions]1,CGMS could provide integritive glucose profiles information, interstitial glucose levels and finger capillary vessel glucose levels had good positive correlation.2,There were glyconic excursion in group GDM,MAGE of group GDM larger than pregnancy women with normal glucose tolerance,the glucose levels before three meals were nomarl,the characteristic of glucose spectrum was manifested by breakfast postprandial glucose levels rising.3,There were conspicuous glyconic excursion in group DM. MAGE of group DM larger than other groups. the characteristic of glucose spectrum showed whold day high glucose levels. |
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