Pontifical Catholic University of Chile, Chile
Title: In pregnancies with overweight / obese gestational diabetes: Basal-bolus insulin therapy reduces maternal excessive triglyceride rise
Pablo R. Olmos finished his Internal Medicine Residency in 1987, plus Endocrinology Fellowship at The Ohio State University (OSU) College of Medicine in 1993, plus a MS degree in Biomedical Engineering at OSU College of Engineering. Olmos has published 49 papers in both national and international journals, plus 1 book and 5 book chapters.
One of the mechanisms for unrelenting macrosomia in the offspring of overweight or obese mothers with glucose-controlled gestational diabetes (GDM) is an excessive rise of maternal triglycerides (TG) during pregnancy. Objectives: To ascertain if basal-bolus insulin therapy (BBIT) or other component of GDM treatment (limitation of weight gain, Metformin), were capable of reducing this excessive rise of TG in GDM. Methods: In a longitudinal-retrospective fashion, we studied 131 singleton GDM pregnancies by means of Stepwise multiple linear regression, which determined that only BBIT (p= 0.011) -and no other aspect of treatment- was related to a decrease in maternal TG Z-Scores. Thereafter, we divided the 131 GDM pregnancies in 2 groups: No-BBIT( n= 58, BMI 20-24.9 Kg m-2), and BBIT(n=71,BMI ≥25.0 Kg m-2 . We also calculated Atherogenic Index of Plasma (AIP, an indirect measure of cholesterol-ester transfer protein, CETP activity) as Log10(TG/HDL), where HDL is high-density lipoprotein cholesterol. Newly Observed Findings: [a] Only BBIT treatment -but neither limitation of weight gain nor Metformin- was capable to decrease maternal TG Z-scores, by doing so in a dose-related fashion (RSpearman = -0.221; p= 0.03). [b] The AIP remained within normal ranges for pregnancy, being similar in both groups (p=0.9). Conclusions: Basal-Bolus Insulin Therapy reduces the excessive rise of maternal triglycerides in overweight-obese GDM mothers with tight glycemic control. This beneficial effect of insulin is not related to changes in the CETP activity.