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PubMed1993

[Serum superoxide dismutase (SOD) activity in diabetes mellitus].

The serum superoxide dismutase (s-SOD) activities in patients with diabetes mellitus (DM) were assayed in order to evaluate its usefulness for monitoring of DM and also evaluate the relation between s-SOD activities and microangiopathies (nephropathy, neuropathy and retinopathy). As results followings were obtained; 1) s-SOD activities in DM patients were significantly higher than those in healthy controls (12.56 +/- 7.73 vs 10.51 +/- 1.69, p < 0.01). 2) There was no relations between s-SOD activities and FBS-, fructosamine- and HbA1-levels, respectively. 3) Among DM patients s-SOD activities were significantly higher in patients with microangiopathy than those in patients without microangiopathy (14.18 +/- 11.00 vs 11.24 +/- 3.13, p < 0.01). 4) Among DM patients with microangiopathy higher s-SOD activities tended to be observed in patients with triopathy such as nephropathy, neuropathy and retinopathy than in those with one or two microangiopathic complications. 5) Among DM patients with nephropathy the correlation was present between s-SOD activities and levels of creatinine. These results suggest that the assay of s-SOD activity is not useful for the monitoring of DM, however, it is suggested that the high s-SOD activity reflects the microangiopathic complications, particularly nephropathy.

Adult↗
PubMed1993

[Patients with type-II diabetes mellitus and neuropathy have no deficiency of vitamins A, E, beta-carotene, B1, B2, B6, B12 and folic acid].

The present study was aimed to determine the vitamin status of vitamins A, E, beta-carotene, B1, B2, B6, B12 and folate in plasma using HPLC and vitamins B1, B2 and B6 in erythrocytes using the apoenzyme stimulation test with the Cobas-Bio analyzer in 29 elderly type II diabetic women with (G1: n = 17, age: 68.6 +/- 3.2 years) and without (G2: n = 12, age: 71.8 +/- 2.7 years) diabetic polyneuropathy. The basic parameters as age, hemoglobin A1c, fructosamine and duration of the disease did not differ in both groups. Furthermore, retinopathy was assessed with fundoscopy and nephropathy with creatinine clearance. The creatinine clearance (G1: 50.6 +/- 3.4 vs. G2: 63.6 +/- 3.7 ml/min, 2p < 0.025) and the percentage of retinopathy (G1: 76.5% vs. G2: 16.7%, 2p = 0.002) were different indicating that G1 had significantly more severe late complications than G2. Current plasma levels of all measured vitamins (A, E, beta-carotene, B1, B2, B6, B12 and folate) and the status of B1, B2 and B6 in erythrocytes did not vary between the two groups (2p > 0.1). In summary, we found a lack of association between the actual vitamin condition in plasma and erythrocytes and diabetic neuropathy.

Aged↗
PubMed1993

[Impairment of bronchial reactivity in patients with diabetes mellitus type I].

Bronchial provocation tests (histamine and acetylcholine) were performed in 40 subjects (30 of them with type 1 diabetes, and 10 healthy volunteers) without any history of respiratory disease, not smoking and not taking any bronchodilating drugs. Bronchial reactivity was assessed using PC20 estimated spirographically by measuring FEV1. The patients were classified into three groups according to the duration of the disease: group I (0-7 yrs), group II (8-15), and group III (> 15). In all the three groups diabetes was at a similar degree of compensation, as evaluated by the mean circadian glycaemia, serum fructosamine and the Schlichtkrull Mw index. Bronchial reactivity to acetylcholine and histamine decreased with diabetes duration. Reaction to acetylcholine was statistically lower after 7 years of diabetes. An autonomic neuropathy was detected within the respiratory system, parallel to tachycardia at rest, alteration of the Valsalva test and orthostatic hypotension.

Adult↗
PubMedDate not supplied

[Postmortem diagnosis of exogenous insulin administration].

Toxicological analyses are presented in connection with the decrease of a 51-year-old female medical practitioner. The woman was found dead in a woodland about 250 metres far from her motor car. According to her relatives the woman had expressed her intention to commit suicide. Two single use syringes, two empty (300 units) cartridges intermediate type human insulin, and one empty ampoule of 10 mg diazepam were found near the corpse. The toxicological analyses of the heart-blood resulted in 210 ng diazepam/ml, 382 mu units/ml insulin and 0.58 ng/ml C-peptide. After extraction of a tissue sample from the injection area (cubital region) 113 milliunits insulin could be detected by radioimmunoassay. The insulin concentration in relation to the C-peptide concentration in the blood of the corpse indicated an exogenous supply of insulin. The HbA1c and fructosamine data in the blood and the histological examination of the pancreas showed that the woman had not suffered from diabetes.

Diagnosis, Differential↗
PubMed1993

[A re-evaluation of the program for diabetes mellitus type 2. A proposal for quality indices].

OBJECTIVE: To find out how accurate our records are and the state of health of the patients with diabetes mellitus type II (DM) in our Base Health Area (BHA) in Osona county (Barcelona), both before and after introducing a new procedure. DESIGN: Quality control study based on the medical records (PCMR) of DM patients. The evaluation took place between 1.1.90 and 31.12.90; and the re-evaluation between 1.1.91 and 31.12.91, after the DM procedure had been put in place as a corrective measure. PATIENTS: 198 patients: all of those suffering from DM type II. MAIN MEASUREMENTS AND RESULTS: 110 women and 88 men, with an average age of 65.4 +/- 11.9, were under study. We observed from the records of attendance that 94.4% were or had been smokers, whereas the question of the eye fundus was only mentioned in 36.8%. The introduction of a procedure has improved the records in almost every parameter. In 1991, 36.8% of the patients had normal-weight criteria, 33.3% had good biochemical control and 15.6% fulfilled both these criteria. CONCLUSIONS: Those tests which could be performed with few instruments were carried out much better than those which needed more complex technology or specialist support. Arising from this study, the authors propose four indicators of quality control: 1) Weight normality. 2) Annual plasmatic fructosamine. 3) Annual eye fundus check. 4) Annual proteinuria check.

Aged↗
PubMed1995

Diabetic nephropathy in an aerobically trained rat model of diabetes.

The purpose of this study was to determine the effects of aerobic training on indices of glycemic control, blood pressure, serum lipids, and diabetic nephropathy (DN) in an animal model of insulin deficient diabetes mellitus. Thirty-four male Sprague-Dawley rats made diabetic with streptozocin were randomly assigned to a trained group or a sedentary group. Fifteen sedentary-nondiabetic rats served as a control group. The animals were trained on a treadmill at 18 m.min-1, 8 degrees incline for 120 min.d-1, 5 d.wk-1. Blood and 24 h urine collections were obtained at various intervals throughout the study. At 21 wk of age systolic blood pressure was measured and kidney tissue was obtained for light and electron microscopy. Analysis of variance was used to detect differences among the groups (P < or = 0.05). The diabetes produced in this investigation resulted in hyperglycemia, increased urine albumin and total protein excretion, elevated systolic blood pressure, increased fractional volume of the mesangium, and widening of the glomerular basement membrane in the sedentary-diabetic animals. Aerobic training significantly reduced the increase in fractional volume of the mesangium and fructosamine. Most importantly, aerobic training did not augment the renal damage seen in DN.

Animals↗
PubMed1996

[Lipoprotein(a) concentrations in type I diabetes mellitus].

OBJECTIVES: To determine the distribution of lipoprotein(a) levels and prevalence of hyperLp(a) in diabetes mellitus type I (IDDM). To analyze the effect of glycemic control and microalbuminuria on Lp(a) levels. METHODS: Cross-sectional study of 263 subjects with IDDM with a mean age of 19.2 +/- 11.6 years and an evolutive course of 6.3 +/- 6.5 years. Apart from Lp(a), measurements were obtained from serum levels of lipids, apolipoproteins AI and B, fructosamine, glycosilated hemoglobin (HbA1c), and albuminuria in all patients. RESULTS: Mean serum concentrations of Lp(a) were 16.5 +/- 18.1 mg/dl and 18.5% of patients had Lp(a) levels > 30 mg/dl [hyperLp(a)]. With a multivariate regression analysis, the only variable correlated with Lp(a) levels was cholesterol LDL (p < 0.001). Patients with hyperLp(a) did not differ from the other patients in any of the other variables analyzed, and patients with HbA1c higher and lower than 8% had similar mean serum Lp(a) concentrations (14.0 +/- 16 vs. 17.9 +/- 20). Lp(a) concentration was also similar among patients with albuminuria higher and lower than 20 micrograms/min (16.6 +/- 20 vs. 17.7 +/- 16). CONCLUSIONS: Control of glycemia and microalbuminuria have no effect on Lp(a) concentrations in diabetes mellitus type I. HyperLp(a) is not indicative of a poor glycemic control.

Adolescent↗
PubMed1996

What is the best index of glycemic control in patients with diabetes mellitus on hemodialysis?

Since red blood cell survival time is shortened in patients with diabetes mellitus (DM) on hemodialysis (HD), it is unlikely that indices of glycemic control accurately reflect the glycemic state of these individuals. In this study, in order to determine the best index of glycemic control in diabetic patients on HD, we measured HbAlc, 1,5-anhydroglucitol (1,5-AG), fructosamine (Fr) and glycated albumin (GA) in 31 diabetic patients on HD (20 males and 11 females, mean age: 66.9 years), and examined the correlation between each index and predialysis plasma glucose level. Since the mean values of predialysis plasma glucose during the final 2 and 4 weeks before the study were best correlated with HbAlc, this parameter was considered to be the most reliable index of glycemic control in diabetic patients on HD. GA was more closely correlated with mean values of predialysis plasma glucose during the final 2 and 4 weeks, than any other index of glycemic control, followed by HbAlc. In conclusion, HbAlc is considered to be the most reliable index of glycemic control in diabetic patients on HD.

Aged↗
PubMedDate not supplied

[Evaluation of the coagulation and fibrinolysis system in 54 patients with type 2 diabetes mellitus: correlations with lipid metabolism and blood glucose control].

Diabetic patients have increased morbidity and mortality attributable to myocardial infarction, cerebrovascular disease and peripheral vascular disease, due to a high incidence of premature atherosclerosis. Abnormalities of hemostasis have been reported in many studies on diabetes over almost thirty years, but unfortunately the results have often appeared contradictory. The hemostatic alterations could lead to increased risk of vascular disease in diabetic patients. We have studied some coagulation factors (Fibrinogen, Factor II, Factor VII) and coagulation inhibitors (Protein C, Protein S), and plasminogen in fifty-four type 2 diabetic patients. The possible relationship between coagulation factors and coagulation inhibitors and parameters for glyco-metabolic control (glycosylated hemoglobin, fructosamine) and disturbed lipid metabolism (cholesterol, triglycerides) have ben analyzed. Our results show increase of fibrinogen, correlated with the metabolic control of the disease, positive correlation between plasminogen, factor II, protein S and hypertriglycerides, decreased levels of protein C correlated neither with metabolic control of disease neither with disturbed lipid metabolism.

Aged↗
PubMed1996

A placebo-controlled, double-blind trial of growth hormone treatment in prepubertal children after renal transplant.

Sustained growth retardation in spite of a successful renal transplantation (RTx) is a serious problem for many pediatric allograft recipients. Biosynthetic growth hormone (GH) was given to 11 prepubertal children with severe growth retardation after RTx in a placebo-controlled double-blind study, assessing its effect on height velocity (HV), bone maturation, renal function, plasma IGF-I and IGF-II, serum IGF-binding proteins (IGFBP), and lipid and carbohydrate metabolism. Six months of GH (4 IU/m2/day s.c.) was either preceded or followed by six months of placebo. The patients underwent a full examination every three months. All children completed the study. Mean HV improved significantly with GH therapy (P < 0.0001), but there was also some improvement with placebo (P = 0.06). The GH-induced HV increment exceeded that of placebo by 2.9 cm/six months. Bone maturation was not accelerated. Acute renal graft rejection did not occur in any of the patients. 125I-thalamate and 131I-hippuran tests showed that mean glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) did not change significantly during GH therapy. GH caused a significant increase in IGF-I (P < 0.0001), which was far greater than the insignificant increase in serum IGFBP-3 levels (P = 0.16). Mean serum levels of total cholesterol, low density lipoprotein, apolipoprotein-A1 and -B, which are elevated at the start of the study compared with that of controls, did not change significantly during GH therapy. GH induced a significant increase in mean integrated plasma insulin levels during oral glucose tolerance test, without changing plasma glucose levels. Serum fructosamine and parathyroid hormone levels remained constant. Impressive HV increment can be achieved with GH therapy in children with growth retardation after RTx, without significant changes in renal function. Bone maturation appears unaffected, suggesting an improve final height.

Adolescent↗
PubMedDate not supplied

[Protective effect on nephropathy and on cataract in the streptozotocin-diabetic rat of the vanadium-lazaroid combination].

Experimental work from our laboratory has confirmed the protective power of vanadium compounds on hyperglycemia and glycosuria in streptozotocin (STZ) diabetes. Furthermore, the diabetic cataract too has been partially prevented. The protection slightly increased, when vanadium was administered in combination with vitamin E. This investigation has introduced a combination of Na3VO4 plus the lazaroid U-83836E, a liposoluble antioxidant much more efficacious than tocopherol, in order to improve the insufficient protection when vitamin E was used. Male Wistar rats, rendered diabetic with STZ, were treated for 12 weeks with Na3VO4 in drinking water, U-83836E carried by the food, or both. The most significant metabolic parameters (food and fluid intake, diuresis and excreted feces) were studied monthly by means of metabolic cages. Body weight, glycemia, glycosuria and proteinuria were also recorded. At week 6 and 12 of the treatment, the opaqueness of the eye lenses was controlled. Circulation glycosylated hemoglobin (HbA1c), fructosamine, N-acetyl-beta-D-glucosaminidase (NAG) and fluorescent peroxides were evaluated at the end of the experiment. After the first month of treatment U-83836E improved significantly the protective effect of vanadate alone on polydipsia and polyuria, but more efficiently on hyperglycemia and glycosuria. The further ameliorating effect of the lazaroid was observed also on HbA1c, NAG and, most important, on the cataract. In conclusion, these findings demonstrate that the lazaroid U-83836E succeeds in further protecting the most important symptoms of diabetes treated with vanadate, and that this antioxidant acts effectively even when it is administered per os, in a non invasive manner.

Animals↗
PubMed1996

[Combination antihypertensive therapy in patients with an increased risk profile].

BACKGROUND: Antihypertensive drug combinations have two major advantages: First, dosage of the single components can be reduced, and second, putative side effects can be minimized. Therefore, we analysed in a cohort of patients with multiple cardiovascular risk factors the metabolic effects of two fixed antihypertensive drug combinations. PATIENTS AND METHODS: 225 patients with essential hypertension (dBP > or = 95 < or = 115 mm Hg) and adipositas (BMI 30.6 +/- 2.5) were randomly treated during 6 months with either quinapril and hydrochlorothiazide (HCTZ) or with metoprolol and hydrochlorothiazide. Compared with healthy controls, patients exhibited significant elevated concentrations of triglycerides (226 +/- 86 vs. 146 +/- 73 mg/dl) and fasting insulin (22.2 +/- 1.8 vs. 9.8 +/- 4.6 microU/ml). RESULTS: The antihypertensive effects and the tolerance of both substances were good and comparable after 3 and 6 months. Serum triglycerides increased during metoprolol/hydrochlorothiazide treatment (230 +/- 81 vs. 244 +/- 185 mg/dl; median 174 vs. 204; + 17%), as well as during treatment with quinapril/hydrochlorothiazide (222 +/- 155 vs. 235 +/- 162 mg/dl; median 166 vs. 174; + 5%). Fasting blood glucose levels, insulin, fructosamine, HbA1c and free fatty acids remained unchanged. In a subgroup of 88 postmenopausal women with upper body obesity (WHR > 0.85) treatment with quinapril/hydrochlorothiazide normalized the VLDL-triglyceride/VLDL-cholesterol ratio (3.8 vs. 5.9, p < 0.05), whereas the ratio only increased from 3.6 to 4.2 in the metoprolol/hydrochlorothiazide group. These changes in the ACE-inhibitor group were due to a decrease in VLDL-cholesterol (41.4 +/- 4.2 vs. 33.9 +/- 9.6). CONCLUSION: These data demonstrate that quinapril or metoprolol in combination with hydrochlorothiazide do not differ significantly with regard to their effects on blood-pressure lowering, lipoprotein profile, and glucose metabolism. Only in the subgroup of adipose postmenopausal women, the modulated VLDL-composition might suggest the elimination of atherogenic VLDL-remnants/IDL during quinapril/hydrochlorothiazide treatment.

Adult↗
PubMed1997

Comparative evaluation of three assay systems for automated determination of hemoglobin A1c.

We evaluated three newly introduced systems for automated determinations of hemoglobin (Hb) A1c, which allow the processing of large amounts of samples in a routine clinical laboratory. We compared these methods--the Variant HPLC, the Hi-Auto A1c analyzer system, and the Roche immunoassay--with the Diamat HPLC system. All showed good precision and good concordance with the Diamat HPLC. The reference range for Hb A1c has to be determined by the laboratory for each assay system. Interference study showed no statistically significant influence of anemia, polycythemia, rheumatoid factor, or chronic hemodialysis, although individual Hb A1c values can be influenced by polycythemia (when measured with the Hi-Auto A1c analyzer) and by chronic hemodialysis (when measured with the Variant HPLC). HPLC was not suitable for measuring Hb A1c in the examined cases of hemoglobin variants; assaying fructosamine seems to be better for monitoring these patients.

Anemia↗
PubMed1996

[Complex evaluation of body reaction in obese boys boys with systematic physical exertion and a low energy diet].

This paper presents the results of researched influence of systematic physical effort together with a calorie restricted diet on fourteen-year-old obese boys. We evaluated their physical efficiency (VO2max), body consistency, blood lipid profile the level of non-enzymatic glycosylation of protein, insulinemia, and insulin resistance measured by the binding of 125I-Insulin to erythrocyte receptors. For 21 days, subjects performed 30 minutes of physical effort on a bicycle ergometer with load of 1 W/kg of body mass. Simultaneously, they were subjected to a calorie restricted diet at an average level of 1300 kcal. Before administering of the therapy and following its completion, the maximal amount of oxygen intake and body consistency was determined. Following that, the boy subjects performed an effort on the bicycle ergometer having an intensity of 70% VO2max and, simultaneously, capillary and venous blood was drawn for testing. In the capillary blood samples indices of acid-base balance, the lactate level, and glucose level were determined. In the venous blood samples levels of lipids, immunoreactive insulin, C-peptide and fructosamine were determined. Binding of 125I-Insulin was determined according to the method described by Gambhir and modified by us. Obtained results show that the administered therapy contributed to an increased physical efficiency, a decrease in the body's fatty mass, a reduction by 20% of insulinemia (p < 0.01) and insulin resistance as measured by the amount of 125I-Insulin binding.

Acid-Base Equilibrium↗
PubMed1997

Sudden death due to diabetic coma in insulin-department diabetes mellitus: an autopsy report.

Sudden death caused by the acute onset of diabetic coma is reported. A 15-year-old female had been suffering from insulin-dependent diabetes mellitus for the prior 8 years and had a fever and vomiting for the past few days. On the 4th day, after the onset of fever and vomiting, she died suddenly, and was autopsied to clarify the cause of death. Macroscopic examination revealed that the pancreas was atrophic (40 g) whereas the liver was markedly enlarged (2,740 g). Histological findings were: 1) The islets of Langerhans were decreased in size and number. They were not positive for aldehyde-fuchsin staining, 2) There were severe fatty changes in the liver cells. The retained blood in the left ventricle was analyzed: glucose, 1,016 mg/dl; acetone, 345 mg/l; acetoacetate, 5.91 mmol/l: D-3-hydroxybutyrate, 4.17 mmol/l; hemoglobin A1c, 10.2%; fructosamine, 416 mumol/l; total serum cholesterol, 220 mg/dl; triglycerides, 205 mg/dl; free fatty acid, 8.0 mEq/l; urea nitrogen, 40 mg/dl. Although the biochemical estimation of the glucose and ketone levels in post-mortem body fluids was recognized as being unreliable, many of these values were far elevated in comparison with those of normal individuals. Thus, we concluded that the cause of death was diabetic ketoacidosis. We also discuss the diagnostic problems of postmortem blood chemistry.

Adolescent↗
PubMed1997

Reference data on the anatomy, hematology and biochemistry of 9-month-old silver foxes.

Anthropometric, anatomical, hematological and biochemical reference values were estimated in clinically healthy male and female 9-month-old silver foxes. The coefficients of variation of anthropometric and anatomical measurements for 9-month-old silver foxes were as low as previously reported for adult foxes. However, in relation to body size, all measurements were smaller. Compared with adult silver foxes, higher values were observed in serum levels of triglyceride, phospholipid, beta-lipoprotein, blood urea nitrogen and total protein. Similarly, higher levels were obtained for serum enzymes, especially aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK). The high levels of these serum enzymes may be due to handling stress. Inorganic phosphorus and calcium concentrations in the young foxes were also high. The alkaline phosphatase (ALP) level, reflecting the level of bone growth, was higher than that of adults. Biochemical values of beta-lipoprotein glucose and calcium in male 9-month-old silver foxes were lower than those of females, whereas those of total cholesterol, total protein, fructosamine, iron, albumin and beta-globulin were higher.

Animals↗
PubMed1997

Elevated levels of sex hormones and sex hormone binding globulin in male patients with insulin dependent diabetes mellitus. Effect of improved blood glucose regulation.

In a prospective study we have measured serum levels of sex hormone-binding globulin (SHBG), androgens, oestrogens and gonadotropins in 20 male IDDM patients with the aim of evaluating the effect of improved glycaemic control on these levels and to compare the IDDM patients with an age- and weight-matched healthy non-diabetic control group. The patients were chosen from the male IDDM patients attending the outpatient clinic at the Department of Endocrinology, Odense University Hospital. Glycaemic control was optimized by a trained diabetologist according to the patients' measurements of home blood glucose concentrations and reported hypoglycaemic episodes during a three month period. Prior to regulation the patients, compared to healthy control subjects, had significantly higher serum levels of oestrone (0.29 +/- 0.02 vs 0.16 +/- 0.01 nmol/l (Mean +/- SEM), p < 0.01), 17 beta-oestradiol (0.12 +/- 0.01 vs 0.08 +/- 0.01 nmol/l, p < 0.01), dihydrotestosterone (4.20 +/- 0.18 vs 1.66 +/- 0.09 nmol/l, p < 0.01), total testosterone (20.7 +/- 0.9 vs 17.8 +/- 1.1 nmol/l, p < 0.05) and SHBG (42.3 +/- 2.9 vs 15.5 +/- 3.5 nmol/l, p < 0.05), while the calculated free-testosterone was lower (0.34 +/- 0.02 vs 0.40 +/- 0.02 nmol/l, p = 0.068). After regulation, the patients obtained significantly lower levels of glycosylated haemoglobin (10.4 +/- 0.3 vs 8.9 +/- 0.2%, p < 0.005) and serum fructosamine (1.50 +/- 0.05 vs 1.34 +/- 0.04 nmol/l, p < 0.005) on a higher 24 hour insulin dose (52.7 +/- 4.4 vs 59.2 +/- 4.6 IU/24 h, p < 0.005). Levels of free-testosterone (0.41 +/- 0.04 nmol/l), oestrone (0.33 +/- 0.03 nmol/l), oestradiol (0.14 +/- 0.01 nmol/l), delta 4-androstenedione (4.44 +/- 0.43 vs 3.85 +/- 0.42 nmol/l), and prolactin (249 +/- 24 vs 200 +/- 19 mIU/l) increased compared to values obtained before regulation (all p < 0.05). We conclude that SHBG, testosterone, dihydrotestosterone and oestrogen levels are increased in male IDDM patients. High SHBG levels tend to keep the free fractions of sex hormones within normal limits. During improvement of glycaemic control with insulin, levels of free-testosterone and its bioprecursors and metabolites rise. This may partly be due to the increased daily insulin dose and/or to the improvement in glycaemic control itself.

Adult↗
PubMed1997

[Intensive care of insulin dependent diabetic pregnant women. Perinatal outcome in relation to gestational age at the initial visit].

BACKGROUND AND AIM: To correlate the perinatal outcome of insulin-dependent diabetic (IDDM) pregnant women with the quality of metabolic control defined as gestational age at initial visit, extent and duration. MATERIALS AND METHODS: A total of 64 pregnant women classified from White's class B to class R were included in the study: 55 pregnant women joined the study before the 9th week (early control group), 9 after the 26th week (late control group). On the basis of perinatal outcome, the 55 pregnant women in the early control group were then subdivided into a further two groups: 34 patients with optimal outcome and 21 with non-optimal outcome. RESULTS: In the early control group of pregnant women, overall mean daily glycemia was significantly lower in the group with optimal outcome compared to that with non-optimal outcome during the 1st and 2nd trimester, but not in the 3rd. Compared to the early control group, during the 3rd trimester patients in the late control group showed significantly higher levels of: overall mean daily glycemia, glycosylated hemoglobin and fructosamine. In the early control group maternal morbidity (p < 0.05), neonatal morbidity (p < 0.03) and perinatal mortality (p < 0.05) were significantly lower than in the late control group. CONCLUSIONS: The achievement of optimal glycometabolic control in the 2nd trimester appears to be a prerequisite for improving maternal-fetal outcome in the early control group compared to that in the late control group in which the attainment of good glycemic control during the 3rd trimester does not seem to be efficacious in reducing overall morbidity and mortality.

Diabetes Mellitus, Type 1↗