Cobas c11

Potentially eligible participants with type 2 diabetes were identified from medical records. Participants needed to have an A1c of >7.0% in the prior 6 months and again at the time of recruitment for the intervention to be eligible. Exclusion criteria were age more than 75 years old (as recommended glycemic targets are higher for adults in this age group), being pregnant, terminal health conditions, and conditions (e.g., severe mental illness, dementia) that would impede meaningful participation. Participants who agreed to participate in the study completed a baseline survey and a clinical assessment in which blood pressure was measured and blood was drawn to be sent for analyses of A1c and cholesterol levels at the Central Laboratory of the Clinic Hospital of the University of São Paulo. A1c was measured using standard internationally validated turbidimetric inhibition immunoassay methods (Roche Cobas C11).

Serum biochemical parameters including glucose, triglycerides, total, and LDL cholesterol were analyzed with a COBAS C11 (Roche, Basel, Switzerland). Serum insulin (Alpco Diagnostics, Salem, NH, USA) and LPS (Cloud-Clone Corp, Houston, TX, USA) were determined using commercial ELISA kits.

Plasma glucose concentrations were measured using an enzymatic method with hexokinase (Cobas C11, Roche Diagnostics Ltd, Switzerland), and the serum insulin level was evaluated by an immunoradiometric method (DiaSource Europe SA, Belgium) using a Wallac Wizard 1470 Automatic Gamma Counter (Perkin Elmer, Life Science, Turku, Finland). Glycated hemoglobin (HbA1c) was assayed by high-performance liquid chromatography (Bio-Rad D-10, Bio-Rad Laboratories, Hercules, USA). The homeostasis model assessment of insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell function were calculated for all women in each trimester of pregnancy. Moreover, in the second trimester, insulin sensitivity was measured using the OGTT insulin sensitivity index of Matsuda and DeFronzo (ISI_OGTT).