#1
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ÒÒÃ (òåñò òîëåðàíòíîñòè ê ãëþêîçå) ïðè áåðåìåííîñòè. Âñå æå öåëåñîîáðàçåí?
European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 121, Issue 1 , 1 July 2005, Pages 51-55 Oral glucose tolerance testing at gestational weeks ≤16 could predict or exclude subsequent gestational diabetes mellitus during the current pregnancy in high risk group Tamás Bitóa, , , Tibor Nyárib, László Kovácsa and Attila Pála aDepartment of Obstetrics and Gynaecology, University of Szeged, Albert Szent-Györgyi Medical and Pharmaceutical Center, Szeged, Hungary bDepartment of Medical Informatics, Szeged, Hungary Abstract Background: An oral glucose tolerance test with a result that is negative but close to the diagnostic cut-off in early pregnancy was hypothesized to serve as a predictor of subsequent gestational diabetes in a high risk group. The aim of the study was to determine those cut-off values of OGTT at gestational weeks ≤16, which can predict or exclude subsequent onset of GDM in a high risk group. Methods: Pregnant women at high risk of gestational diabetes (n = 163) underwent a 2-h, 75-g oral glucose tolerance test at gestational weeks ≤16 were analyzed in this study. In the event of a negative result, subsequent oral glucose tolerance tests were performed at gestational weeks 24–28 and 32–34. The sensitivity, the specificity, the positive and negative predictive values and the Odds ratio of the best cut-off values of fasting and postload glucose levels were calculated. Results: The best cut-off values to exclude subsequent GDM for fasting and postload glucose were 5.0 and 6.2 mmol/l, respectively. In combination, the best cut-off values were 5.3 mmol/l for fasting and 6.8 mmol/l for postload glucose, with negative predictive values of 0.97 and 0.71 and sensitivities of 96.9 and 86.3 at gestational weeks 24–28 and 32–34, respectively. Combination of these cut-off values with obesity proved to be very predictive for gestational diabetes by gestational weeks 32–34, with an Odds ratio of 6.0 [95% confidence interval: 1.7–21.0]. Conclusions: With regard to the very high negative predictive value of the method, pregnant women with glucose levels of ≤5.3 mmol/l at fasting and of ≤6.8 mmol/l at postload in gestational weeks ≤16 should undergo subsequent oral glucose tolerance testing merely at gestational weeks 32–34. Approximately a quarter (24.5%) of the pregnant women at risk of gestational diabetes satisfied these criteria. Keywords: Gestational diabetes mellitus; Oral glucose tolerance test; Risk factors Corresponding author. Present address: Szülészeti és Nõgyógyászati Klinika, H-6725 Szeged, Semmelweis u 1, Hungary. Tel.: +36 62 545757; fax: +36 62 545711. |
#2
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Íà ñàìîì äåëå äàæå àìåðèêàíöû ÍÅ ÌÎÃÓÒ ïðîâîåñòè ÎÃÒÒ âñåì áåðåìåííûì- õîòÿ òàì ýòî ïîëàãàåòñÿ ñäåëàòü. Ñâîèìè óøàìè ñëûøàëà , êàê êòî-òî èç ñóïåðâàæíûõ ãèíåêîëîãîâ ÑØÀ îáúÿñíÿë ñèòóàöèþ òþòü â òþòü êàê ÿ ýòî äåëàþ íà çàíÿòèÿõ- äàâàéòå âíà÷àëå îïðåäåëèì. êîìó è ÊÀÊÎÉ òåñò ìû îáÿçàíû ñäåëàòü.  öåëîì â ñòðàíå íàçðåëà è äàæå ïåðåçðåëà íåîáõîäèìîñòü áîëüøèõ ðàáîò ìåæäèñöèïëèíàðíûõ íà ýòó òåìó( íàäåþñü, ÷òî ïîëó÷èòñÿ)
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Ã.À. Ìåëüíè÷åíêî |
#3
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Ñòàòüÿ î öåëåñîîáðàçíîñòè ïðîâåäåíèÿ òîòàëüíîãî GTT áåðåìåííûì.
Ó àìåðèêàíöåâ åñòü ðàñòâîðû ãëþêîçû 100 ã è 50 ã ñ àïåëüñèíîâûì âêóñîì. ß äàæå âûïèë êàê-òî ïîë áóòûëî÷êè. Äåëàëè â 2000 âñåì ïîäðÿä â 22-24 íåäåëè è ïîâòîðÿëè ó áåðåìåííûõ âûñîêîãî ðèñêà â Íüþ-Éîðêå. À ó íàñ äàæå íåò òàêîãî ôàðì. ïðåïàðàòà Acta Diabetologica Publisher: Springer-Verlag Italia Srl ISSN: 0940-5429 (Paper) 1432-5233 (Online) DOI: 10.1007/s005920200016 Issue: Volume 39, Number 2 Date: June 2002 Pages: 69 - 73 Universal screening and intensive metabolic management of gestational diabetes: cost-effectiveness in Italy G. Di Cianni A1, L. Volpe A1, I. Casadidio A1, P. Bottone A2, L. Marselli A1, C. Lencioni A1, A. Boldrini A3, G. Teti A2, S. Del Prato A1, L. Benzi A1 A1 Department of Endocrinology and Metabolism, Cisanello Hospital, University of Pisa, Via Paradisa 2, I-56126 Pisa, Italy A2 Department of Obstetrics and Gynecology, Cisanello Hospital, University of Pisa, Pisa, Italy A3 Neonatal Care Unit, Santa Chiara Hospital, University of Pisa, Pisa, Italy Abstract: Abstract This study retrospectively evaluated two groups of pregnant women. Group A women (n=1338) were universally screened for gestational diabetes mellitus (GDM) and GDM patients were intensively treated. In Group B (n=4035), screening was performed only in women at high risk for GDM and treatment was conventional. This study confirms the validity of a cost-effective screening program for the diagnosis of GDM and that selective screening may be an option only in a situation where healthcare resources are very scarce and/or universal screening of any kind is not feasible. Once the diagnosis of GDM has been made, metabolic management with an intensive approach is important to reduce maternal and fetal morbidity. Diagnosis of GDM and intensive treatment represent a cost for the public health system, but permit a significant monetary savings in terms of costs linked to maternal and neonatal morbidity. |
#4
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Äà, ÿ óæå ãîâîðèëà â îäíîé èç äèñêóññèé ( â òîé äèñêóññèè ðàòîâàëè çà ÎÃÒÒ âñåì - âñåì- âñåì - ò.å è ìóæ÷èíàì ñ áðþøêîì, è ïóõëåíüêèì. è ðîäñòâåííèêàì), ÷òî äàæå ñàìà íàâåñêà ãëþêîçû â 75 ãð - ýòî íå òàê ïðîñòî è îáñóæäàåòñÿ , ñ êàêîé ãëþêîçîé ( ñëåäóþò áèîõèìè÷åñêèå òîíêîñòè) êàê ñäåëàòü..
Íî åñëè ñ êîòî è íà÷èíàòü - òàê ýòî ñ îñîçíàíèÿ ïðîáëåìû- íóæíî èëè íå íóæíî íàì ïðîâîäèòü ÎÃÒÒ, ðàç óæ ìû ìåòôîðìèíîì âîò ó ýòîé ñ èíñóëèíîðåçèñòåíòíîñòüþ áåðåìåííîñòü âûçâàëè...Ì.á, è ïîòåðè áóäóò ìåíüøå ïëîäîâ ( òåìà óæå ïîøëà- ò.å òåìà óæå äàíà).  îòëè÷èå îò àìåðèêàíöåâ êàíèäñêèå ñîáðàòüÿ ( òàì íà òðåòü íàø ñ Âàìè íàðîä) - ñ÷èòàåò ÎÃÒÒ ó áåðåìåííûõ çpÿøíûì äåëîì- õîòü íàøè è "òàêè ãàðíè, òàêè ïîâíi" . ß ïî÷òè óáåæäåíà, ÷òî âîò çäåñü êðîìå íàñ ñàìèõ íèêòî íå ðåøèò, íàäî èëè íåò íàì ïððîâîäèò áåðåìåííûì èç ãðóïï ðèñêà ÎÃÒÒ- òàê è áûòü, ïåðâîðîäÿùèì òðîñòèíêàì áåç ðîäñòâåííèêîâ ñ äèàáåòîì ìîëîæå 25 ëåò íå áóäåì - à îá îñòàëüíûõ ïîðà äóìàòü..
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Ã.À. Ìåëüíè÷åíêî |
#5
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Óâàæàåìàÿ Ãàëèíà Àôàíàñüåâíà,
ñêàæèòå, ïîæàëóéñòà, êàê Âû îòíîñèòåñü ê îïðåäåëåíèþ ãëèêîçèëèðîâàíîãî ãåìîãëîáèíà? Ó íàñ ïî-ïðåæíåìó åãî íàçíà÷àþò, íî ÿ ÷èòàë, ÷òî ýòîò òåñò óñòàðåë è íå óêàçûâàåò ÷åòêî íà ñòåïåíü êîëåáàíèé óðîâíÿ ãëþêîçû (íà àäåêâàòíîñòü èíñóëèíîòåðàïèè)... |
#6
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Ãëèêîãåìîãëîáèí - îäèí èç âàæíåéøèõ ïîêàçàòåëåé àäåêâàòíîñòè êîíòðîëÿ äèàáåòà, ïîçâîëÿþùèé îöåíèòü äîëãîñðî÷íóþ ( 3-õ ìåñÿ÷íóþ ) ãëèêåìèþ.Ãëèêîãåìîãëîáèí íå çàìåíÿåò è íå ïîäìåíÿåò ñàìîêîíòðîëü è îïðåäåëåíèå ãëèêåìèè, íî â ñîâîêóïíîñòè ïîçâîëÿåò ëó÷øå îõàðàêòåðèçîâàòü ðèñêè îñëîæíåíèé.
Ãëèêîãåìîãëîáèí óêàçûâàåòñÿ êà êîäíà èç îñíîâíûõ öåëåé ëå÷íåèÿ äèàáåòà- à ïðîáëåìû åãî îïðåäåëåíèÿ åñòü âî âñåõ ëàáîðàòîðíûõ ïîêàçàòåëÿõ.. Ïîæàëóéñòà, ïóòü ïàöèåíò ñòàâèò ñèñòåìó ìîíèòîðèðîâàíèÿ ãëþêîçû,- - è èçìåðÿåò ãëþêîçó êàæäûå 15 ìèí...
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Ã.À. Ìåëüíè÷åíêî |
#7
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Ïðè áåðåìåííîñòè îïðåäåëåíèå ãëèêîãåìîãëîáèíà íå áóäåò èíôîðìàòèâíûì. Ïîêàçàòåëü-òî èíòåãðàëüíûé çà 3 ìåñÿöà. À óãëåâîäíûé îáìåí ïðè áåðåìåííîñòè ìîæåò "ñëîìàòüñÿ" â áîëåå êîðîòêèå ñðîêè.
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#8
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Èíòåðåñíîå èññëåäîâàíèå íà áëèçíåöàõ óêàçûâàþùåå íà ãåíåòè÷åñêè-äåòåðìèíèðîâàííóþ ñêëîííîñòü ê ãëèêîëèçàöèè ïðîòåèíîâ ñî âñåìè âûòåêàþùèìè ïîñëåäñòâèÿìè. Ïðè÷åì ñêëîííîñòü ê ãëèêîëèçàöèè íå çàâèñèò îò ãåíîâ, îòâåòñòâåííûõ çà ðàçâèòèå ñàìîãî äèàáåòà.
Diabetes. 2001 Dec;50(12):2858-63. Related Articles, Links HbA(1c) levels are genetically determined even in type 1 diabetes: evidence from healthy and diabetic twins. Snieder H, Sawtell PA, Ross L, Walker J, Spector TD, Leslie RD. Twin Research and Genetic Epidemiology Unit, St Thomas' Hospital, London, UK. HbA(1c), a measure of blood glucose regulation, reflects glucose levels in the preceding months. In diabetes, HbA(1c) levels predict the risk of microvascular complications. The aim of this study was to determine whether genetic factors could influence HbA(1c) levels in normal subjects and type 1 diabetic patients. We performed a classical twin study of HbA(1c) in healthy nondiabetic female twins and 42 monozygotic (MZ) and 47 dizygotic (DZ) pairs. Interclass correlations (r) were higher in MZ (r = 0.77) compared with DZ (r = 0.53) twin pairs, suggesting a substantial genetic effect; this was confirmed by quantitative genetic model fitting. Additive genetic effects (heritability) explained 62% (95% CI 47-75) of population variance in HbA(1c); the remainder was attributable to the influence of unique environment (23% [15-36]) and age (14% [5-28]). Multivariate modeling showed that genetic factors also have a substantial influence on fasting glucose levels (51%). However, HbA(1c) heritability could not be explained by genes in common with fasting glucose. In the patients with type 1 diabetes, HbA(1c) levels were correlated in 33 MZ twins concordant for diabetes (r = 0.68; P < 0.001) but also in 45 MZ twins discordant for the disease (r = 0.52; P < 0.001). These significant correlations for HbA(1c) in both concordant and discordant pairs indicate a diabetes-independent familial effect. Thus, HbA(1c) levels are largely genetically determined and independent of the genes influencing fasting glucose. Even in type 1 diabetes, familial (i.e., diabetes-independent) factors influence protein glycation, implying that familial factors may explain, in part, the risk for microvascular complications, as indicated by high HbA(1c) levels. |
#9
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Öèòàòà:
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#10
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Òîãäà åùå îäèí âîïðîñ: íàñêîëüêî öåëåñîîáðàçíî íàçíà÷àòü HbA 1c áåðåìåííû ñ 1 è 2-òèïàìè?
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#11
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Âîò, ïèøóò, ÷òî òåñò âñå æå ÿâëÿåòñÿ ëó÷øèì èíäèêàòîðîì êîíòðîëÿ ãëèêåìèè.
Ann Clin Biochem. 1998 Mar;35 ( Pt 2):283-9. Related Articles, Links A comparison of automated fructosamine and HbA1c methods for monitoring diabetes in pregnancy. Kennedy DM, Johnson AB, Hill PG. Department of Biochemistry, Derbyshire Royal Infirmary NHS Trust, Derby, UK. Two automated methods for measuring fructosamine (Test Plus and the original fructosamine assay) and glycated haemoglobin (Tina-quant immunoassay) were compared to determine which is the best index of blood glucose control during pregnancy. Thirteen women with type 1 diabetes were studied, with four-weekly measurements of HbA1c and fructosamine Test Plus using a Hitachi 911 analyser and fructosamine measured using an Olympus AU800 analyser. HbA1c correlated better (r = 0.573) with mean blood glucose (MBG) concentration than did fructosamine Test Plus (r = 0.347), even after correction for total protein concentration (r = 0.463), while there was no significant correlation with the original fructosamine method (r = 0.201). HbA1c correlated better with fasting/pre-prandial MBG concentrations, whereas fructosamine Test Plus correlated better with post-prandial MBG concentrations. Fructosamine Test Plus decreased with gestational age, and correlated with albumin and total protein concentrations, whereas HbA1c did not change with gestational age. Thus, HbA1c and fructosamine Test Plus were found to be useful in verifying home blood glucose measurements in diabetic pregnancy, with HbA1c being the best predictor of MBG concentration. |
#12
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Êîãäà ðå÷ü èäåò î äèàáåòå 1-ãî òèïà, òîãäà êîíå÷íî.
Öèòàòà:
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#13
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à 2-é òèï?
Ïðè 1-ì òèïå âî âðåìÿ áåðåìåííîñòè òàêæå õàðàêòåðíî ëàáèëüíîå òå÷åíèå ñ ðåçêèìè èçìåíåíèÿìè óðîâíÿ ãëþêîçû, íåñìîòðÿ íà ïåðåõîä íà êîðîòêèå èíñóëèíû è ò.ä. |
#14
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Öèòàòà:
Íî, êîãäà ðå÷ü èäåò î ãåñòàöèîííîì äèàáåòå, ãëèêèðîâàííûé ãåìîãëîáèí íå àêòóàëåí. |
#15
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ßñíî, ñïàñèáî. ß îòíîñèòåëüíî ÷àñòî âñòðå÷àþ 2-é òèï. À â áîëåå ïîçäíèõ ñðîêàõ ñîòíîøåíèå 2 è 1-é òèï ïðàêòè÷åñêè äîõîäèò äî 1:1 ââèäó òîãî, ÷òî ïðè 1-ì òèïå áåðåìåííîñòü äîñòàòî÷íî ÷àñòî ïðåðûâàþò ïî ìåä. ïîêàçàíèÿì.
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