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Item #13

Gestational Hyperglycemic Women Need Insulin More Often

Autoantibody-positive women with gestational hyperglycemia have fewer features of insulin resistance and need insulin more often than do autoantibody-negative women.

The autoantibody-positive women presumably have pre-symptomatic type 1 diabetes, say Italian researchers. They added that if that were corroborated by the follow-up of larger series, it would be useful to make clinical and immunological distinctions between types of gestational hyperglycemia.

The researchers from the University of Turin and the Hospital of Asti, assessed the prevalence of beta-cell autoantibodies in women with gestational diabetes and impaired glucose tolerance. They also sought to identify clinical characteristics which differentiated hyperglycemic patients with and without autoantibodies.

One hundred and twenty three patients with gestational diabetes, 84 patients with impaired glucose tolerance and 290 normoglycemic patients were all assessed for anti-islet cell antibodies, glutamic acid decarboxylase autoantibodies and the components of the metabolic syndrome.

Autoantibody positivity was 8.9% in patients with diabetes, 17.9% in patients with impaired tolerance and 0.3% in patients with normoglycemia.

Hyperglycemic patients with autoantibodies had lower body mass index, smaller waist measurements, less weight gain at the time of the screening test and a lower percentage of previous pregnancies than hyperglycemic patients who did not have autoantibodies.

Also, the fasting insulin values of hyperglycemic patients were significantly lower. These values were inversely related to the presence of autoantibodies, with the lowest values in patients who were positive for anti-glutamic acid decarboxylase.

Autoantibody-positive women with diabetes were treated more often with insulin than those who were autoantibody-negative. Diabetic Medicine 2003;20(1):64-68.

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FACT:

In patients with type 2 diabetes, hypertension based on self-measurement of blood pressure in the morning after awakening is strongly related to...complications, especially (kidney disease).  "It is concluded that control of morning hypertension may prevent vascular complications in type 2 diabetic patients."   Diabetes Care 2002;25:2218-2223