糖尿病合併症と医学のジャーナル

There are increasing evidence that coronavirus disease-19 (COVID-19) can lead to development of denovo diabetes mellitus (DM) (new onset DM). It has also been observed during last 21 months that there is a bidirectional relationship between COVID-19 and DM. On the one hand, pre-existing diabetic patients has an increased risk of severe COVID-19 disease, intensive care unit (ICU) admissions, need for mechanical ventilation, severe metabolic complications and high doses of insulin requirement. It is an independent predictor of mortality in COVID-19 patients. On the other hand, development of fasting hyperglycaemia and acute-onset denovo DM, have been observed and reported among patients with Covid-19. Various postulated mechanism for development of denovo DM are direct virus-mediated beta-cell damage by angiotensin converting enzyme (ACE) receptor present in endocrine pancreas, triggering of beta-cell autoimmunity by COVID-19 virus which leads to activation of autoreactive T-lymphocytes and further destruction of remaining beta-cell mass, disorganized and exuberant immune response of host to COVID-19 infection which has diabetogenic effects and iatrogenic hyperglycaemia in COVID-19 due to corticosteroids such as dexamethasone which have become the mainstay of management of severe COVID-19 infection. The novel mechanisms of disease leading to DM, its frequency among COVID-19 patients, its natural history, and progression is still unclear. This association of COVID-19 and DM poses a great major challenge to patients and healthcare systems during this pandemic. It is essential that the physicians should be aware of the denovo diabetes mellitus and its proper management to reduce further morbidity and mortality among these patients.

The study's purpose is to see how useful WHO guidelines are for detecting gestational diabetes (GDM) in pregnant women, as well as how effective they are at minimizing negative repercussions for the mother and newborn in women under the age of 18. In a 35-year-old woman, there were no evident risk issues for GDM. The method used in this retrospective study is based on 1,360 pregnant women that gave birth and were tracked at the hospital in Istanbul University. All participating pregnant women between 24th to 28th week underwent the test for 75g Oral Glucose Tolerance. The WHO’s standard criteria that were already formalized were used to establish whether there was evidence of gestational diabetes in each case. The study included the test of oral glucose tolerance utilized to identify around 28% of pregnant women under 35 who had no risk issues related to GDM complications. The rate of primary caesarean sections in the group with GDM, was radically greater than that in the group without gestational diabetes. Premature birth has also been linked to GDM complications. The observations indicated that the admission to NICU, Neonatal critical care unit, was strongly associated to diagnosis of Gestational Diabetes Mellitus (GDM). In neonates, no substantial concerns with airway anomalies. There is a lot of variation in the groupings. The correlation between metabolic problems and gestational diabetes was moderate. According to the WHO’s criteria, childbearing women with no clear risk issues were identified with GDM. It was studied that treatment for these women may reduce their risk of neonatal and maternal hyperglycemia-related problems like caesarean section, polyhydramnios, premature delivery, NICU admission, LGA, and low infant mass.