1985 — 1988 |
Morris, Mary A |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Glycosylated Serum Proteins in Diabetes Mellitus
The major focus has been to examine the utility of glycosylated blood protein concentrations (measured by affinity chromatography) in the assessment of normal pregnancy and pregnancy complicated by diabetes. Gestational biabets, a frequent complication of pregnancy with an incidence of 1.6-3.0%, is associated with increased fetal and maternal morbidity and fetal mortality. In contrast to earlier work suggesting that gestational diabetes occurs only in the third trimester, our work indicated GlyHb (glycosylated hemoglobin concentration) elevation can be detected as early as 15 weeks gestation in those women who ultimately develop gestational diabetes. Additionally, our studies indicate that GlyHb elevation by 15 weeks is predictive of macrosomia in the infants of both women with normal glucose tolerance in pregnancy and women with gestational diabets. GlyHb remains elevated throughout gestation in women with gestational diabets receiving conventional dietary on insulin therapy, and fetal outcome in compromised. As an extension of these studies, a board based clinical investigatin of pregnancy complicated by elevation of glycosylated blood protein concentrations in proposed. Such an investigation is feasible because, in contrast to earlier methodologies, GlyHb and GSP (glycosylated serum protein concentration) offer quantitative assessment of blood glucose regulation in pregnancy. The specific aims of this proposal are to (1) test the hypothesis that intensified therapy for glucose intolerance in pregnancy based on the maintenance of normal GlyHb will result in improved perinatl outcome, (2) determine whether women with GlyHb elevation but normal glucose tolerance in pregnancy can be distinguished for women with gestational diabets by historical, clinical, or biochemical parameters, (3) elaluae longitudinally physical growth, intellectual development, and pancreatic beta cell function in the children of women with mild glucose intolerance in pregnancy, (4) monitor the development of diabetes in women withGlyHb elevation in pregnancy to determine whether euglycemia, as determined by normal GlyHb, maintained throughout gestation results in a decreased risk or severity of glucose intolerance in late pregnancy or in later life, and (5) determine whether the glycosylation of fetal proteins is increased prior to 20 week gestation when maternal GlyHb is elevated.
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0.928 |
1997 |
Morris, Mary Ann |
M01Activity Code Description: An award made to an institution solely for the support of a General Clinical Research Center where scientists conduct studies on a wide range of human diseases using the full spectrum of the biomedical sciences. Costs underwritten by these grants include those for renovation, for operational expenses such as staff salaries, equipment, and supplies, and for hospitalization. A General Clinical Research Center is a discrete unit of research beds separated from the general care wards. |
Diabetes Prevention Trial
The Diabetes Prevention Protocol (DPT-1), begun 2 years ago, is proceeding as scheduled according to the original protocol. The objectives of both the parenteral antigen protocol and the oral antigen protocol are specifically to determine whether intervention with parenteral or oral insulin in prediabetes will delay or prevent the development of clinical IDDM in 'high risk' (parenteral antigen) or 'intermediate risk' (oral antigen protocol) nondiabetic relatives of patients with IDDM. Currently, nationally, the parenteral antigen protocol has been activated and the oral antigen protocol is to be activated in September, 1996, with 131 subjects nationally eligible for enrollment. Please note that, at Duke, we are conducting screening tests but not intervention protcols. Within the past twelve months, we have screened 15 subjects, 7 male, 8 female, and all Caucasian for islet cell antibodies. One of these subjects showed positive islet cell antibodies. We have appreciated the services of the General Clinical Research Center in conducting intravenous glucose tolerance tests on three islet cell antibody subjects, all male and all white. All three subjects had normal intravenous glucose tolerance tests, but one had positive insulin antibodies and will be eligible for the oral antigen protocol. No patients have had adverse sequellae of testing. We recognize that the small sample studied at Duke is not diverse by race or gender, but we do not actively recruit for this study, and will do so only at the suggestion of the national steering committee. Nationally, the goal is to screen a total of 60,000 relatives, and the majority of those subjects have already been studied, ahead of schedule. At this time, a national effort is being made of more timely follow up of "at risk" study subjects. We anticipate continuing this study for one to two more years. Currently, we are not considering expanding to the parenteral and oral antigen intervention protocols.
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0.928 |