The central role of recovery of β-cell function in the remission of prediabetes: a prospective cohort study in Canada.

Background: The mechanistic basis underlying the remission of prediabetes (ie, the return to normoglycaemia) has been suggested to be amelioration of insulin resistance without improvement of β-cell function. We aimed to characterise the relative contributions of changes in insulin sensitivity and β-cell function to the remission of prediabetes.

Methods: In this prospective cohort study, conducted at Mount Sinai Hospital (Toronto, ON, Canada), we screened pregnant women for gestational diabetes, aiming to recruit participants with varying degrees of dysglycaemia and conduct serial postpartum metabolic evaluations.

Gestational Diabetes Mellitus and Heart Failure: A Systematic Review and Meta-Analysis.

Background: The extent of the association between gestational diabetes mellitus (GDM) and the incidence of heart failure (HF) largely remains unclear.

Objectives: The aim of the study was to synthesize the evidence on the association of GDM and risk of HF.

Methods: This study is a systematic review and meta-analysis.

Gestational diabetes mellitus in twin pregnancies versus singleton pregnancies-A retrospective case-control study.

Aims: To compare markers of glycaemic regulation in twin and singleton pregnancies in women with gestational diabetes mellitus (GDM).

Methods: A retrospective case-control study was performed. 53 twin and 212 matched singleton pregnant women with gestational diabetes were included.

Risk of early childhood overweight/obesity following cesarean section: A systematic review and meta-analysis.

Background: Cesarean section is considered as a potential risk factor for early childhood (0-6 years) overweight/obesity; however, the precise magnitude of this risk remains unclear.

Objectives: To estimate the risk of early childhood overweight/obesity in children delivered by cesarean section through a systematic review.

Search Strategy: MEDLINE, Embase, Web of Science, CNKI and Wanfang databases were searched using a combination of relevant terms for cesarean section, overweight/obesity and children.

A1c versus oral glucose tolerance test for chronic glycemic surveillance in women with previous gestational diabetes.

Aims: Women with gestational diabetes (GDM) are advised to undergo an oral glucose tolerance test (OGTT) within 6 months postpartum, owing to their elevated risk of developing pre-diabetes/diabetes. However, the optimal approach to glycemic surveillance in the years thereafter is unclear. We thus sought to compare OGTT, fasting glucose and A1c for chronic monitoring of women with previous GDM.

Approaches to identify scenarios for data science implementations within healthcare settings: recommendations based on experiences at multiple academic institutions.

Objectives: To describe successful and unsuccessful approaches to identify scenarios for data science implementations within healthcare settings and to provide recommendations for future scenario identification procedures.

Materials And Methods: Representatives from seven Toronto academic healthcare institutions participated in a one-day workshop. Each institution was asked to provide an introduction to their clinical data science program and to provide an example of a successful and unsuccessful approach to scenario identification at their institution.

One-Hour Oral Glucose Tolerance Test for the Postpartum Reclassification of Women With Hyperglycemia in Pregnancy.

Objective: The International Diabetes Federation recently endorsed a 1-h oral glucose tolerance test (OGTT) as more convenient than the conventional 2-h OGTT. In practice, women with hyperglycemia in pregnancy are advised to undergo a 2-h OGTT within 6 months after delivery, but this test is often not completed, partly owing to its inconvenience for busy mothers. Recognizing the potential advantage of the 1-h OGTT in this setting, we sought to compare 1-h and 2-h OGTT glucose measurements at 3 months postpartum as predictors of dysglycemia (prediabetes/diabetes) over the first 5 years postpartum.

Longitudinal association of statin treatment with insulin sensitivity and beta-cell function in the PROMISE cohort.

Context: Statin treatment lowers low-density lipoprotein (LDL) cholesterol thereby reducing cardiovascular risk. Meta-analyses of clinical trials report a higher risk of new-onset type 2 diabetes with statins. Current clinical evidence regarding effects of statins on insulin sensitivity and beta-cell function is limited.

Role of the liver in the sustained normalisation of A1c over 2 years following short-term insulin therapy in early type 2 diabetes.

Aims: When administered in early type 2 diabetes (T2DM), the strategy of 'induction' with short-term intensive insulin therapy (IIT) followed by 'maintenance' with metformin thereafter can yield outstanding glycaemic control, with some patients achieving A1c in the normal range of its assay. We thus sought to identify determinants of sustained normalisation of A1c in response to this treatment strategy.

Materials And Methods: In this study, adults with T2DM of mean duration 1.

Representation of racialised and ethnically diverse populations in multicentre randomised controlled trials of GLP-1 medicines for obesity: a systematic review and meta-analysis of gaps.

Introduction: Trials of GLP-1 (glucagon-like peptide-1) medicines have changed the paradigm of obesity treatment. Diversity in trial participation is imperative considering that obesity disproportionately impacts marginalised populations worldwide. We performed a systematic review and meta-analyses to evaluate the representation of racialised and ethnically diverse populations in randomised controlled trials (RCTs) of GLP-1 medicines for obesity.

Sustained Reduction of Subclinical Inflammation in the Years After Breastfeeding.

Context: Lactation is associated with lower future risk of cardiovascular disease (CVD) in women but the mechanism(s) underlying this relationship remain unclear.

Objective: We sought to characterize the relationship between duration of exclusive breastfeeding and CV risk factors over the first 5 years post partum.

Methods: In this prospective cohort study, 328 women underwent serial cardiometabolic characterization (anthropometry, blood pressure [BP], lipids, fasting glucose, adiponectin, C-reactive protein [CRP]) at 1 year, 3 years, and 5 years post partum.

A Glycemic Threshold Above Which the Improvement of β-Cell Function and Glycemia in Response to Insulin Therapy Is Amplified in Early Type 2 Diabetes: The Reversal of Glucotoxicity.

Objective: Alleviation of unrecognized glucotoxicity, with resultant recovery of β-cell function, could amplify the glucose-lowering effect of pharmacotherapy and contribute to the variable therapeutic response observed among patients with type 2 diabetes (T2D). However, clinical evidence supporting this concept is lacking. Short-term intensive insulin therapy (IIT) can ameliorate glucotoxicity and improve β-cell function in early T2D.

Effect of Time-Restricted Eating on β-Cell Function in Adults With Type 2 Diabetes.

Context: Time-restricted eating (TRE), which consists of restricting the eating window to typically 4 to 8 hours (while fasting for the remaining hours of the day), has been proposed as a nonpharmacological strategy with cardiometabolic benefits but little is known about its metabolic effect on type 2 diabetes mellitus (T2DM).

Objective: We evaluated whether TRE can improve pancreatic β-cell function and metabolic status in overweight individuals with early T2DM.

Methods: In a randomized, crossover trial, 39 participants (mean 2.

Omega-3 Polyunsaturated Fatty Acids And Adipose Tissue Inflammation: Longitudinal Analysis in the PROMISE Cohort.

Objectives: Although preclinical studies have shown a beneficial impact of omega-3 (n-3) polyunsaturated fatty acids (PUFAs) on adipose tissue (AT) inflammation, the current literature from human studies is limited. Therefore, we aimed to evaluate the longitudinal associations of circulating levels of n-3 PUFAs with biomarkers of AT inflammation.

Methods: Longitudinal data from participants in the PROMISE cohort (n = 474) were used.

Antenatal Glycemic Management and Postpartum Cardiovascular Disease Risk Screening.

Objectives: This study aims to evaluate the cardiovascular disease (CVD) risk profiles of patients referred to the Maternal Health Clinic (MHC) with a history of gestational diabetes mellitus (GDM).

Methods: Eligible patients had their MHC appointment at 6 months postpartum between November 2011 and May 2022 and experienced GDM in their most recent pregnancy. Included participants were then divided into subgroups comparing methods of glycemic control: diet-controlled GDM and insulin-controlled GDM.

The impact of gestational diabetes on functional capacity of the infant gut microbiome is modest and transient.

Gestational diabetes mellitus (GDM) is a metabolic complication that manifests as hyperglycemia during the later stages of pregnancy. In high resource settings, careful management of GDM limits risk to the pregnancy, and hyperglycemia typically resolves after birth. At the same time, previous studies have revealed that the gut microbiome of infants born to mothers who experienced GDM exhibit reduced diversity and reduction in the abundance of several key taxa, including .

Postpartum weight retention and the early evolution of cardiovascular risk over the first 5 years after pregnancy.

Background: The cumulative effect of postpartum weight retention from each pregnancy in a woman's life may contribute to her risk of ultimately developing type 2 diabetes and cardiovascular disease. However, there is limited direct evidence supporting this hypothesis. Thus, we sought to characterize the impact of postpartum weight retention on the trajectories of cardiovascular risk factors over the first 5-years after pregnancy.

Urinary Vitamin D Binding Protein: A Marker of Kidney Tubular Dysfunction in Patients at Risk for Type 2 Diabetes.

Context: Recent studies have reported elevated urinary vitamin D binding protein (uVDBP) concentrations in patients with diabetic kidney disease, although the utility of uVDBP to predict deterioration of kidney function over time has not been examined.

Objective: Our objective was to assess the association of uVDBP with longitudinal changes in kidney function.

Methods: Adults at-risk for type 2 diabetes from the Prospective Metabolism and Islet Cell Evaluation (PROMISE) study had 3 assessments over 6 years (n = 727).

Future cardiometabolic implications of insulin hypersecretion in response to oral glucose: a prospective cohort study.

Background: The cardiometabolic implications of postprandial hyperinsulinemia are unclear with recent studies suggesting both adverse and beneficial associations. We aimed to evaluate the longitudinal cardiometabolic implications of the post-challenge insulin secretory response over 4-years follow-up.

Methods: In this prospective cohort study, conducted in Toronto (Ontario, Canada), women comprising the full range of antepartum glucose tolerance were recruited in pregnancy (at the time of glucose tolerance screening, late in the second trimester) to undergo cardiometabolic testing in the years thereafter.

Thyroid allostasis in drug-free affective disorder patients.

Aim: To assess the thyroid allostasis in drug-free patients with affective disorder.

Methods: Patients with major depressive disorder or bipolar disorder as drug-free, defined as those without psychiatric drugs exposure for at least 4 months before admission, from a tertiary hospital were recruited in this cross-sectional study. The primary outcomes were "structure parameters of thyroid homeostasis", which include "thyroid's secretory capacity" (SPINA-GT), "sum step-up activity of deiodinases" (SPINA-GD), the ratio of total to free thyroxine and "thyroid homeostasis central set point" (TSH index and "thyroid feedback quantile-based index" [TFQI]), calculated by TSH and thyroid hormones measured at admission.

Gestational diabetes in twin pregnancies-a pathology requiring treatment or a benign physiological adaptation?

There is level-1 evidence that screening for and treating gestational diabetes in singleton pregnancies reduce maternal and neonatal morbidity. However, similar data for gestational diabetes in twin pregnancies are currently lacking. Consequently, the current approach for the diagnosis and management of gestational diabetes in twin pregnancies is based on the same diagnostic criteria and glycemic targets used in singleton pregnancies.

Impact of the diagnosis of gestational diabetes on maternal physical activity after pregnancy.

Aim: The diagnosis of gestational diabetes (GDM) identifies women who are at future risk of developing type 2 diabetes. However, it is unclear if diagnosing GDM thus motivates women to increase physical activity after pregnancy or if this medicalization has the opposite effect of decreasing activity, possibly reflecting assumption of a sick role. We thus sought to evaluate the impact of diagnosing GDM on changes in maternal physical activity after pregnancy.

Contemporary Clinical Perspectives on Targeting Remission of Type 2 Diabetes.

It has long been known that some patients with type 2 diabetes (T2DM) can experience sustained metabolic improvement to near-normal levels of glycemia either spontaneously or after medical intervention. Now recognized as remission of diabetes, this intriguing state is currently more feasible than ever before due to profound advances in metabolic surgery, pharmacologic therapy, and regimens of lifestyle modification. This enhanced capacity to induce remission has revealed new pathophysiologic insights, including the presence of a reversible component of the pancreatic beta-cell dysfunction that otherwise drives the chronic progressive nature of T2DM.