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Does Childhood Overweight, Parental Perception of Overweight, or Family History of Diabetes Mellitus Increase Parental Perception of Type 2 Diabetes Risk for their Child?
Does Childhood Overweight, Parental Perception of Overweight, or Family History of Diabetes Mellitus Increase Parental Perception of Type 2 Diabetes Risk for their Child?J.M. Patient information: See related handout on lifestyle changes to manage type 2 diabetes, written by the authors of this article. Because the majority of diabetic patients have type 2 diabetes, the rest of this web module will focus on diagnosis and management of this population. In type 2 diabetes, it is important to remember that insulin resistance and beta cell dysfunction are closely linked. Before type 2 diabetes fully develops (a€?pre-diabetesa€? period), insulin resistance may already be present. At some point, type 2 diabetics can no longer increase or maintain insulin secretion levels to compensate for increasing insulin resistance. A A patient can also be diagnosed with diabetes mellitus based on an elevated Hemoglobin A1C. The diagnosis of impaired glucose tolerance or pre-diabetes is included in the table below. Diagnosis of diabetes must be confirmed on a subsequent day unless unequivocal symptoms of diabetes are present.
The fasting plasma glucose (FPG) is the preferred test to diagnose diabetes in children and non-pregnant adults. The 75-gram oral glucose tolerance test (OGTT) is more sensitive and slightly more specific than the FPG. The diagnosis of pre-diabetes can be categorized as a€?impaired fasting glucosea€? (IFG) or a€?impaired glucose tolerancea€? (IGT). The incidence of type 2 diabetes in children and adolescents has dramatically increased in the past 10 years.
Clinical judgment should be used to test for for diabetes in high-risk patients who do not meet these criteria. When should women with gestational diabetes (GDM) and no pre-pregnancy history of diabetes be screened initially for diabetes mellitus? Diabetes is an alarming problem as it may lead to loss of vision, kidney cancer or kidney failure and foot problems. In this type of diabetes, the immune system of the body kills all the insulin producing beta cells present in the pancreas in the body.
This type of diabetes can occur at any age, mostly under 40 and is caused by the environmental factors like the presence of bacteria in the air, diet or chemicals in the surrounding area. This is the most common form of diabetes that affects around 90% to 95% of the people .It is also known by the name non-insulin dependent diabetes.
The chances of occurrence of other cardiovascular diseases are more in people who have Type 2 diabetes. In this type of diabetes, people show both types of diabetes and it normally occurs after the age of 30. At the first instance of the diagnosis of LADA patients are capable to produce insulin and they do not need any insulin injections in the early stage. Maturity onset diabetes of the young: Diabetes mellitus that has early onset (usually before the age of 25), is non-insulin-dependent, and is inherited in an autosomal dominant manner.
Diabetes monitor - maturity onset diabetes of the youngMODY is a group of diabetes disorders that affects about 2% of people with diabetes. There is substantial evidence for a role of genetic factors in the development of diabetic nephropathy. Insulin resistance, decreased insulin secretion, and increased hepatic glucose output are the hallmarks of type 2 diabetes, and each class of medication targets one or more of these defects. The American Diabetes Association recommends an A1C goal of less than 7 percent.7 Glycemic control requires the patient to have cognitive, visual, and motor skills to monitor and manage blood glucose levels, and identifying and minimizing barriers for effective self-management is an important first step to setting individualized goals.
The potential impact of family history of metabolic syndrome and risk of type 2 diabetes mellitus: In a highly endogamous population. In the recent years, MetS has internationally evolved into a recognized clinical entity, assuming an epidemic proportion. Definition, diagnosis and classification of diabetes mellitus and its complications part 1: Diagnosis and classification of diabetes mellitus provisional report of WHO consultation.
Gender and age-related differences in patients with the metabolic syndrome in a highly endogamous population. Consequences of a family history of type 1 and type 2 diabetes on the phenotype of patients with type 2 diabetes. A genome-wide scan for loci linked to plasma levels of glucose and HbA (1c) in a community-based sample of Caucasian pedigrees: The Framingham offspring study. Parental transmission of type 2 diabetes mellitus and its influence in the offspring in a highly endogamous population.
Clinical characteristics of type 2 diabetes patients according to family history of diabetes.
Impact of metabolic syndrome risk factors in first-degree relatives of type 2 diabetic patients. Insulin resistance and cardiovascular disease risk factors in children of parents with the insulin resistance (metabolic) syndrome. Metabolic consequences of a family history of NIDDM (the Botnia study): Evidence for sex-specific parental effects. Prevalence of metabolic syndrome according to ATP III and IDF criteria: A population-based study. Defects in insulin secretion and insulin action in non-insulin-dependent diabetes mellitus are inherited: Metabolic studies on offspring of diabetic probands. Expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Strong family history predicts a younger age of onset for subjects diagnosed with type 2 diabetes.
Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. Metabolic syndrome and its correlated factors in an urban population in South West of Iran. Effect of diabetes and level of glycemia on all-cause and cardiovascular mortality: The San Antonio Heart Study. Metabolic syndrome in nondiabetic, obese, first-degree relatives of African American patients with type 2 diabetes: African American triglycerides-HDL-C and insulin resistance paradox. It also suggests that combination therapy for type 2 diabetes will likely play a role in most patients in order to address the insulin resistance and deficiency. It is poorly reproducible, more expensive, and inconvenient for patients, and rarely used in clinical practice.
50% of undiagnosed patients are eventually diagnosed after complications of diabetes develop especially cardiovascular complications. Testing for diabetes should be considered in all individuals at age 45 years and above, particularly in those with a BMI a‰?25* and, if normal, should be repeated at 3-year intervals.
Only children at increased risk for the presence of the development of type 2 diabetes should be tested. Women with GDM should be screened for diabetes 6 a€“ 12 weeks postpartum and should be followed up with a subsequent screening for the development of diabetes or pre-diabetes. It is also known by the name insulin-dependent diabetes and is found in around 10% to 20% of people.
All the people suffering from Type 1 diabetes should get injections of insulin every day with proper diet and exercise schedule to get rid of this diabetes. It is influenced by the factors like obesity, lack of physical work, hypertension and poor eating habits. This type of diabetes can be treated with changes in eating habits, physical work and taking insulin injections at an advanced stage.
To prevent this type of diabetes, self care and changes in eating habits are always required. Research indicates that around 10% of people suffering from Type 2 diabetes suffer from LADA.
So they should try to control the diabetes problem by following healthy eating habits, physical exercises and oral medicines that decrease the blood glucose levels. In Pima Indians, a link between susceptibility to diabetic nephropathy and Type II (non-insulin-dependent) diabetes mellitus has been proposed. Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. Abdullatef,Mahmoud Zirie Diabetes & Metabolic Syndrome: Clinical Research & Reviews.
Over several years, insulin secretion can no longer meet insulin needs and eventually fasting hyperglycemia develops.
People who have prediabetes or borderline diabetes have the glucose levels more than the normal but not so much to match the diabetes levels. In some cases, the symptoms of Type 2 diabetes start appearing at an advanced stage which creates a problem. The factors that contribute to this type of diabetes are family history, age at the time of pregnancy and obesity. LADA shows the slow development of the TYPE 1 diabetes as the sufferers of this diabetes have antibodies that fights with the insulting producing beta cells present in the pancreas of the body.
When the problem of LADA advances then the beta cells of the pancreas are not able to produce insulin as the immune system has been destroyed.

In this study, our aim was to examine the association between a family history of Type II diabetes and diabetic nephropathy in patients with Type I (insulin-dependent) diabetes mellitus.
Other medications include sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones.
Gastrointestinal symptoms associated with its use can be minimized by beginning with a low dose and titrating slowly. Materials and Methods: The survey and measurement were conducted from April 2011 to December 2012 among Qatari nationals above 20 years of age. Type 2 diabetes mellitus (T2DM) is a common metabolic disorder, characterized by hyperglycemia caused by impaired glucose homeostasis, and represents a serious public health problem in many developed countries. Once again, a diagnosis of diabetes must be confirmed on a subsequent day unless unequivocal symptoms of diabetes are present.
Insulin can be used acutely in patients newly diagnosed with type 2 diabetes to normalize blood glucose, or it can be added to a regimen of oral medication to improve glycemic control.
It is also critical to remember that the goal of treatment is not only to reduce A1C levels, but also to prevent premature mortality and morbidity. Additional agents include sulfonylureas, nonsulfonylurea secretagogues, thiazolidinediones, and alpha-glucosidase inhibitors.
Of the 2,182 subjects, who were approached to participate in the study, 1,552 (71%) gave their consent. A diagnosis of diabetes must be confirmed on a subsequent day unless unequivocal symptoms of diabetes are present. Except in patients taking multiple insulin injections, home monitoring of blood glucose levels has questionable utility, especially in relatively well-controlled patients.
Face-to-face interviews were conducted using a structured questionnaire followed by anthropometric measurements and laboratory tests. It has been widely reported that the occurrence of T2DM is triggered by genetic susceptibility and familial aggregation in several populations.
Currently, FPG and 2-hour OGTT are the recommended tests for detecting all states of hyperglycemia.
Once fasting blood glucose approaches near-normal levels, postprandial glucose is addressed by increasing the dose of the current medications or by adding additional agents. Metabolic syndrome was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (ATP III) as well as International Diabetes Federation (IDF). Thirty-four (25 %) of the patients with nephropathy compared with five (9 %) of the patients without nephropathy had a parental history of Type II diabetes (p = 0.019). Sulfonylureas can cause weight gain; this effect is less common with nonsulfonylurea secretagogues. It was estimated that the risk for diagnosed T2DM increases approximately 2-4 fold when one or both parents are affected. However, progressive failure of the beta cells often occurs even with proper diet, exercise, and oral medications, so patients should be counseled that insulin is simply another management tool. Furthermore, there was an excess of risk factors for development of Type II diabetes (higher fasting plasma glucose concentrations, higher prevalence of hypertension, higher waist-hip ratio and a tendency towards more glucose intolerance) among previously non-diabetic parents of patients with nephropathy. Although insulin is typically introduced when glucose control is no longer possible with oral agents, it can also be used when contraindications to oral medications exist.
Genetic or environmental factors or both related to familial Type II diabetes increase susceptibility to diabetic nephropathy in patients with Type I diabetes. Prolonged hyperglycemia can cause glucose toxicity, a potentially reversible impairment in glucose-stimulated insulin secretion. The existence of excess maternal transmission of type 2 diabetes in offspring of affected mothers than affected fathers is currently debated. This can be corrected with aggressive insulin therapy, then oral medications can be added as insulin is tapered or discontinued. In addition, there were significant differences between MetS patients with and without DM in terms of co-morbidities of hypertension, coronary heart disease, and high cholesterol. Pregnant women of any age with family history of early onset autosomal type 2 diabetes should be screened for GDM. Rapid-acting or premixed preparations can be added if fasting blood glucose levels are persistently high or if A1C has plateaued at about 7.5 percent, which indicates that postprandial glucose levels are high. Adding more basal insulin in this setting usually will not help patients reach their target levels.24 Sliding-scale doses can be set by counting carbohydrate grams or by a preset scale (Figure 2). However, only few studies have been performed on its effects on metabolic and clinical factors, except studies on the influence of family history of diabetes on T2DM development. Metformin is approved for use in children 10 years and older and sustained-release preparations are approved for use in persons 17 years and older who cannot maintain glycemic control with diet and exercise.7,27The increased prevalence of comorbid conditions in older adults requires careful consideration of medications. In the Arabic culture, there is a high percentage of relative marriages among the population of Qatar estimated to be about 54%. Serum creatinine levels are not always a reliable predictor of renal insufficiency in the elderly, so metformin should be used with caution.
The high prevalence of heart failure in this population limits the use of thiazolidinediones. Only participants who agreed to participate and signed the consent form were included in the study.Sampling procedureA multistage stratified cluster sampling design was developed using the administrative divisions of the primary health centers in Qatar that had approximately equal number of inhabitants. In order to secure a representative sample of the study population, sampling was stratified with a view to obtaining proportional representation from urban and semi urban areas. Las mujeres embarazadas con antecedentes familiares de inicio temprano de diabetes autosómica tipo 2 deben someterse a pruebas de tamizaje para DMG, independientemente de su edad. Necessary corrections have been done after considering the minor discrepancies that had been found during the pilot study. Families with early onset autosomal dominant type 2 diabetes can be defined as those with two or more first-degree relatives with type 2 diabetes diagnosed before age 35 years, three or more generations affected by diabetes, and diabetes inherited in an autosomal dominant fashion (2).
The first part included information about socio-demographic and anthropometric characteristics. The second part collected information about central obesity, hypertension, triglyceride, high-density lipoprotein; and family history of diabetes, MetS, and hypertension. It was important to identify whether the high prevalence rate of MetS among first and second degree of relatives could be related to the high consanguineous community. All the residents of Qatar have a unique Health Card (HC) number which is used for availing the health services provided by different hospitals and primary health centers under Hamad Medical Corporation. Complete medical record of each individual is linked with HC numbers and can be retrieved easily.
Information regarding MetS among different family members of the study participants was retrieved from the medical records based on HC numbers provided by the participants.The most widely accepted criteria to identify the MetS have been proposed by the World Health Organization (WHO), [1] the European group for the study Insulin Resistance (EGIR) [20] and the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP ATPIII).
In population surveys, the prevalence of the disease among relatives of patients with diabetes has been reported as being 4–10 times greater than in controls (9). In addition, emerging data is increasingly showing an association between ethnicity and type 2 diabetes (1).
There is an increasing presence of early onset type 2 diabetes not linked to MODY 1–6 in African Americans, this type of diabetes is often termed atypical (1).
Height was measured in centimeters using a height scale (SECA, Germany) while the subject was standing bare feet and with normal straight posture. Like GDM, this type of diabetes is frequently characterized by failure of the b cells to compensate for insulin resistance (2, 10). Ethnicity, family history of diabetes, and b cells failure in compensating for insulin resistance are therefore common factors implicated in the pathophysiology of both GDM and early onset autosomal dominant type 2 diabetes worldwide (2, 7, 10). The subjects were asked to remove any objects from their pockets and to stand on the weight scale bare feet with light clothing.
Body Mass Index (BMI) was calculated as the ratio of weight (kilogram) to the square of height (meters).
We therefore conducted a prospective study evaluating the odds for and incidence of GDM in pre-gravid women with and without a family history of atypical diabetes.
The metabolic profiles of these women during the first and second trimesters have also been described. Then the average of the two readings was obtained.Waist circumference was measured in centimeters with subjects wearing light clothes at midway level between lower rib margin and iliac crest using non-stretchable measuring tape.
Early onset autosomal dominant type 2 diabetes was defined as having a family history of diabetes in multi-generations, at least two first degree relatives diagnosed with type 2 diabetes before 35 years of age, and diabetes only on the maternal or paternal side of the family (2). Waist circumference was measured according to the definition of ATP III and IDF and considered as risk factor for metabolic syndrome.Laboratory measurementsFasting blood venous samples were collected from all participants for determination of impaired fasting glucose, low HDL, and triglyceride. In addition, 1 000 pregnant women without a family history of diabetes were identified at the same clinic during the same time period. The criteria for impaired fasting glucose, low HDL, and triglyceride were according to the definition of ATP III and IDF as classified above.Statistical analysisData were analyzed using the Statistical Package for Social Sciences (SPSS, version # 20) software. Student t-test was used to ascertain the significance of differences between two means of a continuous variable. Chi-square test Fisher's exact test (two-tailed) was performed to test for differences in proportions of categorical variables between two or more groups. The study received approval from the Faculty of Medical Sciences of the University of the West Indies and Ethics Committee of the University Hospital of the West Indies.
Body Mass Index (BMI) was calculated at approximately six weeks of gestation by measuring the expectant woman's weight and height.
BMI was classified according to the Institute of Medicine (Washington, DC, United States of America) calculations for weight and weight-gain during pregnancy (11). Systolic and diastolic blood pressure measurements were obtained by using a standard sphygmomanometer while the patient was seated. In addition, there were significant differences between MetS patients with and without T2DM in terms of co-morbidities of hypertension (34.6% vs.

Fasting plasma glucose is used to eliminate women being classified as GDM whose diabetes might likely antedate their pregnancy (15). Baseline samples were also taken at nine weeks for insulin, glucagon, cortisol glucose, triglyceride, and total and HDL cholesterol.
The O'Sullivan Test was repeated at 24–27 weeks of gestation on participants with normal O'Sullivan test results or OGTT results.
The O'Sullivan test was repeated at 32 weeks of gestation on participants with normal O'Sullivan or OGTT results.
Women with family history of early onset autosomal dominant type 2 diabetes who were diagnosed with GDM were screened, along with two affected family members, for sequence variants in the MODY genes by polymerase chain reaction single strand conformation polymorphism (PCR-SSCP) analysis (18). Each individual was genotyped for approximately 425 microsatellite markers with mean distance between markers of < 10 cm.
Mutations in glucokinase, HNF-1a, HNF-1b, HNF-4a, IPF-1, and Neuro-D1 genes linked with early onset autosomal type 2 diabetes were searched for by means of a double gradient, denaturing gradient gel electrophoresis. Also, in our study sample, the prevalence of MetS was high among Qataris and varied according to the definition used.
This was followed by direct sequencing of the products of the PCR that were amplified from the exons, flanking introns and minimal promoters of glucokinase, HNF-1a, HNF-1b, HNF-4a, IPF-1, and Neuro-D1 genes. The MetS prevalence varies depending on the diagnosis criteria; most are higher with IDF than ATP III criteria as seen in our study. As the two definitions are based on much of the same components, the difference in prevalence was mainly related to different waist circumference and to the focus on central obesity as an obligatory component in the IDF definition in contrast to being one out of five equally weighted components in the 2005 ATP III definition.Many factors may play a role in the development of the metabolic syndrome including age, race, weight, menopause in women, smoking, low income and low socio-economic status, [4] high carbohydrate intake, cigarette smoking, low physical activity, consumption of soft drink, [4],[11],[17] antipsychotic drugs, T2DM, poor cardiovascular fitness, and genetic factors.
This information along with the Kolmogorov-Smirnov one-sample test were used to assess the variables approximation to normality.
Such results were used to determine whether a parametric or non-parametric test should be used for comparison of means and medians.
The Mann Whitney U-test was used to compare median differences based on having or not having a family history of diabetes; while the independent group t-test was used to compare mean differences of these two groups.
Moreover, obese participants without insulin resistance were at a threefold higher risk for diabetes relative to normal-weight participants without insulin resistance, whereas overweight individuals without insulin resistance were at no increased risk.In most studies, increasing age [4],[26] was the key factor affecting the prevalence of metabolic syndrome and it also showed in our study. Using binary logistic regression, odd ratios for getting GDM were derived employing the predicator variables: family history, age, BMI, insulin resistance, hypertension, and cholesterol level.
No significant differences in age, BMI , glucose, cortisol, glucagon, total cholesterol, HDL, or systolic and diastolic blood pressures were noted between women with a family history of early onset autosomal dominant type 2 diabetes and those without. This is expected since T2DM is an established risk factor of cardiovascular diseases [29] and long ago has been found to be associated with the different clusters of the MetS such as high cholesterol, triglycerides, [30] and hypertension. This is consistent with the present study.Furthermore, a parental history of MetS increases the risk of developing MetS among their offspring. This is advocated by the findings that genetic factors may account for as much as 50% of the variable in level of the MetS traits in offspring. Further analysis should be made to investigate this interesting finding.Limitations of studyThis study is cross-sectional in nature with no follow up and, therefore, it has inherent difficulty to determine the temporal association between cause and effect. However, the various differences according to family history that were shown in this study might be clinically meaningful for the prevention of T2DM among MetS patients. There were no significant differences between the two groups in glucose, glucagon, cortisol, HDL, total cholesterol, or systolic and diastolic blood pressure levels at 24–27 weeks of gestation. Women from both groups who had normal glucose tolerance at 24–27 weeks remained normal throughout pregnancy. Mutation screen- ing via SSCP (18), sequencing (2), and linkage analysis was negative for the six known MODY genes (HNF-4a, GCK, HNF-1a, IPF-1, HNF-1b, and Neuro-D1). This clearly is suggestive of the b cell dysfunction in the face of insulin resistance in pregnancy. Detailed metabolic studies have revealed abnormalities in glucose-mediated insulin secretion in some forms of early onset autosomal dominant diabetes (3, 5). It seems possible therefore, that there is a threshold of insulin sensitivity above which the development of GDM is very unlikely and there is also a stage in the development of GDM too late to protect b cells by reducing insulin resistance. Although b cell dysfunction is associated with MODY (3), mutation screening of the women and family members with early onset autosomal dominant type 2 diabetes for the MODY genes 1–6 ruled out b cell defects associated with MODY as the cause of GDM.
However, evidence for such autoimmunity is present in only a small minority of patients (27–29).
The frequency of anti-islet cell and anti-GAD antibodies in GDM parallels ethnic trends in the prevalence of type 1 diabetes outside of pregnancy (10). We therefore do not believe the 12% incidence of GDM in the women with a family history of early onset autosomal dominant type 2 diabetes is due to autoimmune diabetes. A large number of mutations in lipoprotein lipase (LPL) have been identified (33) and these can cause hypertriglyceridemia.
However, it is doubtful that most cases of endogenous hypertriglyceridemia can be explained by mutations in LPL, which appear to be relatively rare. Another attractive suggestion for defective lipolysis of VLDL-TG has recently been proposed.
The hepatic synthesis of apo CIII apparently is insulin responsive (35); in the presence of insulin resistance, apo CIII may be over-expressed, which can inhibit lipolysis of plasma VLDL-TG and lead to hypertriglyceridemia. These women were overweight at 24–27 weeks of gestation, over 30 years of age, and hypertensive with elevated total cholesterol and high insulin resistance.
This subset of women without family history of diabetes who developed GDM had many of the features of the metabolic syndrome, associated with increased incidence of GDM (19, 21–23). In the face of increasing insulin resistance in the second trimester, appropriate hyperinsulinemia occurred. Robust plasticity of b cell function in time of insulin resistance is the hallmark of normal glucose regulation during pregnancy (10). The myriad of obesity, age, high blood pressure, and elevated total cholesterol in these women are markers of increased insulin resistance (19) to which the insulin resistance of pregnancy was additive. This exaggerated resistance to insulin and ability to suppress glucose production and stimulate glucose uptake resulted in hyperglycemia in pregnancy. During the fasting state in GDM, severe insulin resistance is characterized by an overproduction of glucose by the liver; while in the fed state, severe insulin resistance is characterized by a decrease in insulin-mediated glucose uptake by the muscle (36). Allele frequencies of candidate genes in women with GDM and controls have not documented any specificity for phenotypic sub-classification (10, 38). Several studies have also evaluated a series of a priori candidate genes for a role in early-onset type 2 diabetes (42). Sequence variants have been identified in genes such as HNF-3b, NeuroD4, Neurogenin-3, HNF-6, and GLUT-2; however, none of these have been conclusively shown to predispose to type 2 diabetes or GDM (40).
Therefore, GDM appears to be multifaceted and may be caused by both genetic and environmental factors that characterize other types of diabetes. Because of the increased suceptibility to GDM that Jamaican women with a family history of early onset type 2 diabetes have at any age, it is important that they be screened for GDM early in pregnancy. Molecular mechanisms and clinical pathophysiology of maturity-onset diabetes of the young. Metabolic consequences of a family history of NIDDM (the Botnia study): evidence of sex-specific parental effects. Fasting plasma glucose test at first pre-natal visit as a screen for gestational diabetes. Prevalence of gestational diabetes mellitus among James Bay Cree women in Northern Quebec. A comparison of rates, risk factors, and outcomes of gestational diabetes between Aboriginal and Non-Aboriginal women in the Saskatoon Health District.
Familiarity of quantitative metabolic traits in Finnish families with non-insulin-dependent diabetes mellitus. Heritability of insulin secretion, peripheral and hepatic insulin action, and intracellular glucose partitioning in young and old Danish twins. Incidence and significance of islet cell antibodies in women with previous gestational diabetes. Islet cell antibodies identify a subset of gestational diabetic women with higher risk of developing diabetes shortly after pregnancy.
Prevalence and predictive value of women with islet cell antibodies and insulin autoantibodies in women with gestational diabetes.
Sphlanchic secretion rates of plasma triglycerides and total and Splanchnic turnover of plasma free fatty acids in men with normo- and hypertriglyceridaemia. Impaired catabolism of very low-density lipoprotein-triglyceride in a family with primary hypertriglyceridaemia.
Diminished very low density lipoprotein fractional catabolic rate associated with increased apo CIII reduced apo E on particles. An apolipoprotein CIII haplotype protective against hypertriglyceridaemia is specified by promoter and 3' untranslated region polymorphisms. Association of the E23K polymorphism in the KCNJ11 gene with gestational diabetes mellitus.
Homozygosity for a common polymorphism in the islet-specific promoter of the glucokinase gene is associated with a reduced early insulin response to oral glucose in pregnant women. A genome-wide scan in families with maturity onset diabetes of the young: evidence for further genetic heterogeneity.

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