| Background:Gestational dibaetes melliuts (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy, it's do harm to maternal and fetal health. The pathogenesis of GDM is still unclear although it is recognized that insulin resistance (IR) andβcell dysfunction play an important role in its pathogenesis. It is well known that CGMS is an effective method to evaluate the fluctuation of blood glucose in diabetic patients but the study on using CGMS to monitor the stability of blood glucose in patients with GDM, and explore the relationship between the fluctuation of blood glucose and pregnancy outcomes are still less.Objective:1. To assess the insulin sensitivity and the characteristics of insulin secretion in the pregnant patients who were diagnosed with GDM in the late second or early third trimester of pregnancy, and obtain the complete blood glucose profiles with CGMS in these patients.2. To compare the accuracy and stability of CGMS data from implanting in different sites to find out a suitable implanting site.3. To evaluate the relationship between boold glucose and pregnancy outcomes, sequentially provide the basis for the clinical decision-making and excellent glucose control.Method:1. Subjects:33 pregnant women who were diagnosed with GDM were recruited from hospital of the authors in Changchun, China. All the patients follow diet recommandation for 7d～10d, insulin was commenced if blood glucose levels is still above 6.7 mmol/1 2-h postprandially, or fasting glucose is above 5.6 mmol/L. GDM were diagnosised following two steps:Firstly, pregnant women were screened with 50g glucose challenge test (GCT). If 1-h plasma glucose>7.8mmol/L the women with abnormal results will then take 100gOGTT (Oral glucose tolerance test). GDM was diagnosed when two or more of the four hourly postchallenge glucose level exceeded the following threshold:fasting≥5.3, 1-h≥10.0,2-h≥8.6, and 3-h≥7.8mmol/L.The diagnosised GDM patients were divided into two groups according to their treatment methods:Group A (15 patients with diet only) and Group B (18 patients with insulin treatment). HbA1C were assayed in all the patients.2. The serum insulin and C peptide levels were measured during the four hourly postchallenge of 100g OGTT. The CGMS was worn continuously for 72h after the blood glucose was controled to fasting glucose≤5.6 mmol/L and 2-h postprandial blood glucose≤6.7 mmol/L.3. Statistics:All the data were expressed as means±SD. The differences between two groups were analyzed by t-test, the enumeration datas were analyzed by x2-test. The correlations between two groups were analyzed by Pearson coefficient analysis. Adverse pregnancy outcomes related factors were performed using Logistic regression model. All statistical analysis was performed using SPSS 13.0 software.Result:1. There was no significant difference between the two groups in age, gestational weeks, BMI, weight gain during pregnancy, calorie intake and exercise time per day.2. Blood glucose levels in group B were higher than that in group A at the diagnosis point. HbA1C (8.34%±2.93% vs 5.85%±0.54%); 2hPG [(12.34±2.78) mmol/L vs, (9.66±1.66) mmol/L]; 3hPG [(8.91±1.04) mmol/L vs (10.93±2.27) mmol/L](P <0.05).3. Insulin secretion index and HOMA-HBCI in group B was lower than those in group A(△AI60/△G60 (11.69±7.12vs 17.46±8.96) and HOMA-HBCI (55.47±9.43vs 93.72±11.16) (P<0.05).4. C-peptide level of group B was significantly lower than that of group A, especially the fasting (1.85±1.69 vs 3.69±1.32) and OGTT 1h C-peptide level (6.72±4.33 vs 12.38±6.10) (P<0.05). The peaks of C-peptide secreting in two groups were delayed to 60 to 120 minutes. 5. To evualte the insulin therapy related factors, the logistic regression analysis were used by establishing the Logistic regression model. It indicated that OGTT2-h glucose had significant correlation.6. The blood glucoses results monited by CGMS had a good correlation with the finger-stick values (r2= 0.896, F= 548.16, P= 0.000), no matter in arms or hip. But the correlation wearing in waist is better than in arms (r=0.922 vs r= 0.794, P<0.05).7. There were significant difference between the two group in MAGE value (P= 0.038). Compare to group A, group B had more hypoglycemia, nocturnal hypoglycemia and hyperglycemia events (P<0.001).8. There were no significant difference in delivery time (P= 0.659), delivery style (x2 =2.19, P>0.05) and baby birth weight (P= 0.712). There were 4 cases of polyhydramnios,1 case of premature delivery, and 2 cases of neonatal hypoglycemia in group B, but none was happen in group A. Logistic multivariate regression analysis showed that HbA1C, MAGE had statistically contributed to bad pregnancy outcomes, HbA1C [B=0.741, Wald=4.530,P=0.046, OR=2.098,95%CI (0.969-4.543)], MAGE [B=2.535, Wald=4.748, P=0.049, OR=12.612,95%CI(0.971-4.543)]. Conclusions:Considered the accuracy and comfortable properity of CGMS in pregnant women, the probe implanted in waist was better than that in upper arm. The peaks of postprandial blood glucose in GDM patients were between 1h and 1.5h, so it is better to monitor 1-h postprandial blood glucose level in GDM women. The insulin treatment raised a possibility of glucose variability compared to diet only from the different results of MAGE although the patients have an almost same level of HbAIC. Which also contribute to the difference pregnancy outcomes. |
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