RESUMEN
OBJECTIVE: The effect of a diet rich in monounsaturated fatty acids (MUFA) on blood pressure, glycemic control, lipids and insulin sensitivity was evaluated in women with gestational diabetes mellitus. DESIGN AND METHODS: A randomized, unpaired diet intervention was performed in 27 women with gestational diabetes mellitus in an outpatient clinic. After randomization the women received either a high-carbohydrate diet (H-CHO) or a high-MUFA diet (H-MUFA) from the 33rd gestational week of pregnancy. Outcome measures were 24 h ambulatory blood pressure, blood lipids, glycemic control and insulin sensitivity estimated by an intravenous glucose tolerance test. RESULTS: The 24 h diastolic blood pressure increased more in the H-CHO group than in the H-MUFA group (P<0.04). CONCLUSIONS: After 5 weeks of treatment with a MUFA-enriched diet, no increase in 24 h diastolic blood pressure and no adverse effects on blood lipids were seen. The favorable effect on the blood pressure by the MUFA diet is a possible non-medication treatment. The H-MUFA diet had no advantage to the H-CHO diet in ameliorating the decline of insulin sensitivity in third term of pregnancy in GDM.
Asunto(s)
Glucemia/metabolismo , Presión Sanguínea/efectos de los fármacos , Diabetes Gestacional/fisiopatología , Carbohidratos de la Dieta/farmacología , Ácidos Grasos Monoinsaturados/farmacología , Adulto , Glucemia/efectos de los fármacos , Diabetes Gestacional/sangre , Diabetes Gestacional/dietoterapia , Carbohidratos de la Dieta/administración & dosificación , Ácidos Grasos Monoinsaturados/administración & dosificación , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/sangre , Insulina/metabolismo , Metabolismo de los Lípidos , EmbarazoRESUMEN
OBJECTIVE: To estimate the prevalence and possible under-diagnosing of substance use disorders and to consider factors that might influence diagnosing of substance use disorders. METHOD: Data collected from case records and PSE interviews of psychiatric in-patients from 12 psychiatric departments in Denmark admitted during October 1996 were compared with data from the Danish Psychiatric Register. RESULTS: A substantially lower prevalence of substance use diagnoses were found in the register (26.1%) than in the research data (50.0%). A high prevalence of co-occurrence between substance use disorders and mental disorders other than substance use disorders was found (37.3%). In the majority of cases knowledge of the substance use disorders was present in the case records, although they had not resulted in a diagnosis. CONCLUSION: The under-diagnosis of substance use disorders is due not only to concealed diagnostic signs and symptoms but also to an under-diagnosis by the psychiatrists, in spite of the fact that information on the substance use was accessible.
Asunto(s)
Trastornos Mentales/terapia , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Anciano , Diagnóstico Diferencial , Diagnóstico Dual (Psiquiatría) , Femenino , Humanos , Incidencia , Pacientes Internos , Masculino , Trastornos Mentales/complicaciones , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
Twenty-nine pregnant women with gestational diabetes mellitus (GDM) diagnosed before the 34th gestational week had three intravenous glucose tolerance tests (IVGTT) performed during pregnancy and a follow-up with OGTT post partum. The women with a normal OGTT post partum had a significant decrease in fasting serum glucose from the 33rd to the 38th week in pregnancy (4.8-->4.0 mmol/l, p < 0.05). However, the women with a diabetic/borderline OGTT showed no decrease in fasting serum glucose during the same period (5.1-->5.0 mmol/l). The K-value (the diminution rate of blood glucose) of the IVGTT in week 38 was significantly lower in women with puerperal diabetic/borderline OGTT compared with women with a normal post partum OGTT (1.05 +/- 0.07 vs. 1.32 +/- 0.08 -10(2) x mmol/l x min-1, respectively, p < 0.05). Diabetic or borderline diabetic OGTT in the first week post partum was significantly associated with a decrease in the K-value from week 33 to 38 (p < 0.05). Early diagnosis of GDM was found to be associated with a pathological OGTT post partum (p < 0.05). Five of 22 women (23%) with previous GDM had a diabetic and one (5%) a borderline OGTT at follow-up four to thirteen months post partum. High fasting serum glucose levels during the last trimester in GDM can identify the women at risk of diabetic/borderline OGTT post partum.