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Lois Jovanovic

Publications and source records attributed to Lois Jovanovic.

34 records · Page 2Linked to original sources
PubMed2004

Nutrition and pregnancy: the link between dietary intake and diabetes.

Pregnancy is a time when serial metabolic changes in the mother are carefully regulated to provide optimum substrate to both mother and fetus. Subtle perturbations in maternal metabolism can have implications not only for the index pregnancy, but also for future generations. The literature provides evidence that maternal nutrition plays a major role in the destiny of the offspring. Both maternal malnutrition and overnutrition are associated with subsequent diabetes in the offspring. Pregnancy represents a window of opportunity for health care providers to change dietary patterns toward habits that will be healthier for the individual now, as well as impacting on the future. The challenge for clinicians is to provide nutritional information based on scientific evidence that facilitates the normalization of fetal nutrition, and thus minimize the risk that the child will develop diabetes.

Diabetes Mellitus, Type 2↗
PubMed2004

Efficacy comparison between preprandial and postprandial insulin aspart administration with dose adjustment for unpredictable meal size.

BACKGROUND: Patients with type 1 diabetes mellitus (DM) may encounter situations in which meal size and content is unpredictable. In theory, postprandial injection of rapid-acting insulin analogues could prove more effective in achieving glucose control at such times because this treatment strategy could allow adjustment of insulin dose for the actual size of the meal consumed rather than being based on an estimate of what will be consumed. OBJECTIVE: This study compared the postprandial glycemic control achieved with meal-related insulin aspart injected immediately before a meal with that injected immediately after a meal. METHODS: This randomized, crossover study was conducted at Sansum Diabetes Research Institute, Santa Barbara, California. Adult patients with type 1 DM were enrolled. At study visit 1, patients were randomly assigned to inject insulin aspart 0 to 5 minutes before the start of the meal or immediately after the meal. The timing of injection relative to the meal was reversed at study visit 2. The meal-related dose was calculated based on the anticipated caloric and carbohydrate intake (preprandial injection) or actual calories and carbohydrates ingested (postprandial injection). Postprandial blood glucose concentrations were evaluated as markers of efficacy of postprandial aspart administration. RESULTS: Twenty patients were enrolled in the study (mean [SE] duration of DM, 22.5 [3.2] years; mean [SE] body mass index, 26.2 [1.0] kg/M2; age range, 22-82 years); 19 completed it. Total glucose AUC during the meal test was 22% less when insulin aspart was injected immediately before the study meal (mean [SE], 23,014 [1832] mg/dL.min) than when injected immediately after the meal (mean [SE], 29,535 [2243] mg/dL.min) (P < 0.001), but baseline-adjusted AUC was similar. Maximum mean (SD) glucose concentrations in the postprandial period were <180 mg/dL, the current DM treatment goals specified by the American Diabetes Association (149.0 [9.9] mg/dL and 102.0 [9.2] mg/dL, following postprandial insulin aspart injection and preprandial injection, respectively; P < 0.001). There was variation in the number of calories consumed, but patients consumed a similar number of calories in the 2 treatment regimens. The frequency of postprandial hypoglycemia was comparable. Adjustment of postprandial insulin aspart dose for the actual meal size consumed maintained postprandial glucose concentrations within currently recommended treatment guidelines. CONCLUSIONS: Preprandial insulin aspart injection produced a better glucose profile and is preferred when conditions permit. However, both preprandial and postprandial insulin aspart administration achieved postprandial glucose concentrations within currently recommended treatment guidelines.

Adult↗
PubMed2004

Treatment of type 2 diabetes with a combination regimen of repaglinide plus pioglitazone.

The efficacy and safety of combination therapy (repaglinide plus pioglitazone) was compared to repaglinide or pioglitazone in 24-week treatment of type 2 diabetes. This randomized, multicenter, open-label, parallel-group study enrolled 246 adults (age 24-85) who had shown inadequate response in previous sulfonylurea or metformin monotherapy (HbA(1c) > 7%). Prior therapy was withdrawn for 2 weeks, followed by randomization to repaglinide, pioglitazone, or repaglinide/pioglitazone. In the first 12 weeks of treatment, repaglinide doses were optimized, followed by 12 weeks of maintenance therapy. Pioglitazone dosage was fixed at 30 mg per day. Baseline HbA(1c) values were comparable (9.0% for repaglinide, 9.1% for pioglitazone, 9.3% for combination). Mean changes in HbA(1c) values at the end of treatment were -1.76% for repaglinide/pioglitazone, -0.18% for repaglinide, +0.32% for pioglitazone. Fasting plasma glucose reductions were -82 mg/dl for combination therapy, -34 mg/dl for repaglinide, -18 mg/dl for pioglitazone. Minor hypoglycemia occurred in 5% of patients for the combination, 8% for repaglinide, and 3% for pioglitazone. Weight gains for combination therapy were correlated to individual HbA(1c) reductions. In summary, for patients who had previously failed oral antidiabetic monotherapy, the combination repaglinide/pioglitazone had acceptable safety, with greater reductions of glycemic parameters than therapy using either agent alone.

Adult↗
PubMed2004

Glycohemoglobin (A1C) distribution in school children: results from a school-based screening program.

OBJECTIVE: To establish the normal distribution for glycohemoglobin (A1C) in sixth and seventh grade children and to assess the practicality of a school-based fingerstick screening program. RESEARCH DESIGN AND METHODS: Fingerstick capillary whole blood was collected from 400 children aged 11 to 13 years and the percent A1C was determined on-site. RESULTS: Among the boys, the A1C was significantly higher among the minorities (4.88+/-0.37%, mean+/-S.D.) than among the non-hispanic whites (4.73+/-0.41%, P<0.01), but was similar in the two groups of girls (4.74+/-0.41 and 4.75+/-0.34, respectively, P=0.88). None of the students had abnormal glucose tolerance by the standards published for adults. CONCLUSIONS: A1C in boys was higher among minorities than among the non-hispanic whites, even at this young age of 11-13 years. This may be an early sign of predisposition to type 2 diabetes among the groups known to be at higher risk for type 2 diabetes. However, this difference was not seen among girls. Reasons for the discrepancy between boys and girls is unexplained. A school-based fingerstick screening program proved to be practical. As the risk of obesity-related diseases, such as type 2 diabetes mellitus, increases among youth, the classroom may become an important location for screening.

Adolescent↗
PubMed2004

Screening for and treatment of polycystic ovary syndrome in teenagers.

Polycystic ovary syndrome (PCOS) usually arises during puberty and is marked by hyperinsulinemia and hyperandrogenism. Adolescents with PCOS are at an increased risk of developing health problems later on in life such as type 2 diabetes, cardiovascular disease, and infertility. Furthermore, the physical signs of PCOS can be detrimental to a teenage girl's self-image. Early diagnosis and treatment of PCOS in adolescents are essential in ensuring adulthood health and restoring self-esteem. Treatments for an adolescent with PCOS include diet and exercise, metformin, and oral contraceptive pills. Each of these options has been shown to be effective in improving certain aspects of PCOS, and probably the best treatment plan involves some combination of them.

Adolescent↗
PubMed2004

Achieving euglycaemia in women with gestational diabetes mellitus: current options for screening, diagnosis and treatment.

Gestational diabetes mellitus is one of the major medical complications of pregnancy. Untreated, the mother and the unborn child may experience morbidity and fetal death may even occur. It is important to diagnose and treat all hyperglycaemia appearing during pregnancy. Ideally, a screening and diagnostic test that identified all women at risk for hyperglycaemia-associated complications would be employed in all pregnant women. Unfortunately, there is no such test available currently. The best alternative is to administer an oral glucose challenge test to all pregnant women and then apply the best strategies for interpretation. This article discusses the limitations of our present diagnostic tools and suggests an option for the clinician until the definitive test has been elucidated. In addition, this article outlines one dietary and management strategy that has been associated with an outcome of pregnancy that is similar to the outcome of pregnancies in healthy women. This strategy includes starting with a "euglycaemic" diet (comprising < 40% carbohydrates and > or =40% fat), which can then be individualised according to the patient's glucose levels. Appropriate exercise, such as arm ergometer training, may enhance the benefits of diet control. For patients who require insulin, if the fasting glucose level is >90 mg/dL or 5 mmol/L (whole blood capillary) then NPH insulin (insulin suspension isophane) should be given before bed, beginning with dosages of 0.2 U/kg/day. If the postprandial glucose level is elevated, pre-meal rapid-acting insulin should be prescribed, beginning with a dose of 1U per 10g of carbohydrates in the meal. If both the fasting and postprandial glucose levels are elevated, or if a woman's postprandial glucose levels can only be blunted if starvation ketosis occurs, a four-injections-per-day regimen should be prescribed. The latter can be based on combinations of NPH insulin and regular human insulin, timed to provide basal and meal-related insulin boluses. The total daily insulin dose for the four-injection regimen should be adjusted according to pregnant bodyweight and gestational week (0.7-1 U/kg/day); doses may need to be increased for the morbidly obese or when there is twin gestation. There is now some evidence that insulin lispro, other insulin analogues and oral antihyperglycaemic drugs may be beneficial in gestational diabetes, and more data on these agents are awaited with interest.

Diabetes, Gestational↗
PubMed2003

Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus.

OBJECTIVE: To compare the daily glycemic profile reflected by continuous and intermittent blood glucose monitoring in pregnant women with type 1 diabetes and to compare the treatment protocols based on the two monitoring methods. METHODS: The study sample consisted of 34 gravid patients at gestational weeks 16-32, with type 1 diabetes being treated by multiple insulin injections. Data derived from the continuous glucose monitoring system for 72 hours were compared with finger stick glucose measurements performed 6-8 times per day. During the study period, patients documented the time of food intake, insulin injections, and hypoglycemic events. Data on demographics, gravidity, parity, body mass index, hemoglobin A1c, and fructosamine levels were collected for each patient. RESULTS: An average (+/- standard deviation) of 780 +/- 54 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level greater than 140 mg/dL) undetected by the finger stick method was 192 +/- 28 minutes per day. Nocturnal hypoglycemic events (glucose level less than 50 mg/dL) were recorded in 26 patients; in all cases, there was an interval of 1-4 hours before clinical manifestations appeared or the event was revealed by random blood glucose examination. Based on the additional information obtained by continuous monitoring, the insulin therapeutic regimen was adjusted in 24 patients (70%). CONCLUSION: Continuous glucose monitoring can diagnose high postprandial blood glucose levels and nocturnal hypoglycemic events that are unrecognized by intermittent blood glucose monitoring and may serve as a basis for determining treatment regimens. A large, prospective study on maternal and neonatal outcome is needed to evaluate the clinical implications of this new monitoring technique.

Adult↗
PubMed2003

A retrospective cohort study of diabetes mellitus and antipsychotic treatment in the United States.

Treatment-emergent diabetes mellitus (DM) has been described for conventional and atypical antipsychotics. In our study, antipsychotic prescription claims from AdvancePCS's database were used to identify patients starting antipsychotic monotherapy. The relative risk of developing DM was determined using prescription claims for antidiabetic agents in the following cohorts: AdvancePCS general patient population, combined conventional antipsychotics, and combined atypical antipsychotics. Cox proportional hazards regression was used to adjust for differences in age, gender, and duration of antipsychotic exposure between cohorts in the estimation of risk of developing diabetes. Hazard ratios for developing DM in the combined conventional, combined atypical, and individual conventional and atypical antipsychotic treatment cohorts were greater than the AdvancePCS general patient population cohort. An increased risk of developing diabetes compared with the AdvancePCS general patient population was observed during treatment with conventional or atypical antipsychotics.

Adolescent↗
PubMed2003

Serum 1,5-anhydroglucitol (GlycoMark ): a short-term glycemic marker.

1,5-Anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, has been measured and used clinically in Japan for over a decade to monitor short-term glycemic control. Evaluation of glucose control otherwise requires measuring plasma glucose or glycated proteins whose levels reflect average glucose concentration over the half-life of the protein analyzed. Hemoglobin A1c measurements reflect blood glucose levels over that past 2-3 months, while fructosamine can be used to evaluate glycemic control over 10-14 days. In contrast, 1,5-AG levels in blood respond within 24 h as a result of glucose's competitive inhibition of 1,5-AG reabsorption in the kidney tubule. When glucose levels rise, even transiently, urinary loss of 1,5-AG occurs, and circulating levels fall. Because of changes in renal hemodynamics in normal pregnancies, 1,5-AG appears of limited usefulness in evaluation of gestational diabetes. However, the characteristics of 1,5-AG levels in patients with moderate to near-normal glycemic control suggest that it may be a valuable complement to frequent self-monitoring or continuous monitoring of plasma glucose to confirm stable glycemic control. Measurements performed daily or weekly in a given patient would suggest that overall glycemic control has been stable or improved if 1,5-AG levels are stable or increasing. If 1,5-AG levels fall, greater attention to glucose monitoring and both lifestyle and medical management could be prescribed to correct the glycemic excursions that would underlie such changes. The behavior of this analyte is different from all others used in the management of diabetes, creating potential opportunities for its use in clinical practice.

Biomarkers↗
PubMed2003

Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus.

OBJECTIVE: To assess the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests. RESEARCH DESIGN AND METHODS: The study included 15 women with GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed-the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart. RESULTS: The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. Glucose areas under the curve above baseline were significantly lower with insulin aspart (180-min area, 7.1 mg. h. dl(-1); P = 0.018), but not with regular insulin (30.2 mg. h. dl(-1); P = 0.997), than with no insulin (29.4 mg. h. dl(-1)). CONCLUSIONS: This study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion.

Adult↗
PubMed2002

Pregnancy hormones prevent diabetes and reduce lymphocytic infiltration of islets in the NOD mouse.

Pregnancy is associated with a depression of the immune inflammatory system, and with increased growth and function of the pancreatic islets of Langerhans. We monitored glucosuria, blood glucose concentration, and lymphocytic infiltration of pancreatic islets in 30 female, 10-wk-old, pre-diabetic nonobese diabetic (NOD) mice divided into 3 treatment groups for 13 wk: group 1, saline; group 2, pregnancy hormones (dexamethasone 4 mg/Kg/day, progesterone 1.7 mg/Kg/day, growth hormone 0.6 mg/Kg/day, prolactin 1 mg/Kg/day, and estradiol 0.05 mg/Kg); and group 3, prolactin alone (1 mg/Kg/day). At sacrifice, the pancreases were fixed in paraformaldehyde and islet infiltration was evaluated. In the saline-treated group (#1) 4/10 mice developed diabetes, while in the hormone treated group (#2) none of the mice developed diabetes. Only 1/10 mice in the prolactin-treated group (#3) developed diabetes during the study. Islets from the hormone cocktail treated group were significantly less infiltrated than islets from the other 2 treatment groups (p <0.001). Thus, the pregnancy hormones protected NOD mice from developing diabetes and significantly reduced or eliminated insulitis and islet infiltration. Prolactin alone had a partial protective effect. The results have implications for prevention of type 1 diabetes and for immune suppression in patients receiving islet cell transplantation.

Animals↗
PubMedDate not supplied

Glucose and insulin requirements during labor and delivery: the case for normoglycemia in pregnancies complicated by diabetes.

OBJECTIVE: To present protocols for maintaining normoglycemia during labor and delivery in order to achieve optimal outcomes of pregnancy in women with diabetes. RESULTS: Labor has a glucose-lowering effect. In the case of women with insulin-requiring gestational diabetes, no additional insulin is needed with the onset of labor; sufficient glucose should be infused to keep such women from becoming ketotic from the pronged period of starvation. Likewise, protocols derived from glucose-controlled insulin infusion studies reveal that women with type 1 diabetes require no more subcutaneously administered insulin on the morning of an induction of labor or at the onset of spontaneous labor. The intravenously administered solutions should be started with isotonic saline or electrolyte solutions. As soon as active labor is achieved, the solutions should be switched to a glucose-containing fluid and administered at a rate of 2.55 mg/kg per minute. CONCLUSION: Labor is a form of exercise and thus obviates the insulin requirement in women with all types of diabetes, but it also necessitates an eightfold increase in glucose substrate in order to prevent maternal hypoglycemia and ketosis. The literature presents clear evidence that neonatal hypoglycemia is directly related to maternal hyperglycemia during labor and delivery. Thus, protocols for maintaining normoglycemia during labor and delivery are necessary to achieve optimal results.

Animals↗