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- Page navigation anchor for RE: Diabetes Mellitus Will Always Be a Spectral IllnessRE: Diabetes Mellitus Will Always Be a Spectral Illness
The retrospective cohort study of Blotsky et al. serves well the epidemiology of diabetes in youth.(1) Their work, and supportive studies otherwise, have used administrative databases to establish diagnoses of diabetes, and they rely on validations previously made that provide some reasonable predictive values for discharge diagnoses as being representative of a gold standard laboratory diagnosis.(2-7) Making extrapolations in this regard has its perils, however, and also has the tendency to bring us further away from the complex clinical entity we recognize as diabetes mellitus.
Decades ago, criteria for and diagnoses of diabetes mellitus were simplistic and often more clinically-based. Fundamentally, diabetes mellitus is a complex and heterogeneous group of pathologies which are unified by the concepts of disordered carbohydrate metabolism. A major difficulty with harnessing such complexity is the perceived need to create more palpable boundaries for definitions. Such definitions may be more tailored towards assisting epidemiological, administrative, and to some extent clinical usages. There was eventually a move to ascribe the gold standards to strictly laboratory parameters and descriptions. Internationally, the choice of such standards were fraught with controversy, although there was some consensus that the laboratory definitions of diabetes mellitus would strongly rely on the creation of thresholds for the diabetic state as indicated by the frequency of asso...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Pregnancy a test of beta cell reserveRE: Pregnancy a test of beta cell reserve
Pregnancy is considered a test for beta cell reserve. If there is a good function insulin resistance will be overcome. If not gestational will occur. Insulin resistance (IR) that is present in normal pregnancy is to provide nutrients to the growing fetus. There is a rapid increase in insulin in such insulin resistant state.(1-3) The possibility of lipid deposition in muscle fibers( intramyocellular) could be one of the possible mechanism of IR in gestational diabetes mellitus (GDM).(3-4) The poor response of insulin release, possible fat deposition in the skeletal muscle or ectopic fat deposition may cause dysfunctional homeostasis in GDM.(5) This will definitely influence the fine tuning of metabolic machinery of a growing fetus. Children born with such subtle metabolic state probably may be more prone for glucose intolerance and ectopic lipid deposition. The finding that children born to GDM mothers are prone to glucose intolerance may be an eye-opener to monitor such children for beta cell function.
References:
1.Ryan EA, Enns L. Role of gestational hormones in the induction of insulin resistance. J Clin Endocrinol Metab 1988;67:341-342.Catalano,PM,Huston L, Amini SB,Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal gluocose tolerance and gestational diabetes. Amer J Obstet.Gynecol 1999;180:903-916.
3.Buchanan TA, Xiang A,Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care 2007;30:2...
Show MoreCompeting Interests: None declared.