History Of Gestational Diabetes Research Articles

Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis

ObjectiveTo quantify the risk of overall and type specific cardiovascular and cerebrovascular diseases as well as venous thromboembolism in women with a history of gestational diabetes mellitus.DesignSystematic review and meta-analyses.Data...

The use of metformin for type 2 diabetes prevention: Observational multicenter study from Saudi Arabia.

BackgroundPatients with prediabetes are at higher risk of developing type 2 diabetes. While intensive lifestyle modification is the primary approach to delaying diabetes, metformin has been shown to be effective, especially among patients younger than 60 years and obese (body mass index (BMI) > 35 kg/m2), patients with fasting blood glucose ≥ 6.1 mmol/L or HbA1c ≥ 6%, and women with history of gestational diabetes. Thus, metformin is now recommended as an option for diabetes prevention by the American Diabetes Association (ADA). The use of metformin among patients with prediabetes in Saudi Arabia and their adherence to the guideline's recommendation for the prevention of type 2 diabetes is unknown. This study aimed to identify the prevalence of metformin use among prediabetes patients overall and patients who are more likely to benefit from metformin use per the ADA guidelines.MethodsA retrospective cohort study was conducted encompassing data from three tertiary care hospitals between January 2015 and June 2019. All patients aged 20 to 70 years with prediabetes (HbA1c of 5.7–6.4%) were included, while patients with an established diagnosis of diabetes, creatinine clearance <45 ml/min, using antihyperglycemic medications other than metformin, or on metformin for other indications were excluded. Prediabetes patients who are most likely to benefit from metformin for type 2 diabetes prevention are those younger than 60 years with a BMI ≥ 35 kg/m2, patients with fasting blood glucose ≥ 6.1 mmol/L or HbA1c ≥ 6%, and women with history of gestational diabetes. This study examined the prevalence of metformin use among all patients with prediabetes, as well as patients who would be more likely to benefit from metformin use per the ADA guidelines.ResultsA total of 251 patients were included in this study; 52.2% were female, with a mean age of 47.0 (11.9) years and BMI of 32.3 (6.5) kg/m2, and the median HbA1c at baseline was 5.8% (5.7–6.0). Among the overall sample, 18 patients (7.2%) received metformin for the prevention of type 2 diabetes, 14 of those were from the groups that are more likely to benefit from metformin use per the ADA guidelines (9.9%).ConclusionsAmong individuals with prediabetes in Saudi Arabia, metformin use was very low despite the evidence supporting its safety, convenience, and efficacy. Healthcare providers seemed hesitant to medicalize prediabetes; furthermore, the low use of metformin suggests the existence of several barriers that need to be identified and resolved. Increasing providers' knowledge and awareness regarding screening and management of prediabetes is highly encouraged.

Impact of prior gestational diabetes on long-term type 2 diabetes complications

AimsWhile women with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus (T2DM) and at a younger age, it is unknown whether T2DM following GDM is associated with worse clinical outcomes. This study aims to examine the impact of GDM on subsequent development of long-term complications of T2DM. MethodsAll women with T2DM from the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of US population, between 2007 and 2018 (n = 2494) were stratified into two groups: those with a history of GDM (n = 385) and those without (n = 2109). Rates of macrovascular and microvascular complications of T2DM were compared between the two groups using bivariate and multivariate analyses. ResultsOf 2494 participants with T2DM included in the analysis, 385 (15.4 %) had a history of GDM and 2109 (84.6 %) did not. A history of GDM was independently associated with increased risk of myocardial infarction (aOR 2.53, 95%Cl: 1.18–5.40) and likely coronary artery disease (aOR 2.15, 95 % Cl: 1.00–4.66). ConclusionsIn this cohort, women with T2DM and a history of GDM had higher risk of macrovascular complications of myocardial infarction and coronary artery disease, compared to those with no history of gestational diabetes.

Evaluation of subclinical atherosclerosis and cardiac functions in children of mothers with gestational diabetes and maternal obesity.

We aimed to evaluate the effects of maternal obesity or gestational diabetes on body composition, lipid, and glucose metabolism, arterial morphology, and functions in children, and to investigate these effects in terms of cardiometabolic diseases. The study group was composed of 48 children who had a history of gestational diabetes or maternal obesity, and the control group was composed of 33 children. Echocardiographic assessments were performed. Socio-economic status and education level of mothers were obtained. In the study group, carotid intima-media thickness, epicardial adipose tissue thickness, and arterial stiffness values were found to be significantly higher compared to the control group (p < 0.001, p < 0.001, p = 0.003, respectively), while arterial distensibility and arterial strain values were found to be significantly lower (p = 0.003, p = 0.008, respectively). Among the children who had similar body mass index in both groups, children in the study group had higher carotid intima-media thickness and epicardial adipose tissue thickness values. Arterial stiffness values were significantly reduced (p = 0.028) and arterial distensibility and strain values were significantly increased (p = 0.039, p = 0.033, respectively) in the children whose mothers had gestational diabetes and high socio-economic status. Left ventricular mass and left ventricular end-diastolic internal thickness were found to be significantly increased in the children who had obese and unemployed mothers (p = 0.04, p = 0.03, respectively). Low socio-economic status was found to be associated with increased maternal obesity and gestational diabetes. Poor socio-economic status, poor glycaemic control and being overweight during pregnancy indicate negative cardiometabolic outcomes for children in the long term.

Gestational Diabetes, Subsequent Type 2 Diabetes, and Food Security Status: National Health and Nutrition Examination Survey, 2007-2018.

IntroductionDespite many studies linking various risk factors to the association between gestational diabetes and subsequent type 2 diabetes, little is known about how food insecurity affects their association. We aimed to assess how the association between gestational diabetes and subsequent type 2 diabetes varies by food security status among women in the US.MethodsThis study is a secondary data analysis of 9,505 US women aged 20 years or older who had at least 1 live birth; we used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2007 through 2018. The main outcome was a diagnosis of type 2 diabetes in the subsequent years after the first live birth. We used multivariable survey-weighted negative binomial regressions to examine whether the association between gestational diabetes and subsequent type 2 diabetes differed by food security status, with and without adjusting for health behavior factors.ResultsGestational diabetes was significantly associated with subsequent type 2 diabetes (incidence rate ratio [IRR], 2.57; 95% CI, 2.45–2.69). The association between gestational diabetes and subsequent type 2 diabetes was significantly different by food security status (IRR, 2.34; 95% CI, 2.23–2.45 among food-secure women; IRR, 2.99; 95% CI, 2.70–3.28 among food-insecure women).ConclusionThe association between gestational diabetes and subsequent type 2 diabetes differs significantly by food security status. Public health and health care practitioners should consider food security status when designing and implementing diabetes prevention interventions for women with a history of gestational diabetes.

Oxidative stress contributes to reductions in microvascular endothelial- and nitric oxide-dependent dilation in women with a history of gestational diabetes.

Women with a history of gestational diabetes mellitus (GDM) are twice as likely to develop cardiovascular disease (CVD) and ∼7 times as likely to develop type 2 diabetes as their age-matched counterparts. However, the mechanism(s) mediating these associations remain unclear. We hypothesized that endothelium- and (nitric oxide) NO-dependent dilation would be attenuated through oxidant stress mechanisms in the microvasculature of women with a history of GDM compared with control women with a history of uncomplicated pregnancy (HC). Ten HC (35 ± 4 yr) and 10 GDM (34 ± 4 yr) underwent a standard local heating protocol (42°C; 0.1°C·s-1). Two intradermal microdialysis fibers were placed in the ventral forearm for local delivery of lactated Ringer's (control) or 5 mM l-ascorbate. After full expression of the local heating response, 15 mM NG-nitro-l-arginine methyl ester (NO synthase inhibition) was perfused. Red cell flux was measured continuously by laser-Doppler flowmetry, and cutaneous vascular conductance (CVC = flux/MAP) was standardized to maximum (% CVCmax; 28 mM SNP + 43°C). Urine albumin:creatinine ratio (ACR) was measured. GDM had attenuated endothelium-dependent (GDM: 67 ± 7 vs. HC: 90 ± 4% CVCmax; P < 0.001) and NO-dependent (GDM: 54 ± 7 vs. HC: 71 ± 3% CVCmax; P = 0.001) dilation at the control site and tended to have higher urine ACR (P = 0.06). Both endothelium-dependent (R2 = 0.53, P = 0.02) and NO-dependent (R2 = 0.56, P = 0.01) dilation were related to urine ACR in GDM. l-ascorbate perfusion improved endothelium-dependent (82 ± 5% CVCmax; P = 0.03 vs. control) and NO-dependent (68 ± 5% CVCmax; P = 0.02 vs. control) dilation in GDM but had no effect in HC (P > 0.05). Otherwise healthy women with a history of GDM have attenuated microvascular endothelial function and this dysfunction is mediated, in part, by oxidative stress.NEW & NOTEWORTHY Women who have gestational diabetes during pregnancy are at greater risk for cardiovascular disease and type 2 diabetes in the decade following pregnancy. However, the mechanisms mediating this increased risk are unclear. Herein, we demonstrate that microvascular dysfunction, mediated by increase in oxidative stress, persists after pregnancy in women who had gestational diabetes, despite the remission of glucose tolerance.

Association Between Gestational Diabetes History with Endometrial Hyperplasia and Cancer

Association Between Gestational Diabetes History with Endometrial Hyperplasia and Cancer

Metformin Prescription Rates for Patients with Prediabetes.

Prediabetes is a serious public health concern, with 34.5% of US adults meeting the criteria for prediabetes. The American Diabetes Association has highlighted metformin therapy as a consideration for individuals with BMI ≥ 35 kg/m2, those aged < 60 years, and women with a history of gestational diabetes. We examined metformin prescription rates among a national sample of commercially insured, higher risk patients with prediabetes. We gathered 2012 to 2018 demographic, laboratory, and prescription data for 53,551 patients with prediabetes from the IBM MarketScan research database. Our primary outcome was metformin prescription rates 1 or 3 years after a laboratory confirmation of prediabetes among patients who have a BMI ≥ 35 kg/m2 or are aged < 60 years. Overall, 2.4% (n = 1,124) of patients received a metformin prescription within 1 year of a laboratory confirmed prediabetes result, including 2.4% of patients aged < 60 years and 10.4% of those with BMI ≥ 35 kg/m2. By a 3 year follow-up, 4.1% (n = 1901) received a metformin prescription, including 3.9% of patients aged < 60 years and 14.0% with BMI ≥ 35 kg/m2. Patients who developed type 2 diabetes within the 1 (n = 2,769) or 3 year (n = 7,268) follow-up periods were excluded from analysis. Few prediabetes patients who were either obese or aged < 60 years received a metformin prescription between 2012 and 2018. Prescription rates increased slightly between 1 and 3 years after a prediabetes diagnosis, so strategies to support timely intervention among higher risk patients with prediabetes are critically needed.

Prevalence and Related Risk Factors of Diabetes Mellitus among Multigravida Females with the History of Gestational Diabetes Mellitus; A Retrospective Cross-Sectional Study

Background: Pakistan is having higher prevalence of Diabetes Mellitus. Gestational diabetes mellitus (GDM) has been linked with substantial short- and long-term adverse health results, such as Diabetes Mellitus, increased risk of cardio-metabolic disorders later in life among both women and infants. GDM has seven times significantly increased risk of diabetes mellitus. The objective of this study is to calculate the prevalence of diabetes mellitus among multigravida females with the history of gestational diabetes.&#x0D; Methodology:&#x0D; A cross sectional study was conducted on 153 women with multigravida having history of gestational diabetes was selected by convenient sampling. This study was conducted between Augusts to December 2021. Data were collected by a self-structured questionnaire. Data were entered and analyzed by SPSS 24. P value ? 0.05 was considered as significant value.&#x0D; Results:&#x0D; Out of total 153, prevalence of diabetes mellitus persists among the females with multigravida and having the history of gestational diabetes was observed 71(46.40%). Obesity, stress, lack of physical activity, Family history of Diabetes, Hypertension, elevated birth weight are some major risk factors of Diabetes mellitus after GDM.&#x0D; Conclusion: Diabetes mellitus that persists after GDM have high prevalence and higher risk among multigravida females. For prevention of DM, early diagnosis screening, awareness should create about risk factors of DM and appropriate exercises during gestation period in females should perform.&#x0D; Keywords: Cross-sectional, Gestational Diabetes Mellitus, Diabetes Mellitus, Multigravida, Nulliparous.

The ability of a low value on an early GCT to identify women not needing repeat testing in the second trimester

Objective To evaluate the predictive value of a low early glucose challenge test (GCT) in ruling out a subsequent diagnosis of gestational diabetes in the second trimester. Methods This was a retrospective cohort study of women at a single clinic who had a normal early GCT between 2016 and 2020. Patients who did not have repeat screening in the late second trimester were excluded. Demographic data were extracted from the record. The primary outcome was a normal GCT or glucose tolerance test in the late second trimester. Logistic regression and receiver operator curves (ROC) were performed to assess the ability of the early GCT value to predict subsequent normal glucose screening. Results Of the 532 pregnant persons with normal early GCT, 62 (11.7%) were subsequently diagnosed with gestational diabetes in the second trimester. None of the patients (N = 56), who had a GCT value less than 80 mg/dL were diagnosed with gestational diabetes in the second trimester. The prediction of subsequent normal screening using the early GCT on a ROC plot produced an area under the curve (AUC) of 0.67, 95% CI (0.60–0.74). Adding age, prior history of gestational diabetes and family history of diabetes mellitus to the prediction, only improved the AUC to 0.75, 95% CI (0.66, 0.82). Conclusion Early GCT value was a fair predictor for normal second trimester glucose testing for gestational diabetes. However, high-risk patients with an early GCT value of less than 80 mg/dL may be able to forego repeat second trimester screening.

Hemoglobin A1c Value of Pregnant Diabetic Women with Their Neonatal Outcome

Background: HbA1c is now accepted as a standard measure for diagnosing type 2 diabetes mellitus. Maternal high HbA1c levels have been associated with increased risk of adverse neonatal outcomes. Objective: To find out the relationship between maternal HbA1c and neonatal outcomes. Materials &amp; Methods: This prospective observational study was conducted from February 2018 to January 2019 in the Department of Neonatology and Department of Gynecology &amp; Obstetrics, BSMMU, Dhaka. Diabetic mothers with known HbA1c Value and their infants who were born in this study period in BSMMU were enrolled. Neonates were divided into two groups. One group that had maternal HbA1c &lt;6% and the other group &gt;6%. Neonatal weights, routine capillary blood glucose were recorded. Results: Among the total 94 mothers, HbA1c level were &lt;6% in 56 mothers and ³6% in 38 mothers. The mean weight, BMI and previous history of gestational diabetes of mothers were significantly higher in HbA1c ³6% group. Birth weight and large for gestational age infants was high in ³6% HbA1c group. Neonatal hypoglycemia developed more in high HbA1c group. Total visible birth defect was 4 and all were in high HbA1c group (p=0.022). Conclusion: Elevated HbA1c level during pregnancy is a predictor for large for gestational age infants as well as neonatal hypoglycemia. BANGLADESH J CHILD HEALTH 2021; VOL 45 (2) : 74-78

Effects of Sleep-Extend on glucose metabolism in women with a history of gestational diabetes: a pilot randomized trial

ObjectivesWomen with a history of gestational diabetes (GDM) are at 7-fold increase in the risk of developing diabetes. Insufficient sleep has also been shown to increase diabetes risk. This study aimed to explore the feasibility of a sleep extension in women with a history of GDM and short sleep, and effects on glucose metabolism.MethodsWomen age 18–45 years with a history of GDM and actigraphy confirmed short sleep duration (<7 h/night) on weekdays were randomized at a ratio of 1 control (heathy living information) to 2 cases (6 weeks of “Sleep-Extend” intervention: use of a Fitbit, weekly digital content, and weekly coaching to increase sleep duration). An oral glucose tolerance test (OGTT), 7-day actigraphy recording, and questionnaires were obtained at baseline and 6 weeks. Mean differences between baseline and end-of-intervention parameters were compared using independent samples t-tests.ResultsMean (SD) sleep duration increased within the Sleep-Extend group (n=9, +26.9 (42.5) min) but decreased within the controls (n=5, − 9.1 (20.4) min), a mean difference (MD) of 35.9 min (95% confidence interval (CI) − 8.6, 80.5). Fasting glucose increased, but less in Sleep-Extend vs. control groups (1.6 (9.4) vs 10.4 (8.2) mg/dL, MD − 8.8 mg/dL (95% CI − 19.8, 2.1), while 2-h glucose levels after an OGTT did not differ. Compared to controls, Sleep-Extend had decreased fatigue score (MD − 10.6, 95%CI − 20.7, − 0.6), and increased self-report physical activity (MD 5036 MET- minutes/week, 95%CI 343, 9729. Fitbit compliance and satisfaction in Sleep-Extend group was high.ConclusionSleep extension is feasible in women with a history of GDM, with benefits in fatigue and physical activity, and possibly glucose metabolism. These data support a larger study exploring benefits of sleep extension on glucose metabolism in these high-risk women.Trial registrationClinicalTrials.gov, NCT03638102 (8/20/2018)

142-OR: Global Extended Polygenic Score Predicts Incident Type 2 Diabetes in Women with History of Gestational Diabetes

Around 30-50% of women with history of gestational diabetes (GDM) develop type 2 diabetes (T2D) within years after parturition. However, the role of polygenetic score on prediction of T2D in these women is still unclear. We aimed to investigate the utility of global extended polygenic scores (gePS) in predicting incident T2D using GDM cohorts from 1) UK Biobank (N=941) , 2) Seoul National University Hospital (SNUH, N=357) , and 3) Korean Genome and Epidemiology Study (KoGES, N=379) . We calculated gePS for T2D using Bayesian regression and continuous shrinkage priors, with summary statistics from representative genome-wide association studies in Europeans and East Asians. We performed time-to-event analysis for incident T2D with gePS and assessed improvement of C-statistic when gePS was added to clinical risk factors. In addition, risk of T2D was estimated for those who were in the top percentile of gePS compared to the remainders. The incidence of T2D was 19.8% in UK Biobank, 28.3% in SNUH, and 23.5% in KoGES cohort with median follow-up duration of 28, 4, and 28 years, respectively. The normalized mean PRS for those who developed T2D was higher in each cohort: 0.25±1.vs. -0.06±0.99 in UK Biobank, 0.22±1.vs. -0.09±0.97 in SNUH, and 0.52±0.96 vs. -0.16±0.96 in KoGES (all P&amp;lt;0.01) . When meta-analyzed, adding gePS to clinical risk factors improved the C statistic from 0.715 (95% confidence interval [CI] 0.658-0.766) to 0.743 (95% CI 0.698-0.784) . The standardized gePS was associated with incident T2D in women with history of GDM when the results of the three cohorts were meta-analyzed: hazard ratio 1.68 (95% CI 1.52-1.86, P&amp;lt;0.001) . Furthermore, those who were in the top percentile had 3.52-fold increased risk of T2D: (95% CI 2.68-4.62, P&amp;lt;0.001) . To sum up, genetic information in women with previous GDM pregnancy could be used to identify those who are at high risk of future development of T2D and provide the opportunity for tailored prevention. Disclosure J.Choi: None. H.Lee: None. M.Han: None. D.Choi: None. H.Jang: None. K.Park: None. S.Kwak: None.

FLOW MEDIATED-DILATATION IS ALREADY ABNORMAL IN PRE-IMPAIRED GLUCOSE TOLERANCE (PRE-IGT) AND WITH NO CORRELATION WITH SYSTOLIC BLOOD PRESSURE AND DIASTOLIC BLOOD PRESSURE

Objective: Pre-impaired glucose tolerance (Pre-IGT) is a stage of compensatory hyperinsulinemia to maintain normoglycemia. It is the earliest stage of glucose dysmetabolism, where beta cells can still compensate for the insulin resistance thru hyperinsulinemia. Endothelial dysfunction is a critical part in the pathogenesis of macrovascular and microvascular chronic complications in type 2 diabetes, ordinarily due to uncontrolled hyperglycemia. In pre-IGT the main problem is hyperinsulinemia on a background of normal blood sugar. C-peptide, a segment cleaved off from pro-insulin is equimolar to insulin, and has shown to cause intima media thickening. This study was undertaken to determine endothelial function of patients with pre-IGT thru flow-mediated dilatation of the brachial artery and to correlate the FMD with the insulin level, systolic blood pressure and diastolic blood pressure. Design and method: This is a cross-sectional analytical study of adult patients with risk factors for developing diabetes such as, having first-degree relative with diabetes, obesity, history of gestational diabetes, and polycystic ovary syndrome (PCOS). Systolic and diastolic BP, BMI, 2-hour serum insulin, blood sugar, and lipids were determined. Patients with pre-IGT underwent brachial artery FMD. Results: Of the 27 subjects, 21 (77.8%) had pre-IGT. The mean oral glucose tolerance test at 2-hours post-prandial was normal at 109.53 mg/dL (SD = 30.26). Results of the laboratory tests were as follows: mean Hba1c and insulin at 2 hours were 5.34% (SD = 0.44) and 112.21 uIU/mL (SD = 111.24, normal range 2.60–24.90), respectively. Comparative analyses of the demographic and clinical profiles showed similar characteristics between the normoinsulinemic and the pre-IGT subjects (p &gt; 0.05), although there were more with positive history of type 2 DM and obesity on the latter group. Systolic and diastolic BP levels were normal. Of the 27 subjects, four (4) had abnormal FMD which had a small positive correlation with thee insulin level, systolic BP, and diastolic BP, although not statistically significant (p &gt; 0.05). Conclusions: Endothelial dysfunction has shown to exist already in the pre-IGT subjects depicted in the abnormality in the arterial flow-mediated dilatation study. Systolic BP and diastolic BP levels have not shown any significant correlation with the FMD finding, and the insulin level.

1119-P: Persistent and Heterogeneous Long-Term Effects of the Diabetes Prevention Program (DPP) Intensive Lifestyle (ILS) Intervention on Diabetes Incidence

During the three years of the DPP, ILS reduced incidence of diabetes compared with placebo in high-risk adults. Diabetes was defined using ADA criteria based on 1) annual OGTT or semi-annual fasting glucose (the primary DPP outcome, diab-G, hazard ratio (HR) =0.42 and rate difference (RD) = -6.2 cases/100 person-years) or 2) annual HbA1c ≥ 6.5% (diab‑A1C, HR=0.51 and RD = -4.2) . After DPP ended, participants were unmasked, placebo was discontinued, and all participants were offered group-based ILS and followed in the DPP Outcomes Study. We now compare the original ILS and placebo groups over a mean of 21 years since randomization. We test heterogeneity across subgroups defined by demographics and baseline glucose, HbA1c, BMI, and history of gestational diabetes and express it by interaction p-values (P-het) . During the total follow-up, ILS, compared with placebo, significantly reduced incidence of diab‑G: HR=0.76 (95% CI=0.68, 0.85) , RD= -1.62 (-2.28, -0.97) and of diab-A1C: HR=0.80 (0.70, 0.92) , RD= -1.67 (‑2.24, -1.10) . Effects on diab-G were homogenous across subgroups except for fasting glucose (P-het &amp;lt;0.01) and HbA1c (P-het &amp;lt;0.02) with greater effects at higher baseline values. By contrast, ILS reduced incidence of diab-A1C more in older than younger persons (P-het &amp;lt;0.02) , and more in men than women (P-het &amp;lt;0.03) . Notably, ILS was highly effective in reducing incidence of diab‑A1C if baseline HbA1c was already elevated (HbA1c=6.0-6.4%: HR=0.62, RD= -3.27) but ineffective if baseline HbA1c was normal by ADA criteria (HbA1c &amp;lt;5.7%: HR=1.09, RD= +0.19; P-het &amp;lt;0.001) . In sum, ILS effects on reducing incidence of diab-G and diab-A1C persisted but decreased during total follow-up from that observed during DPP (i.e., HRs and RDs closer to 1 and 0) . ILS effects on diab-G were greater in those with higher baseline fasting glucose or HbA1c. Effects on diab-A1C were greater in men, older participants, and those with higher baseline HbA1c. Disclosure W.C. Knowler: None. S. Edelstein: None. P.H. Bennett: Stock/Shareholder; Baxter INTERNTN Health Care, Merck &amp; Co., Inc., UnitedHealth Group. D. Dabelea: None. M.A. Hoskin: None. S.E. Kahn: Advisory Panel; Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Intarcia Therapeutics, Inc., Merck &amp; Co., Inc., Novo Nordisk, Pfizer Inc. R. Kalyani: None. C. Kim: None. S. Raghavan: None. M. Temprosa: None. E.M. Venditti: Advisory Panel; PeopleOne Health. D.M. Nathan: None. D. Research Group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, and UDK048400)

The Genetics of Type 2 Diabetes in Youth: Where We Are and the Road Ahead

The Genetics of Type 2 Diabetes in Youth: Where We Are and the Road Ahead

Evaluation of knowledge about gestational diabetes mellitus among postpartum women and its connection with women's sociodemographic and clinical characteristics: a quantitative cross-sectional study

Objectiveto define the knowledge level among postpartum women affected by gestational diabetes and identify its association with women's sociodemographic and clinical characteristics. Design and Settinga cross-sectional comparative study was conducted. Data collection took place in a single university hospital in the German speaking part of Switzerland. Participantsa total of 107 postpartum women diagnosed with gestational diabetes in the current pregnancy completed a gestational diabetes mellitus specific knowledge questionnaire (GDMKQ) in German or English in their postpartum period. Further, sociodemographic and clinical characteristics were collected. ResultsWomen were between 24 and 45 years old, 56.1% had an academic degree, 60.7% were migrant women coming mainly from other European countries, 17.8% had a previous history of gestational diabetes, and 31.8% had a family history of diabetes. As measured with the GDMKQ, women with a higher educational level obtained higher scores and therefore showed a better knowledge level about gestational diabetes compared to women with primary and secondary educational levels (M 13.3 vs M 11.1 and 12.5; χ2 (2) = 13.003, p = .002). In addition, women with a previous history of gestational diabetes also reached higher scores compared to women with no history of gestational diabetes (M 13.6 vs M 12.5, Z = − 2.278, p = .023). Conclusion and implication for practiceEven if the knowledge status among women attending this single Swiss hospital is presently very good, a lower educational level was associated with a lower knowledge level and identified as the main factor to hinder women's comprehension of gestational diabetes. More individually tailored consultations by health care professionals may serve to meet women's needs more adequately and support them better in the understanding of their condition.

Oxidative Stress Contributes to Microvascular Endothelial Dysfunction in Women With a History of Gestational Diabetes

Women with a history of gestational diabetes mellitus (GDM) are twice as likely to develop cardiovascular disease as their age‐matched counterparts. GDM is associated with endothelial dysfunction and elevated oxidative stress during pregnancy, and vascular dysfunction postpartum. However, the mechanism(s) mediating this postpartum dysfunction are unknown. Using the cutaneous circulation as a model, we examined if oxidative stress contributes to microvascular dysfunction in healthy women with a history of GDM (GDM). We hypothesized that: 1) endothelium‐ and nitric oxide (NO)‐dependent dilation would be attenuated in GDM compared to women with a history of normal pregnancy (NP), and 2) local antioxidant (L‐ascorbate) administration would augment endothelium‐ and NO‐dependent dilation in GDM. Ten NP (35±1yrs) and 10 GDM (34±1yrs) underwent a standard local heating protocol (42°C; 0.1°C·s‐1). Two intradermal microdialysis fibers were placed in the ventral forearm for local delivery of lactated Ringer’s (control), or 5mM ascorbate. After full expression of the local heating response, 15mM NG‐nitro‐L‐arginine methyl ester (L‐NAME; NO synthase‐inhibition) was perfused. Red cell flux was measured continuously by laser‐Doppler flowmetry and cutaneous vascular conductance (CVC=flux/MAP) was standardized to maximum (%CVCmax; 28mM SNP + 43°C). Urine albumin to creatinine ratio (ACR) and plasma concentrations of oxidized LDL (oxLDL) and thiobarbituric acid reactive substances (TBARS) were measured. Women with history of GDM had attenuated endothelium‐dependent (GDM: 67±7 vs. NP: 90±4%CVCmax; p&lt;0.001) and NO‐dependent (GDM: 54±7 vs. NP: 71±3%; p=0.001) dilation at the control site and tended to have higher urine ACR (p=0.06). Both endothelium‐dependent (r2=0.53, p=0.02) and NO‐dependent (r2=0.56, p=0.01) dilation were related to urine ACR in GDM. Local ascorbate perfusion improved endothelium‐dependent (82±5%CVCmax; p=0.03 vs. control) and NO‐dependent (68±5%; p=0.02 vs. control) dilation in those with history of GDM but had no effect in HC (p&gt;0.05). There were no differences in plasma oxLDL (hxGDM:60.5 vs hxNP:50.9 U/L; p=0.18) or TBARS (hxGDM: 0.3 vs hxNP: 0.2 μM; p=0.26) concentrations between groups. These data suggest that otherwise healthy women with a history of GDM have attenuated microvascular endothelial function and that this dysfunction is mediated, in part, by oxidative stress at the level of the vasculature.

Association of Type 2 Diabetes Risk Perception With Interest in Diabetes Prevention Strategies Among Women With a History of Gestational Diabetes.

ObjectivesThe aims of this study were to identify predictors of perception of type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM) and to determine factors associated with interest in evidence-based strategies for type 2 diabetes prevention.Research Design and MethodsWe surveyed women with a history of GDM who had not progressed to type 2 diabetes from a large academic medical center. We used multivariate logistic regression to assess predictors of high levels of perception of type 2 diabetes risk. We also tested associations between risk perception and interest in a lifestyle change program and/or metformin therapy.ResultsIn our diverse sample of 264 women, 28% were unaware that GDM is a risk factor for incident type 2 diabetes after pregnancy, and 48% believed their personal risk of type 2 diabetes was low. In multivariate analyses, family history of diabetes (odds ratio [OR] 2.2, 95% CI 1.2–4.4) and knowledge of GDM as a risk factor for incident type 2 diabetes (OR 4.5, 95% CI 2.1–9.8) were significant predictors of greater perception of type 2 diabetes risk. Women with higher risk perception were more likely to express interest in a lifestyle change program compared with women with lower risk perception (OR 2.4, 95% CI 1.3–4.5).ConclusionAlthough some women are aware that GDM is a risk factor for incident type 2 diabetes, many still perceive their own risk of developing type 2 diabetes as low. Higher risk perception predicted interest in an evidence-based diabetes prevention program, highlighting the importance of personalized risk assessment and communication about risk for women who have had GDM.

Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China.

Background:Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.Methods:A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.Results:In 6204 participants, there are 1002 women (1002/6204, 16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02–1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01–1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.Conclusions:The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.