Ppt notes

Good morning respected chairperson, honorable external and internal examiners, and respected faculty
members. My name is Dr. Uzma. Today I will be presenting my research thesis titled ‘Comparative
Effects of Metformin and Insulin on Biomarkers Interleukin-1 Beta, SII, and SIRI in Women with
Gestational Diabetes Mellitus and Healthy Pregnant Women.’ This research was conducted under the
supervision of Dr. [Supervisor’s Name] at [Name of Institution]. Thank you for giving me the opportunity
to present my work.”

Gestational Diabetes Mellitus, commonly known as GDM, is a condition characterized by

glucose intolerance that is first identified during pregnancy. It occurs when the body is unable to
effectively regulate blood glucose levels due to increased insulin resistance associated with
pregnancy.

GDM is most commonly diagnosed between 24 and 28 weeks of gestation through routine
screening tests such as the oral glucose tolerance test.

This condition is clinically important because it is associated with several maternal and fetal
complications. Maternal complications may include preeclampsia, increased risk of cesarean
delivery, and a higher likelihood of developing type 2 diabetes later in life.

For the fetus and newborn, uncontrolled maternal blood glucose can lead to complications such
as macrosomia, neonatal hypoglycemia, respiratory distress, and increased risk of metabolic
disorders in later life.

Therefore, early detection, proper glycemic control, and appropriate management strategies are
essential to reduce these complications and improve both maternal and neonatal outcomes.”

“During pregnancy, several placental hormones induce physiological insulin resistance.

Hormones such as human placental lactogen, progesterone, estrogen, cortisol, and growth
hormone reduce the sensitivity of maternal tissues to insulin.

In healthy pregnancies, pancreatic β-cells compensate by increasing insulin secretion. However,

in susceptible women, this compensatory mechanism is insufficient.

As a result, maternal blood glucose levels rise, leading to hyperglycemia. The excess glucose
crosses the placenta and exposes the fetus to higher glucose levels.

In addition, chronic low-grade inflammation further worsens insulin resistance, which plays an
important role in the development and progression of gestational diabetes mellitus.”

Globally, GDM affects a significant proportion of pregnancies. According to IDF data, approximately one
in six live births are affected by hyperglycemia in pregnancy. South Asian populations, including
Pakistan, demonstrate higher prevalence rates due to genetic and lifestyle factors. This rising burden
highlights the importance of optimizing treatment strategies.”

“Gestational diabetes mellitus is a common metabolic complication of pregnancy globally,

affecting roughly 14–15% of pregnancies, and an estimated one in six pregnancies experience
elevated hyperglycemia during gestation. Regionally, South Asian countries including Pakistan
show higher prevalence. A recent meta-analysis estimated that around 16.7% of pregnant
women in Pakistan have GDM, but individual studies show variability due to different diagnostic
criteria and populations studied.”

“Gestational diabetes is not just a metabolic disorder; it is associated with chronic low-grade
inflammation. Pro-inflammatory cytokines, particularly IL-1β, play a key role in worsening insulin
resistance. Systemic inflammation can be measured using biomarkers like SII and SIRI, which reflect
immune-inflammatory status. These inflammatory changes are important because they can impact both
maternal and neonatal outcomes. Understanding these mechanisms helps in optimizing treatment and
predicting prognosis.”

Gestational diabetes is increasingly common, yet the inflammatory processes involved remain
underexplored. There is limited evidence comparing how metformin and insulin affect
inflammatory biomarkers like IL-1β, SII, and SIRI. Most previous studies are small, single-
center, or do not include detailed biomarker analysis. By addressing this gap, our study aims to
provide insights that can guide better treatment strategies and improve outcomes for both
mothers and babies.”

This was a prospective observational comparative study. We did not assign treatments; patients
received therapy according to clinician recommendations, and we observed outcomes systematically.”

“Statistical analysis was performed using SPSS software. Continuous variables were expressed as mean
plus-minus standard deviation, while categorical variables were presented as frequencies and
percentages. Independent t-tests and ANOVA were used for intergroup comparisons, and paired t-tests
were applied for pre- and post-treatment analysis. A p-value less than 0.05 was considered statistically
significant.”

To explore independent predictors of post-treatment inflammatory markers, we performed multivariate

linear regression analysis adjusted for clinical and metabolic parameters.”

Results

“Out of 129 initially recruited women, 39 were excluded due to incomplete information or follow-up
loss. Final analysis included 90 participants equally divided into three groups.”

Most participants were housewives and had sedentary lifestyles; age distribution differed significantly
among groups.”

This table shows the baseline demographic characteristics of participants in the three study
groups. The mean age differed significantly among the groups (p = 0.041), with slightly higher
age in the Metformin + Insulin group. Most participants in all groups had a sedentary lifestyle
and were housewives. Other demographic variables such as education and occupation were
comparable among the groups.”

“This table presents the baseline anthropometric characteristics of participants in the three study
groups. The mean systolic blood pressure showed a statistically significant difference among the groups
(p = 0.014), while diastolic blood pressure was comparable. The mean BMI was slightly higher in the
GDM groups compared with healthy controls. Most women in both GDM groups were categorized as
obese, whereas a greater proportion of healthy controls were in the overweight category.”

This table shows the medical and obstetric history of participants. History of PCOS, previous GDM,
urinary infections, antibiotic use, and hospitalization during pregnancy were significantly more common
in the GDM groups, particularly in the Metformin + Insulin group. Hypertension history and number of
miscarriages were comparable among the groups.”

This table presents the obstetric characteristics of the study participants. The mean gestational age at
diagnosis of GDM was slightly earlier in the Metformin group compared with the Metformin + Insulin
group, although the difference was not statistically significant. Hypertension during pregnancy and
adherence to a special diet recommended by a dietician showed significant differences among the
groups. Blood sugar monitoring was significantly more frequent among women in the GDM groups,
particularly in the Metformin + Insulin group, whereas most healthy controls rarely monitored their
blood glucose.”

This table shows the pre-treatment biochemical and inflammatory marker profiles of the study
participants. Fasting blood sugar as well as 1-hour and 2-hour glucose levels were significantly higher in
both GDM groups compared with healthy controls, indicating poor glycemic control before treatment.
Hemoglobin levels were slightly lower in the Metformin + Insulin group, although the difference was not
statistically significant. Among inflammatory markers, SII and SIRI showed significant differences
between the groups, suggesting increased systemic inflammation in women with GDM. IL-1β levels were
higher in the GDM groups compared with healthy controls, but the difference did not reach statistical
significance.”

This table presents the post-treatment biochemical, hematologic, and inflammatory marker levels
among the three study groups. Hemoglobin levels were comparable among the groups and did not show
a significant difference. HbA1c levels remained higher in the GDM groups compared with healthy
controls, showing a significant difference. Among inflammatory markers, SII and SIRI demonstrated
significant differences between the groups, indicating persistent systemic inflammation in women with
GDM. IL-1β levels were higher in the GDM groups compared with controls; however, this difference was
not statistically significant.”

“This table compares the pre- and post-treatment biochemical, hematological, and inflammatory
markers within each study group. Hemoglobin levels did not show significant changes in any group after
treatment. However, SII decreased significantly in both treatment groups, indicating a reduction in
systemic inflammation. SIRI showed a slight decrease after treatment but the change was not
statistically significant. IL-1β levels showed a significant reduction in the Metformin + Insulin group,
while changes in the Metformin-only and control groups were not significant.”
This table presents the delivery outcomes and postpartum complications among the study groups.
Spontaneous vaginal delivery was more common in the Metformin group and healthy controls, whereas
the majority of women in the Metformin + Insulin group underwent cesarean section, showing a
significant difference. The gestational age at delivery was slightly lower in the Metformin + Insulin group,
although the difference was not statistically significant. Pre-eclampsia was observed only in the GDM
groups, while none of the healthy controls developed this complication. Additionally, gastrointestinal
upset and hospitalization due to adverse effects were reported more frequently in the Metformin +
Insulin group.”

This table shows the correlation of the Systemic Immune Inflammatory Index (SII) with baseline and
clinical parameters in the three study groups. In the GDM groups, SII showed a significant positive
correlation with age, BMI, systolic blood pressure, and fasting blood sugar, indicating that higher values
of these parameters were associated with increased systemic inflammation. SII also demonstrated a
positive correlation with IL-1β levels, suggesting a link between inflammatory biomarkers. In healthy
controls, SII showed a weaker association with most variables, with a significant correlation mainly
observed with systolic blood pressure.”

“This table shows the correlation of the Systemic Inflammatory Response Index (SIRI) with baseline and
clinical parameters among the study groups. In the GDM groups, SIRI showed a significant positive
correlation with age, BMI, systolic blood pressure, and fasting blood sugar, indicating that higher
metabolic risk factors were associated with increased systemic inflammation. A positive association was
also observed between SIRI and IL-1β, suggesting a relationship between inflammatory markers. In
healthy controls, the correlations were generally weaker, with a significant association mainly observed
with systolic blood pressure.”

This table presents the correlation of Interleukin-1β (IL-1β) with baseline and clinical parameters in the
study groups. In the GDM groups, IL-1β showed positive correlations with age, BMI, blood pressure, and
fasting blood sugar, indicating that higher metabolic risk factors were associated with increased
inflammatory activity. A negative correlation was observed between IL-1β and hemoglobin levels. IL-1β
also demonstrated associations with inflammatory indices such as SII and SIRI, suggesting a relationship
between cytokine levels and systemic inflammation.”

This table shows the correlation of post-treatment inflammatory markers SII, SIRI, and IL-1β with clinical
markers in the three study groups. In the Metformin + Insulin group, SII and SIRI showed significant
positive correlations with HbA1c, indicating that higher glycemic levels were associated with increased
systemic inflammation. SIRI also demonstrated a significant positive correlation with IL-1β, suggesting a
close relationship between inflammatory indices and cytokine levels. In the Metformin-only and healthy
control groups, the correlations were generally weaker and mostly not statistically significant.”