Nida ÖZTOP, Ayşe KUBAT ÜZÜM, Selda ÇELİK, Cemile İDİZ, Yıldız TUTUNCU, Elif BAĞDEMİR, Nevin DİNÇCAĞ

GESTASYONEL DİABETES MELLİTUSTA GLİSEMİK DEĞİŞKENLİKLERİN ÖNEMİ VE FARKLI YÖNTEMLERLE ARAŞTIRILMASI

Amaç: Gestasyonel Diabetes Mellitus (GDM)’da gün içi glukoz dalgalanmaları ve bunun bebek üzerine etkisini belirlemek; ayrıca, glukozdaki dalgalanmaların HbA1c, fruktozamin (FRM) ve 1,5-Anhidroglucitol (1,5-AG) ile korelasyonunu saptamaktır. Gereç ve Yöntem: Sadece diyetle takip edilen GDM tanısı alan ve ≥35 gebelik haftasındaki 31 hastada devamlı glukoz ölçüm sistemi (CGMS) ile 72 saatlik glisemik değişkenlikler (ortalama mutlak değer %MAD ve ortalama glukoz değeri) ölçüldü, ayrıca hastalardan, CGMS takılı olduğu günler, kendi kendine glukoz ölçüm sistemi (SMBG) her öğün öncesinde ve birinci saat sonrasında parmak ucundan kan glukoz düzeylerini ölçmeleri istendi. 1,5 AG, Hba1c ve FRM düzeyleri CGMS çıkarıldığı üçüncü gün hastalardan alındı. Bulgular: Hastaların ortalama HbA1c, FRM ve 1,5-AG sırasıyla %5,0±0,3, 2,1±0,2 μmol/L, ve 17,0±4,9 ng/mL idi. Üç günlük izlemde maximum-minimum glukoz düzeyi ortalaması 131,1±22,5 ve 54,7±11,6 mg/dL iken %MAD değeri %6,7±3,1 idi. SMBG ve CGMS ile ölçülen ortalama glukoz değeri birbiri ile koreleyken (82,9±10,2 ve 86,1±10,3 mg/dL); glukoz dalgalanması ile FRM, HbA1c ve 1,5-AG arasında anlamlı korelasyon yoktu. Hastaların glikoz dalgalanmaları varsa doğumdaki bebek ağırlığının ve baş çevresinin düşük olduğu belirlendi. Sonuç: Çalışmamızda biyobelirteçlerin glisemik dalgalanmayı yansıtmadığı; istenilen glukoz seviyesinin sağlanması için, diyetle regüle GDM de bile, SMBG’un sık, düzenli olarak yapılmasının gerekliliği saptanmıştır; ancak glisemik dalgalanmaları fazla olan GDM’li annenin bebeğinde baş çevresi ve doğum kilosu daha düşük saptanmıştır ve glisemik dalgalanmayı daha yakından gösteren CGMS’ in her ne kadar maliyet ve uygulama zorluğu olsa da, SMBG’ ye alternatif yöntem olabileceği gösterilmiştir.

Anahtar Kelimeler:

Gestasyonel diabetes, 1.5 anhidroglucitol, glisemik değişkenlik, HbA1c, fruktozamin

DETERMINING THE IMPORTANCE OF GLYCEMIC VARIABILITY IN GESTATIONAL DIABETES MELLITUS USING VARIOUS TECHNIQUES

Objective: The study aims to determine glycemic variation in patients with gestational diabetes mellitus (GDM) and to evaluate the effect on the fetal growth using a continuous glucose monitoring system (CGMS) and to investigate the correlation between glucose variation through biomarkers including HbA1c, fructosamine (FRM), and 1.5-Anhydroglucitol (1.5-AG). Materials and Methods: The study involves 31 women with GDM at gestational week ≥35 who’d only had diet therapy. Blood glucose levels were monitored for three consecutive days using CGMS to evaluate mean blood glucose levels and mean absolute difference (MAD). Self-monitoring of blood glucose (SMBG) was required from the patients while having the CMGS on their body. Blood samples were collected to measure serum 1.5-AG, HbA1c, and FRM. Results: The mean levels were HbA1c=5.0±0.3%, FRM=2.1±0.2 μmol/L, 1.5-AG=17.0±4.9 ng/ml, and 3-day average max-min glucose range=131.1±22.5 and 54.7±11.6 mg/dl (MAD=6.7±3.1%). The mean glucose levels measured using SMBG and CGMS were similar (82.9±10.2 vs 86.1±10.3 mg/dL). No correlation occurred between CMGS and biomarkers. The baby weight at birth and head circumference was determined to be lower for patients with glucose fluctuations. Conclusion: Biomarkers do not reflect glycemic fluctuation, and regular SMBG is required to achieve the desired glucose level, even in diet-regulated GDM. Lower head circumference and birth weight were determined in GDM mothers with high glycemic fluctuations, and CGMS may be an alternative method despite its cost and application difficulties.

Keywords:

Gestastional diabetes, 1.5 anhydroglucitol, glycemic variability, HbA1c, fructosamine,

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