| Abstract | CILJ ISTRAŽIVANJA
Hipoteze ovog istraživanja jesu: nove smjernice sa strožim kriterijima za prihvatljive razine
glikemije i povećan broj mjerenja glukoze u plazmi trudnica prouzrokuju znatan porast
pojavnosti GD-a u našoj populaciji, pri čemu se vjerojatnost pojave GD povećava se s dobi
trudnica zbog veće vjerojatnosti razvoja inzulinske rezistencije.
Shodno navedenim hipotezama, ciljevi su rada odrediti: pojavnost GD-a u populaciji trudnica
Varaždinske županije sukladno važećim smjernicama i utvrditi postoji li korelacija između
pojavnosti GD i rastuće životne dobi.
ISPITANICI I METODE
U retrospektivno istraživanje uključene su 522 trudnice upućene u Medicinsko biokemijski
laboratorij Doma zdravlja Varaždinske županije na test opterećenja glukozom (OGTT),
tijekom razdoblja istraživanja (ožujak – prosinac 2014.). Koncentracije glukoze određivane su
na biokemijskom analizatoru Olympus AU 400 (Beckman Coulter, SAD) enzimskim UV
testom metodom heksokinaze istog proizvođača. Sukladno važećim smjernicama rezultati su
podijeljeni po skupinama – u svakoj vremenskoj točki u postotku je određena prevalencija
rezultata koji zadovoljavaju kriterij GD - natašte (5,1 – 6,9 mmol/L); nakon 60 minuta (≥
10,0 mmol/L) i nakon 120 minuta (8,5 – 11,0 mmol/L). U završnoj obradi podataka trudnice s
patološkim vrijednostima nadalje su podijeljene prema dobi u tri skupine: 21 ± 3,5 godina,
n=30; 30 ± 4,5godina, n=139 i 41 ± 5godina, n=20.
REZULTATI
Sukladno važećim smjernicama prevalencija gestacijskog dijabetesa u ispitivanoj skupini bila
je 189/514 ili 37%. Najviše trudnica s gestacijskim dijabetesom n=149/189 imalo je povišenu
razinu glukoze u samo jednom mjerenju, n=32/189 u dva mjerenja i n=8/189 u sva tri
mjerenja. Prosječna koncentracija glukoza natašte bila je x=5,36±2SD mmol/L, nakon 60
minuta x=10,68±2SD mmol/L i x=9,12±2SD mmol/L nakon 120 minuta. Statistički bitna
razlika među dobnim skupinama potvrđena je Kruskal Walisovim testom: P=0,024155, (P <
0,05) u uzorkovanju nakon 120 minuta. Prosječna koncentracija izmjerene glukoze nakon 120
minuta u prvoj skupini bila je x=8,65±2SD mmol/L, u drugoj skupini x=9,14±2SD mmol/L i
u trećoj skupini x=9,57±2SD mmol/L.
ZAKLJUČAK
Pojavnost gestacijskog dijabetesa, prema novim kriterijima, znatno je porasla u našoj
populaciji i iznosi 37% u odnosu na starije kriterije kada je iznosila 8 – 10%. Postoji
korelacija između pojavnosti gestacijskog dijabetesa i rastuće dobi trudnica uz porast
prosječnih koncentracija izmjerenih glukoza, osobito u mjerenju nakon 120 minuta kao
posljedice višeg stupnja inzulinske rezistencije. |
| Abstract (english) | AIM OF THE STUDY
Hypotheses of this research are: new guidelines which propose considerably stricter criteria
for acceptable glycemia levels and an increased number of plasma glucose measurements,
cause a significant growth in GD incidence in population. The probability of GD incidence
increases with age of pregnant women due to higher probability of insulin resistance
development.
According to the above hypotheses, the objectives of the paper are to determine: the incidence
of GD in the pregnant women of the Varaždin County in accordance with the valid guidelines
and to determine whether there is a correlation between the GD and increasing age in
pregnant women.
SUBJECTS AND METHODS
A retrospective study of oral glucose tolerance test (OGTT) included 522 pregnant women,
patients of the Medical Biochemistry Laboratory of the Varaždin County Health Center
during the study period (March - December 2014). Glucose concentrations were determined
on the biochemical analyzer Olympus AU 400 (Beckman Coulter, USA) by the enzymatic
UV test using the hexokinase method by the same manufacturer. In accordance with valid
guidelines, the results were divided into groups - at each time point, the prevalence of results
was determined in percentage which corresponds to the criteria for GD - fasting (5.1-6.9
mmol/L); after 60 minutes (≥10.0 mmol/L) and after 120 minutes (8.5-11.0 mmol/L). In the
final data analysis, pregnant women with pathological values were further divided based on
age into three groups: 21 ± 3.5 years, n = 30; 30 ± 4.5 years, n = 139 and 41 ± 5 years, n = 20.
RESULTS
In accordance with valid guidelines, the prevalence of gestational diabetes was 189/514 or
37%. Most pregnant women with gestational diabetes n = 150/189 had elevated glucose levels
in only one measurement, n = 31/189 in two measurements and n = 8/189 in all three
measurements. The average glucose concentrations were x=5.36 ±2SD mmol/L, x=10.68
±2SD mmol/L after 60 minutes, and x=9.12±2SD mmol/L after 120 minutes. Statistically
significant difference between the age groups was confirmed by the Kruskal Wallis test: P =
0.024155, (P <0.05) in the sample after 120 minutes. The average concentration of glucose
measured after 120 minutes in the first group was x=8.65±2SD mmol/L, in the second group
x=9.14±2SD mmol/L, and in the third group x=9.57±2SD mmol/L.
CONCLUSION
The incidence of gestational diabetes, in line with the new criteria, has increased considerably
in our population and is 37% compared to older criteria when it was 8-10%. There is a
correlation of the prevalence of gestational diabetes and the increasing age of pregnant
women with an increase in average concentrations of measured glucose, especially regarding
the measurement after 120 minutes as a result of a higher degree of insulin resistance. |
