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Markedly improved glycemic control and enhanced insulin sensitivity in a patient with type 2 diabetes complicated by a suprasellar tumor treated with pioglitazone and metformin.

A patient with type 2 diabetes and hypothalamic damage due to a suprasellar tumor developed impaired glycemic control and central obesity. The patient showed exaggerated adrenocorticotropic hormone responsiveness as determined by a corticotrophin releasing hormone test and elevated serum leptin concentrations associated with ravenous appetite and insulin resistance mediated in part through disturbances in leptin signaling. Combination treatment with metformin and pioglitazone was markedly effective in improving glycemic control. Additionally, metformin treatment showed marked anorectic effects on the hyperphagia. This case has important implications for the pathogenesis and management of diabetes in patients with hypothalamic-pituitary-adrenal axis deficiencies.

Blood Glucose↗

Silent coronary atheromatosis in type 1 diabetic patients and its relation to long-term glycemic control.

Type 1 diabetic patients have a pronounced risk of premature coronary artery disease and death. We sought to evaluate the prevalence of silent coronary atheromatosis and to evaluate the relation between coronary atheromatosis and glycemic control. Coronary atheromatosis was evaluated in type 1 diabetic patients with no symptoms of coronary artery disease by exercise electrocardiogram (ECG) in 39 patients and quantitative coronary angiography and by intravascular ultrasound (IVUS) examinations in 29 patients. The findings from the IVUS examinations were related to mean HbA(1c) collected prospectively over 18 years. Abnormal exercise ECGs were found in 15% of patients, and angiographic diameter stenosis of >50% in one or more of the main coronary arteries was found in 34% of patients. All patients examined with intracoronary ultrasound had developed atherosclerotic plaques with an increased intimal thickness (>0.5 mm) in one or more of the coronary arteries. Coronary artery plaque formation, as judged by ultrasound, was significantly related to mean HbA(1c) during 18 years (P < 0.05) after adjustment for total cholesterol and age. This study demonstrates a high prevalence of silent coronary atheromatosis in type 1 diabetic patients with no symptoms of coronary heart disease. Long-term glycemic control was shown to be associated with coronary atheromatosis.

Adult↗

Achieving good glycemic control: initiation of new antihyperglycemic therapies in patients with type 2 diabetes from the Kaiser Permanente Northern California Diabetes Registry.

OBJECTIVE: To compare the effectiveness of antihyperglycemic therapies in type 2 diabetic patients with poor glycemic control (baseline glycosylated hemoglobin [HbA1C] > 8%). STUDY DESIGN: Longitudinal (cohort) study. METHODS: Study patients were 4775 type 2 diabetic patients who initiated new antihyperglycemic therapies and maintained them for up to 1 year. The study setting was Kaiser Permanente Northern California Medical Group, an integrated, prepaid, healthcare delivery organization. Treatment regimens were 1 or more of the following: insulin, thiazolidinediones, sulfonylureas, biguanides (metformin), or other less frequently used options (including meglitinides or alpha-glucosidase inhibitors). RESULTS: In this cohort, the mean HbA1C was 9.9% when therapy was initiated. Within 1 year, there was a drop of 1.3 percentage points in the mean HbA1C (to 8.6%), and 18% of new initiators achieved HbA1C values of < or = 7%. After adjusting for baseline clinical differences, the proportion of patients treated to goal was greatest among those receiving thiazolidinediones in combination (24.6%-25.7%) or a regimen of metformin and insulin (24.9%), while the least success was experienced by those receiving sulfonylureas alone (12.5%) or insulin-sulfonylureas regimens (10.9%). The probability of achieving the target goal was most strongly predicted by the level of glycemic control before initiation, but patient behaviors (eg, frequent self-monitoring, lower rates of missed appointments) also were strongly associated with greater levels of control. CONCLUSION: Overall, therapy initiation resulted in an impressive population-level benefit. However, since most new initiators still had not achieved good control within 12 months, careful monitoring and prompt therapy intensification remain important.

Aged↗

Serum zinc levels in diabetic patients and effect of zinc supplementation on glycemic control of type 2 diabetics.

OBJECTIVE: The present study is an attempt to assess serum zinc level in a sample of diabetic patients (both type 1 and type 2 diabetics) in comparison with those of apparently healthy controls, and to ascertain the relationship between the levels of serum zinc with some epidemiological variables. Furthermore, a trial of zinc supplementation for 3 months conducted to assess the effect of zinc supplementation on glycemic control of the studied type 2 diabetic patients, and the factors that affect the response to this supplementation. METHODS: Collection of data was carried out during the period between November 2002 to February 2003 at the Diabetic Center of Merjan Teaching Hospital in Babil Governorate, Iraq. In the first part of the study (a case-control study), the diabetic group included 133 diabetic patients (type 1 and 2) who were chosen from patients attending the Diabetic Center during the period of the study. The control group included 133 apparently healthy subjects who were selected from the workers of the same hospital. Selection of cases and controls was carried out by using systematic random sampling procedure. In the second part of the study (single blind were intervention study), type 2 diabetic patients (101 patients) divided into 2 groups; the first group included 50 patients supplemented with oral zinc sulfate (30 mg of elemental zinc/cap/day) for 3 months and second group included 51 patients given placebo and designed as control group. RESULTS: The first part of the study shows that the mean value for serum zinc level was significantly lower in diabetic patients than healthy controls (64.2 +/- 12.6 microg/dl for type 1 diabetics, and 68.9 +/- 11.9 microg/dl for type 2 diabetics versus 83.4 +/- 12.5 microg/dl for healthy controls). Using simple linear regression, significant positive correlation was found between serum zinc level and years of education and significant negative correlation was found between serum zinc level and baseline HbA1c% value, in the diabetic group. While significant positive correlation found between serum zinc level and estimated zinc intake in the control group. Using multiple regression analysis, serum zinc level showed significant positive correlation with gender (being a male compared with female), and estimated zinc intake and significant negative correlation with diabetes state (diabetic compared with non-diabetic), residence (urban compared with rural residents), and plant protein intake. The second part of the study shows that the mean value for HbA1c% concentration of the supplemented group decreased significantly at the end of the 3 months of follow up, while no significant changes were found in the mean value for HbA1c% of the control group. The present study showed that the change in HbA1c% after supplementation had significant negative correlation with baseline HbA1c% value. CONCLUSION: Diabetic patients have significantly lower mean serum zinc levels compared with healthy controls. Zinc supplementation for type-2 diabetics has beneficial effects in elevating their serum zinc level, and in improving their glycemic control that is shown by decreasing their HbA1c% concentration.

Adult↗

Suboptimal glycemic control, independently of QT interval duration, is associated with increased risk of ventricular arrhythmias in a high-risk population.

BACKGROUND: Although cardiovascular disease is the leading cause of mortality in diabetic patients, little is known about the impact of glycemic control on ventricular tachycardia (VT). OBJECTIVE: To investigate whether hemoglobin A1c (HbA1c) is associated with increased incidence of VT. METHODS: A retrospective study of 336 implantable cardioverter-defibrillator patients (both diabetes mellitus (DM) and non-DM) was conducted. RESULTS: HbA1c levels between 8% and 10% had a significant association with spontaneous VT, but not with QT/QTc. CONCLUSIONS: Glycemic index is a significant predictor of spontaneous VT, independently of QT interval. Optimal glycemic control may help reduce occurrence of VT and sudden cardiac death in high-risk DM patients.

Aged↗

Intrapartum maternal glycemic control in women with insulin requiring diabetes: a randomized clinical trial of rotating fluids versus insulin drip.

OBJECTIVE: The purpose of this study was to determine whether continuous insulin infusion provides a greater degree of intrapartum maternal glycemic control than rotating between glucose and non-glucose containing intravenous fluids. STUDY DESIGN: Laboring patients with pregestational or gestational diabetes were recruited and randomized to an "insulin drip" or "rotating fluids" protocol. The primary outcome measure was mean maternal capillary blood glucose (CBG) levels (mg/dL). Power analysis indicated that 16 patients were needed in each arm to find a difference of 10 mg/dL. RESULTS: Fifteen patients were randomized to the rotating fluids protocol and 21 patients to an insulin drip. There was no difference in mean intrapartum maternal CBG levels (103.9 +/- 8.7 mg/dL and 103.2 +/- 17.9 mg/dL in the rotating fluids and insulin drip group, respectively, P = .89). Neonatal outcomes were also similar between the 2 treatment groups. CONCLUSION: In patients with insulin requiring gestational diabetes, intrapartum glycemic control may be comparable with a standard adjusted insulin drip or a rotation of intravenous fluids between glucose and non-glucose containing fluids.

Adult↗

Glycemic control and spontaneous abortion in insulin-dependent diabetic women.

Insulin-dependent diabetic women without adequate glucose control have a higher spontaneous abortion rate when compared with the general population. The present study examined whether the increased rate of spontaneous abortions in insulin-dependent diabetic women was associated with poor glycemic control in the early postconceptional period or close to the abortive event itself. Measurements of glycohemoglobin A1 at eight to nine weeks' gestation provide retrospective indexes of glucose control during the early postconceptional period, whereas measurement of glycosylated serum albumin and serum protein at the same time reflects short-term glycemic control before the abortive event. This study evaluated 84 consecutive pregnancies occurring in 68 insulin-dependent diabetic women; 66 pregnancies progressed beyond 20 weeks with no malformation or death, and 18 pregnancies terminated in spontaneous abortions before 20 weeks' gestation. The mean glycohemoglobin A1 concentrations of women experiencing spontaneous abortions were significantly greater than that of women who did not abort (P less than .05). In contrast, maternal glycosylated proteins and glycosylated albumin concentrations did not differ between groups. The authors suggest that poor control of diabetes in the early conceptional period, rather than that just before abortion, increases the risk of spontaneous abortion.

Abortion, Incomplete↗

Glycemic control in patients with type 2 diabetes mellitus switched from twice-daily immediate-release metformin to a once-daily extended-release formulation.

BACKGROUND: The extended-release formulation of metformin (MXR) prolongs drug absorption in the upper gastrointestinal tract and permits once-daily dosing in patients with type 2 diabetes mellitus. This newer formulation may enhance patient compliance with oral therapy and improve long-term control of diabetes compared with the conventional immediate-release formulation of metformin (MIR). OBJECTIVE: The goal of this study was to determine the effects on glycemic control of a switch to MXR therapy in patients with type 2 diabetes currently treated with MIR. METHODS: This was a multicenter, randomized, double-blind, parallel-group study in patients with established type 2 diabetes. Eligible patients were to have a glycated hemoglobin (HbA1c) value < or = 8.5% and mean fasting plasma glucose (FPG) concentrations < or = 200 mg/dL while receiving MIR 500 mg BID for at least 8 weeks. After a 2-week, single-blind lead-in period, patients were randomly assigned to receive MXR 1000 or 1500 mg QD for 24 weeks or to continue MIR 500 mg BID for 24 weeks. The primary efficacy variable was change in HbA1c from baseline to week 12. Other variables included change in FPG levels; change in HbA1c; distribution of HbA1c values; mean daily blood glucose concentrations (self-monitored); levels of fructosamine, serum insulin, and lipids; and body weight. RESULTS: Two hundred seventeen patients were randomized to treatment. The mean change from baseline in HbA1c values at weeks 12 and 24 were small and similar in the 3 treatment groups. At week 12, the mean change from baseline in HbA1c was 0.15% for MIR, 0.23% for MXR 1000 mg, and 0.04% for MXR 1500 mg. The corresponding mean changes at week 24 were 0.06%, 0.25%, and 0.14%. CONCLUSIONS: In this study, patients with type 2 diabetes who had been receiving twice-daily MIR achieved comparable glycemic control when therapy was switched to once-daily MXR at the same or a greater total daily dose.

Blood Glucose↗

Foods with a low glycemic index do not improve glycemic control of both type 1 and type 2 diabetic patients after one month of therapy.

Twenty four diabetic patients (12 type 1 and 12 type 2) were studied to determine the influence of using foods rich in carbohydrates with either low or high glycemic indexes on the glycemic control of Diabetes Mellitus. All patients were treated with insulin. During 2 periods of 4 weeks the patients received, at lunch, 2 types of foods rich in carbohydrates as part of their usual diet. Meal A: foods with a low glycemic index and Meal B: foods with a high glycemic index. During the last 7 days of each period the patients determined, at home, their capillary glucose levels before and 1, 2, and 3 hours after lunch by means of a reflectometer. At the end of each period HbA1 levels were also determined. No differences in insulin dose or changes in body weight were found during the two periods of the study for both types of diabetic patients. Capillary glucose levels before lunch were similar on both diets and for both types of diabetic patients. Similarly, postprandial capillary glucose levels 1, 2, and 3 hours later were not different for both died A and diet B. No statistically significant differences were found either in HbA1 values for both periods of the study. These results confirm previous ones obtained in acute studies. The present findings indicate that the glycemic response of foods rich in carbohydrates is modified when included in a mixed meal by the other components of the meal. From these date it can be inferred that the use in a diet of foods with a low glycemic index does not improve the glycemic control of patients affected of Diabetes Mellitus.

Adult↗

Insufficient glycemic control increases nuclear factor-kappa B binding activity in peripheral blood mononuclear cells isolated from patients with type 1 diabetes.

OBJECTIVE: The redox-sensitive transcription factor nuclear factor-kappa B (NF-kappa B) is believed to contribute to late diabetic complications. It is unknown whether NF-kappa B is influenced by glycemic control. RESEARCH DESIGN AND METHODS: To determine whether NF-kappa B is activated in patients with insufficient glycemic control (HbA1c > 10%), we developed a tissue culture-independent electrophoretic mobility shift assay (EMSA)-based semiquantitative detection system that allowed us to determine NF-kappa B activation in ex vivo-isolated peripheral blood mononuclear cells (PBMCs). We included 43 patients with type 1 diabetes in this cross-sectional study. 10 of those received the antioxidant thioctic acid (600 mg/day p.o.) for 2 weeks. RESULTS: Monocytes of patients with HbA1c levels > 10% demonstrated significantly higher NF-kappa B binding activity in an EMSA and a stronger NF-kappa B staining in immunohistochemistry than monocytes of patients with HbA1c levels of 6-8%. The increase in NF-kappa B activation correlated with an increase in plasmatic markers of lipid peroxidation. Treatment with the antioxidant thioctic acid decreased NF-kappa B binding activity. CONCLUSIONS: Hyperglycemia induces activation of the transcription factor NF-kappa B in ex vivo-isolated PBMCs of patients with type 1 diabetes. NF-kappa B activation is at least partially dependent on oxidative stress, since the antioxidant thioctic acid significantly lowered the extent of NF-kappa B binding activity.

Adult↗

The effect of glycemic control on the incidence of macrovascular complications of type 2 diabetes.

Of all the complications of diabetes mellitus, macrovascular complications, ie, large-vessel atherosclerosis, account for the largest share of morbidity, mortality, and health care expenditures. Whereas there is now highly persuasive evidence that glycemic control reduces the risk of microvascular complications in type 1 diabetes, and probably in type 2 diabetes as well, such evidence is unavailable for macrovascular complications. Prospective epidemiologic studies, however, indicate that poor glycemic control enhances cardiovascular risk, and a number of biochemical mechanisms have been advanced to explain this phenomenon. However, data from animal studies, in vitro studies, and prospective epidemiologic studies suggest that endogenous insulin or insulin resistance may be atherogenic. Thus, a dilemma exists for insulin treatment, although the weight of evidence still favors its aggressive use. For persons whose glycemia can be adequately controlled with oral agents, the use of agents such as metformin and troglitazone--which do not raise, and may even lower, insulin concentrations--may offer an advantage. Definitive clinical trials on the benefits and risks of insulin therapy related to macrovascular complications are lacking and urgently needed.

Arteriosclerosis↗

The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes.

In this prospective study 246 women with gestational diabetes were followed up to determine the characteristics of metabolic control associated with large-for-gestational-age infants. Memory-based reflectance meters were used for self-monitoring blood glucose. Ambulatory glucose profiles were produced to characterize glycemic control levels throughout pregnancy. With these novel approaches to the collection and representation of glucose data, the severity of glucose intolerance (hyperglycemia) was found to be associated with both maternal and neonatal morbidity in terms of infant size and cesarean section rate. By use of hierarchical cluster analysis to identify three groups on the basis of control levels (low less than 87 mg/dl, mid 87 to 105 mg/dl, high greater than 105 mg/dl) we were able to show a positive outcome in the low group with reduced rates of large-for-gestational-age (2%) and macrosomatic (0%) infants. Furthermore, we showed that as mean blood glucose levels and instability in glycemic control increased from group to group, incidence of large-for-gestational-age and macrosomatic infants increased. Whereas obesity increased the relative risk of adverse neonatal outcome, type of treatment (insulin versus diet) did not appear to be significant. Appropriately monitored toward stability within a narrow range to achieve tight metabolic control, ambulatory glycemia in pregnancy is associated with a decreased risk of maternal and fetal complications.

Blood Glucose↗

Motivation and glycemic control in diabetes mellitus.

Although adherence to treatment regimes is clinically important in diabetes mellitus, the best way to improve it is unclear. As a precursor to evaluating the place of a brief intervention (motivational interviewing) in the treatment of diabetes, this study investigated the relation between motivation and glycemic control in 361 diabetic out-patients. Outcome measures were the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and HbA1C level--a measure of glycemic control. The majority of patients (86.7%) could be allocated to a single motivational stage, indicating that this concept is applicable in the study of diabetes. There were significant associations between HbA1C level and motivational stage, but not in the direction predicted. That is, patients at an earlier motivational stage had lower HbA1C levels than those at later stages. The results suggest that feedback of HbA1C level may partly determine the patient's motivation to control their diabetes, although the effect is quite weak.

Adolescent↗

A case of slowly progressive type 1 diabetes with unstable glycemic control caused by unusual insulin antibody and successfully treated with steroid therapy.

A 75-year-old man with type 1 diabetes and history of insulin therapy for previous 3 years using only human recombinant ones was suffering from unstable glycemic control. He had a high level of total insulin and a high titer of insulin antibodies (IA) (bound/total ratio: 89.8%). Low affinity constant (k(1): 0.0312 x 10(8) M(-1)) and high binding capacity (b(1): 51.8 x 10(-8) M) of IA in the patient detected by the Scatchard analysis were not compatible with those of IA associated with exogenous insulin injections in the diabetic patients, but compatible with those of the insulin autoantibodies found in patients with insulin autoimmune syndrome (IAS), although he had DRB1*0405, which may have protection against IAS development. The glucose infusion rate during hyperinsulinemic euglycemic clamp was 2.84 mg/kg/min, suggesting a high level of insulin resistance. Steroid pulse therapy (1000 mg for 3 days) aimed at reducing the possible effect of the IA on his insulin resistance and glycemic instability successfully decreased IA titer (from 89.8 to 58.3%), lowered its binding capacity (51.8-9.8 x 10(-8) M), increased glucose infusion rate (from 2.84 to 5.55 mg/kg/min) and improved glycemic control (HbA(1c): from 10.0 to 7.4%) with reduced blood glucose excursion. In conclusion, the alteration in insulin pharmacokinetics induced by IA seemed to be the cause of the brittle diabetes of the present case. Steroid treatment might be useful for the improvement of glycamic control in such patients with high IA levels and unstable blood glucose.

Administration, Oral↗

Erythrocyte Ca, Na/K-ATPase in long-term streptozotocin diabetic rats. Effect of good glycemic control and a Ca antagonist.

This study evaluated the effect of chronic hyperglycemia on erythrocyte membrane Ca and Na/K-ATPase activities in streptozotocin-induced diabetic rats. The activity of Ca-ATPase was significantly lower in diabetic than in normal rats. Good glycemic control by insulin restored the Ca-ATPase activity to normal. By contrast, diltiazem, a calcium entry blocker, had no effect on the enzyme activity. Calmodulin stimulated Ca-ATPase activity in all groups of rats. Na/K-ATPase activity was not altered in diabetic rats, and no effects of either insulin or diltiazem treatments were observed. The results suggest that erythrocyte Ca-ATPase activity is decreased in diabetic rats and is normalized by good glycemic control.

Animals↗

Optimized basal-bolus therapy using a fixed mixture of 75% lispro and 25% NPL insulin in type 1 diabetes patients: no favorable effects on glycemic control, physiological responses to hypoglycemia, well-being, or treatment satisfaction.

OBJECTIVE: To investigate the effects of a multiple injection regimen with a mixture of 75% lispro and 25% intermediate-acting insulin (lispro high mixture [HM]) before meals on glycemic control, physiological responses to hypoglycemia, well-being, and treatment satisfaction. RESEARCH DESIGN AND METHODS: We studied 35 type 1 diabetes patients. After an 8- to 10-week lead-in period, patients were randomized to HM or human regular insulin therapy for 12-14 weeks. During the lead-in and treatment periods, HbA1c levels and hypoglycemic frequencies were measured, and patients completed the Well-Being Questionnaire and the Diabetes Treatment Satisfaction Questionnaire. In 19 patients, responses to hypoglycemia were tested during stepped euglycemic-hypoglycemic clamps. RESULTS: HM treatment improved postprandial glycemia but had no effect on HbA1c, frequency of hypoglycemia, well-being, or treatment satisfaction. During experimental hypoglycemia, HM therapy was associated with a slightly lower total adrenaline response and a higher autonomic symptom threshold (i.e., the autonomic symptom response occurred at a lower blood glucose level) than human regular insulin therapy. We speculate that this effect resulted from an accumulation of insulin during the night. CONCLUSIONS: Multiple injection therapy with HM rather than human regular insulin before meals does not offer advantages regarding glycemic control, frequency of hypoglycemia, well-being, or treatment satisfaction. In addition, this regimen causes an attenuation of the adrenaline and autonomic symptom responses to hypoglycemia.

Adult↗

Additive effect of the mutations in the beta3-adrenoceptor gene and UCP3 gene promoter on body fat distribution and glycemic control after weight reduction in overweight subjects with CAD or metabolic syndrome.

OBJECTIVE: To analyze the effects of the mutations in the beta3-adrenoceptor (beta3-AR) gene and/or uncoupling protein3 (UCP3) gene promoter on body fat distribution and glycemic control after mild weight reduction in overweight-obese subjects with coronary artery disease (CAD) or metabolic syndrome. DESIGN: Clinical intervention study of the -300 kcal/day mild weight reduction program for 12 weeks. SUBJECTS: A total of 224 overweight-obese subjects with CAD or metabolic disorder, subdivided into the following four categories: (1) wild type (TT-CC, n=73); (2) only UCP3 promoter variant (TT-CT/TT, n=90); (3) only beta3-AR variant (TA/AA-CC, n=29); (4) both variants (TA/AA-CT/TT, n=32). MEASUREMENT: Body mass index (BMI), blood pressure, calorie intakes, body fat distribution, serum glucose, insulin, free fatty acids, C-peptide and lipids before and after weight reduction. RESULTS: After 12 weeks, all subjects lost approximately 5% of their initial body weight. Despite similar weight reduction, the highest decreases in abdominal adipose tissue at both L1 and L4 levels were observed in the 'wild-type' group (P<0.001) and the second highest in 'only UPC3 promoter variant' group (P<0.001). On the other hand, both variant-carriers had the smallest reduction only in visceral fat area at the L4 level. All subjects except both variant-carriers showed significant reductions in the fasting levels of glucose and FFA. The response areas of glucose (P<0.01) and insulin (P<0.05) were reduced largest in the 'wild-type' group and second largest in the 'UCP3 promoter variant' group. CONCLUSION: All the four groups showed similar weight reduction after -300 kcal/d for 12 weeks. However, the beneficial effects on body fat distribution and glycemic control were greatest in the 'wild-type' group and smallest in 'both variants' group. In addition, these effects were less beneficial in carriers with beta3-AR gene variant than with UCP3 gene promoter variant.

Adipose Tissue↗

[Cord blood erythropoietin in relation to glycemic control in the last weeks of pregnancy].

The relationship between cord blood erythropoietin (EPO) and maternal HbA1c and fructosamine levels were examined in the aim to answer a question, whether occurrence of prenatal hypoxia in newborns of diabetic mothers depends from maternal glycemic control during the last weeks of pregnancy. The study was performed in the group of 178 mothers and newborns divided into two groups: diabetic and control. The diabetic group consisted of 116 mothers (33 with IDDM and 83 with GDM) and newborns and the control group consisted of 62 healthy mothers and newborns. Maternal HbA1c (Micro Column Test BIORAD Prospecta) and fructosamine (Roche fructosamine Test) levels were estimated on the day of delivery. Cord blood to estimate EPO (radioimmunoassay) and fructosamine levels were drawing immediately after delivery the babies. The relationship between the study parameters were calculated on the basis of a covariance analysis test. In the diabetic group the significant positive correlation between EPO and maternal HbA1c and fructosamine levels was found as well as between EPO and fetal fructosamine levels. We conclude that higher levels of cord blood EPO are associated with poor maternal glycemic control during the last weeks of pregnancy.

Adult↗