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Carol J Homko

Publications and source records attributed to Carol J Homko.

15 recordsLinked to original sources
PubMed2006

Women and diabetes.

Women with diabetes face unique health challenges throughout their life cycle. Health concerns begin at puberty and continue throughout the reproductive years and later stages of life. Diabetes can have a significant impact on puberty, menstruation, reproduction, and cardiovascular and bone health. All women with diabetes require an individualized reproductive health plan that addresses contraception, the importance of planning pregnancies, and life-style changes. Anticipatory guidance and education in each phase of development can help the woman with diabetes avoid health care problems, reduce her risk of complications, and achieve a health outcome.

Adolescent↗
PubMed2006

Insulins and oral hypoglycemic agents in pregnancy.

Numerous studies have established a direct relationship between maternal levels of glycemic control and neonatal outcomes for pregnancies complicated by diabetes. The past several years have seen the addition of insulin analogues as well as many new oral agents to the pharmacological armamentarium available to treat diabetes. Insulin analogs (both rapid and long acting) are of potential interest for women with insulin-requiring diabetes because of the improved control reported in non-pregnant individuals. Insulin lispro is the only insulin analog to be systematically studied in pregnancy. At this time, the majority of evidence suggests that insulin lispro does not cross the placenta and does not have adverse maternal or fetal effects during pregnancy in women with diabetes. For women with gestational diabetes mellitus (GDM) and type 2 diabetes, which are characterized by insulin resistance and relatively decreased insulin secretion, treatment with oral hypoglycemic agents is generating much excitement. Most retrospective studies and the published clinical experience have failed to demonstrate an increased risk of neonatal hypoglycemia and other neonatal morbidities with glyburide or metformin. To date there has been only one randomized controlled trial utilizing glyburide, which found it to be safe and effective in the management of GDM. More intensive investigation regarding the safety and feasibility of oral agents in pregnancies complicated by type 2 diabetes is necessary.

Abnormalities, Drug-Induced↗
PubMed2006

Longitudinal assessment of insulin sensitivity in pregnancy. Validation of the homeostasis model assessment.

OBJECTIVE: To validate the use of the homeostasis model assessment (HOMA) for measurement of insulin sensitivity in obese women during gestation and the postpartum period. DESIGN: Three consecutive measurements of insulin resistance (IR) were performed during and after pregnancy to compare the homeostasis model assessment insulin sensitivity index (HOMA-IR) to glucose utilization rates obtained during hyperinsulinaemic euglycaemic clamps (G(Rd)). PATIENTS: Six obese women (mean second trimester BMI = 30.4 kg/m(2)) with normal glucose tolerance were studied during the second and third trimesters of pregnancy and once in the postpartum period. Thus, there were a total of 18 measurements for analysis. RESULTS: Correlations between the rate of glucose disappearance (G(Rd)) (the gold standard) and the HOMA-derived metabolic parameters of insulin sensitivity were significant, with a multiple R(2) of 43.5% (P = 0.003). However, when controlling for variations between patients using dummy variables, we observed that one patient differed from the other five in the relationship between G(Rd) and HOMA-IR. Applying this regression we obtained a R(2) of 72.6% (P < 0.001). When the regression constant was omitted, we observed that the individual trends during pregnancy and postpartum in two patients differed statistically from the other patients between the two assessments, and we obtained a multiple R(2) of 97.3% (< 0.001). CONCLUSIONS: HOMA estimation of insulin resistance is appropriate for use during both the second and third trimesters of pregnancy and postpartum in obese women with normal glucose tolerance. It lacks sensitivity for the evaluation of individuals, where more precise measures of insulin sensitivity should be utilized.

Adult↗
PubMed2005

One hour versus two hours postprandial glucose measurement in gestational diabetes: a prospective study.

OBJECTIVE: To compare the rate of adverse perinatal outcomes among women with gestational diabetes mellitus (GDM), monitored by 1 versus 2 hour-postprandial glucose (PPG) measurements. METHODS: A total of 112 women diagnosed with GDM, by the criteria of Carpenter-Coustan, were included in the study population. Women were recruited from two different treatment settings, but were managed by the same team of health-care professionals using a standardized protocol. Allocation to treatment group was based on treatment setting. Glucose levels were measured fasting, and either 1 hour (1-hour monitoring group-target values <140 mg/dl) or 2 hours (2-hour monitoring group-target values <120 mg/dl) postprandially. Demographic data and perinatal outcomes were collected from their medical records. RESULTS: In all, 66 women were assigned to 1-hour monitoring group (1 h-PPG) and 46 women to 2-hour monitoring group (2 h-PPG). There were no differences in parity, family history of diabetes, rate of GDM in previous pregnancies, weight gain, pregestational BMI and 50-g-glucose challenge test (GCT) and 100-g oral glucose challenge test (OGTT) results. As expected, there was a significant difference in mean blood glucose levels between the two groups (108.1+/-19.2 and 94.9+/-21.2 mg/dl, 1- and 2 hours, respectively, p<0.0001); however, HbA1C levels were similar in the two groups. Perinatal outcomes were defined as gestational week at delivery; fetal weight (3325+/-471 vs 3309+/-608 g, respectively) and percentile (47.2+/-27 vs 49.6+/-30, respectively), and were similar for both groups. Insulin therapy was initiated more frequently in 2-hour monitoring group (28 and 40% of women in groups 1 and 2, respectively; p<0.05). Rates of macrosomia (7.5 versus 10.6%), large for gestational age (7.4 versus 15.2%), and delivery by cesarean section (24 versus 30%) were increased in group 2 (2 h-PPG) but these differences did not reach statistical significance. CONCLUSION: These data suggest that diet control in women with GDM managed by 1-hour PPG measurements is associated with a decreased rate of insulin therapy. However, neonatal and obstetrical outcomes are not determined by the timing of their glucose determinations.

Adult↗
PubMed2005

Elevated serum uric acid levels in gestational hypertension are correlated with insulin resistance.

The purpose of this study was to assess a possible correlation between insulin resistance and uric acid levels in gestational hypertension (GH) and preeclampsia. Fourteen pregnant, nondiabetic women with either GH (n = 7) or preeclampsia (n = 7) and nine pregnant healthy controls in the third trimester were enrolled onto the study. Fasting serum was collected and insulin sensitivity was determined by Homeostasis Model Assessment based on the algorithm developed by Turner and colleagues. Serum samples were also analyzed for creatinine and uric acid levels. Insulin resistance and uric acid levels were compared between hypertensive and control pregnant women, and the association between these two variables was calculated. There were no significant differences in mean age, weight, body mass index, and glucose challenge test between all hypertensive patients and controls. Significant differences were revealed in insulin sensitivity between hypertensive and nonhypertensive pregnant women (45 +/- 31.2% vs. 79.7 +/- 33%; p = 0.018). In our study, uric acid levels were not significantly higher for hypertensive patients (5.46 +/- 0.85 vs. 4.53 +/- 1.4 mg/dL in controls; p = 0.06). The elevated serum uric acid levels were highly correlated to insulin resistance in patients with GH. In contrast, uric acid levels did not correlate with insulin sensitivity in patients with preeclampsia and controls. Insulin resistance is associated with the elevated uric acid levels found in nonproteinuric gestational hypertensive disease.

Adult↗
PubMed2004

Is there a role for oral antihyperglycemics in gestational diabetes and type 2 diabetes during pregnancy?

Diabetes mellitus is a heterogeneous disorder of glucose intolerance that is generally classified into the following categories: type 1 and type 2 diabetes and gestational diabetes (GDM). Currently, the number of pregnancies complicated by type 2 diabetes and GDM exceed those affected by type 1 diabetes. Numerous studies have established a direct relationship between maternal glycemic control and neonatal outcomes for all types of diabetes. Therefore, modern treatment protocols during pregnancy emphasize strict glycemic control by a combination of diet and medication. Traditionally, insulin therapy has been considered the gold standard for management because of its efficacy in achieving tight glucose control and the fact that it does not cross the placenta. Since GDM and type 2 diabetes are characterized by insulin resistance and relatively decreased insulin secretion, treatment with oral antihyperglycemic agents that target these defects is of potential interest. However, because of concerns regarding transplacental passage and, therefore, the possibility of fetal teratogenesis and prolonged neonatal hypoglycemia, these agents are not currently recommended in pregnancy. There are no randomized controlled trials on which to draw conclusions regarding the teratogenicity of these oral agents. However, most retrospective studies and the published clinical experience have not demonstrated an increased risk of malformed infants among women treated with oral antihyperglycemic agents. Rather, the data indicate that the increased risk for major congenital anomalies appears to be related to maternal glycemic control prior to and during conception. These studies and currently available data on the use of both metformin and sulfonylureas in pregnancy have also failed to demonstrate an increased risk of neonatal hypoglycemia and other neonatal morbidities. To date, there has only been one randomized controlled trial to test the effectiveness and safety of sulfonylurea therapy (glyburide [glibenclamide]) in the management of women with GDM. Both the insulin- and glyburide-treated women were able to achieve satisfactory glucose control and had similar perinatal outcomes. Glyburide was not detected in the cord serum of any infant in the glyburide group. In summary, based on the currently available data, it appears that glyburide could be safely and effectively utilized in the management of GDM. However, more intensive investigation regarding the safety and feasibility of oral agents in pregnancies complicated by type 2 diabetes is necessary. It is important to emphasize that it is the level of metabolic control achieved and not the mode of therapy that is crucial to improving outcomes in these pregnancies.

Administration, Oral↗
PubMed2003

Development of early-onset type 2 diabetes in the young: implications for child bearing.

The prevalence of type 2 diabetes mellitus is increasing in children and adolescents worldwide, particularly among minority youth. This has led to an increase in the number of pregnancies complicated by type 2 diabetes, which has now exceeded pregnancies complicated by type 1 diabetes. Although the data are somewhat limited, those studies that are available seem to indicate that the rate of adverse maternal and fetal outcomes is at least as great, if not greater, for type 2 as for type 1 diabetes. It has been postulated that some of the excess risk is due to the fact that women with type 2 diabetes are older, heavier, less likely to seek early prenatal care, and are generally in less satisfactory glycemic control. This article reviews the existing data on pregnancies complicated by type 2 diabetes and the implications for management and prevention.

Adolescent↗
PubMed2003

Effects of free fatty acids on glucose uptake and utilization in healthy women.

To study effects of sex on free fatty acid (FFA)-induced insulin resistance, we have examined the effects of acute elevations of plasma FFA levels on insulin-stimulated total body glucose uptake in nine healthy young women. Euglycemic-hyperinsulinemic (approximately 500 pmol/l) clamps were performed for 4 h with coinfusion of either lipid/heparin (L/H) to acutely raise plasma FFA levels (from approximately 600 to approximately 1,200 micro mol/l) or saline/glycerol to lower fatty acids (from approximately 600 to approximately 50 micro mol/l). L/H infusion inhibited insulin-stimulated glucose uptake (determined with [3-(3)H]glucose) and glycogen synthesis by 31 and 40%, respectively (P < 0.01), almost completely abolished insulin suppression of endogenous glucose production (EGP) (13.6 vs. 10.0 micro mol x kg(-1) x min(-1), NS), prevented the insulin induced increase in carbohydrate oxidation (8.1 vs. 7.4 micro mol x kg(-1) x min(-1), NS), and stimulated fat oxidation (from 3.6 to 5.1 micro mol x kg(-1) x min(-1), P < 0.01). These data showed that acute increases in plasma FFA levels inhibited the actions of insulin on glucose uptake, glycogen synthesis, and EGP in women to a degree similar to that previously reported in men. We conclude that at insulin and FFA levels in the postprandial range, women and men were susceptible to FFA-induced peripheral and hepatic insulin resistance.

Adipose Tissue↗
PubMed2002

Impact of fetal reduction on the incidence of gestational diabetes.

OBJECTIVE: To estimate the rate of gestational diabetes in triplet pregnancies and to assess the impact of fetal reduction on the incidence of this complication. METHODS: One hundred eighty-eight consecutive triplet pregnancies referred to the Sheba Medical Center between 1994 and 1998 were included. One hundred three of these pregnancies continued as triplets, whereas 85 women elected to undergo fetal reduction to twins. The incidence of gestational diabetes (based on the criteria of Carpenter and Coustan) and other outcome variables were compared between the two groups. Student t-tests and chi(2) analysis were used as appropriate. RESULTS: Mean (+/-SD) maternal age was 29.2 +/- 4.8 in the triplet group and 29.3 +/- 4.1 in the reduction group. The groups had similar median parity (1.6 +/- 1.1 in the triplet group and 1.5 +/- 0.7 in the reduction group). The rate of gestational diabetes was significantly higher in the triplet group than in the reduction group (22.3% vs 5.8%). A lower birth weight (1764 +/- 448 g vs 2208 +/- 526 g) and an earlier gestational age at delivery (33.4 +/- 2.8 weeks vs 36.0 +/- 2.8 weeks) were observed in the triplet group compared with the reduction group. CONCLUSION: The number of fetuses in multifetal pregnancies influences the incidence of gestational diabetes. These findings support the hypothesis that an increase in placental mass and, thus, an increase in diabetogenic hormones play a role in the etiology of gestational diabetes.

Adult↗
PubMedDate not supplied

The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes.

PURPOSE: The purpose of this study was to examine the effects of self-monitoring of blood glucose (SMBG) on feelings of self-efficacy, dietary compliance, and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus (GDM). METHODS: Fifty-eight women with GDM and a fasting blood glucose level < 95 mg/dL were randomly assigned to 2 groups. The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory. Metabolic status was assessed in the control group by periodic monitoring at prenatal visits. Otherwise the management protocol was identical for both groups. The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy. Dietary compliance was assessed at each visit. RESULTS: Both groups of women achieved excellent glucose control; only 1 woman in each group required insulin therapy. There were no significant differences with regard to feelings of self-efficacy, dietary compliance, birth weight, gestational age at delivery, Apgar scores, and neonatal complications. Rates of macrosomia, delivery by cesarean section, and occurrence of birth trauma were similar. CONCLUSIONS: SMBG appears to have little effect on maternal feelings of self-efficacy, dietary compliance, or pregnancy outcomes in women with diet-controlled GDM.

Adult↗