History Of Gestational Diabetes Research Articles

Adverse Pregnancy Outcomes and Future Metabolic Syndrome.

Background: Metabolic syndrome (MetS) is associated with a history of gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), and preterm birth (PTB), but it is unclear whether this association is due to the pregnancy complication(s) or prepregnancy/early pregnancy confounders. The study examines the association of GDM, HDP, and PTB with MetS 2-7 years later, independent of early pregnancy factors. Materials and Methods: Large, diverse cohort of nulliparous pregnant people with singleton gestations enrolled during their first trimester and who attended a follow-up study visit 2-7 years after delivery. The longitudinal cohort was recruited from eight medical centers across the United States. Using standardized protocols, anthropometry, biospecimens, and surveys were collected at study visits and pregnancy outcomes were abstracted from medical records. We estimated the relative risk of prevalent MetS at the follow-up study visit for participants with GDM, HDP, or PTB (vs. no complications), adjusting for early pregnancy age, body mass index, self-reported race/ethnicity, insurance type, and smoking status. Results: Of 4,402 participants, 738 (16.8%) had MetS at follow-up: 13.1% (441/3,365) among those with no complications, and 27.9% (290/1,002) among those with complications. MetS occurred in 39.0% of GDM (73/187, adjusted relative risk [aRR] = 1.75; 95% confidence interval [CI] 1.42-2.16); 29.2% of HDP (176/603, aRR = 1.49; 95% CI 1.27-1.75); and 29.7% of PTB (113/380, aRR = 1.78; 95% CI 1.49-2.12). Those who had both HDP and PTB (n = 113) had an aRR = 1.95 (95% CI 1.50-2.54). Conclusions: People whose pregnancies were complicated by GDM, HDP, or PTB are at a higher risk of MetS within 2-7 years after delivery, independent of early pregnancy risk factors. The highest MetS risk follows pregnancies complicated by both HDP and PTB.

Synergistic effect of non-alcoholic fatty liver disease and history of gestational diabetes to increase risk of type 2 diabetes.

Whether non-alcoholic fatty liver disease (NAFLD) improves risk prediction for subsequent type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (pGDM) is uncertain. We examined the combined effects of NAFLD and pGDM on risk prediction for incident T2DM. This retrospective cohort study included 97,347 Korean parous women without diabetes mellitus at baseline whose mean (SD) age was 39.0 (7.8) years. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident T2DM according to self-reported pGDM and ultrasound-diagnosed NAFLD at baseline. When combined with conventional diabetes risk factors, the incremental predictive ability of NAFLD and pGDM to identify incident T2DM was assessed. During a median follow-up of 3.9 years, 1,515 cases of incident T2DM occurred. Multivariable-adjusted HRs (95% confidence intervals [CIs]) for incident T2DM comparing pGDM alone, NAFLD alone, and both NAFLD and pGDM to the reference (neither NAFLD nor pGDM) were 2.61 (2.06-3.31), 2.26 (1.96-2.59), and 6.45 (5.19-8.00), respectively (relative excess risk of interaction = 2.58 [95% CI, 1.21-3.95]). These associations were maintained after adjusting for insulin resistance, body mass index, and other potential confounders as time-dependent covariates. The combination of NAFLD and pGDM improved risk prediction for incident T2DM (based on Harrell's C-index, also known as the concordance index, and net reclassification improvement) compared to conventional diabetes risk factors. In conclusion, NAFLD synergistically increases the risk of subsequent T2DM in women with pGDM. The combination of NAFLD and pGDM improves risk prediction for T2DM.

Frequency of gestational diabetes mellitus & its responsible factors among pregnant women presenting at a tertiary care hospital, Karachi

Controlling the related factors implicated in the development of GDM may help to mitigate the sharp rise in the prevalence of GDM and its detrimental effects on maternal and newborn problems. Maternal age (over 30 years), prior history of gestational diabetes, increased BMI, family history of diabetes, parity, belonging to an ethnic group with a high correlation with GDM and prior birth of a large baby are the key related factors of GDM. Aim: The main goal is to determine the frequency of gestational diabetes mellitus among pregnant women and its causing factors. Place and Duration: This Descriptive, cross-sectional study was held in Department of Gynecology, Liaquat National Hospital, Karachi from 16th January 2017 to 15th July 2017. Methods: 250 pregnant women with gestational diabetes mellitus between the 18-45 years of age were included. Multiple gestations, unbooked cases, and cases of known DM were not included. Development of gestational diabetes is the primary outcome factor which was determined. Maternal age, parity, gestational age, grand multiparity, BMI (for obesity), prior GDM, prior experience of macrosomic infant, family history of DM & PCOS are additional study variables (responsible factors).

Oxidative stress contributes to attenuated insulin-mediated dilation in the microvasculature of women with a history of gestational diabetes

Women with a history of gestational diabetes mellitus (GDM) are at greater risk for cardiovascular disease (CVD) and type II diabetes mellitus (T2DM). Endothelium- and nitric oxide-dependent dilation are attenuated in the microvasculature of otherwise healthy women with a history of GDM and this reduction is mediated, in part, by increased oxidative stress. However, whether this attenuation also reduces insulin-mediated microvascular responses in these women is unknown. We hypothesized that 1) insulin-mediated vasodilation would be attenuated, and that 2) antioxidant treatment would increase these responses, in women with a history of GDM compared to matched women with a history of healthy pregnancy (HC). Nine HC (32±6 yrs.) and 8 GDM (33±6 yrs.) participated in 1 experimental visit. Three microdialysis fibers were placed in the ventral forearm for the local delivery of lactated Ringer’s (control), 15mM N G-nitro-L-arginine methyl ester (L-NAME; NO synthase-inhibition), or 5mM ascorbate (non-specific antioxidant). Following baseline measurements, increasing doses of insulin [10-8 -10-4 M] were added to the site-specific perfusates. Red blood cell flux was measured continuously with laser-Doppler flowmetry, and cutaneous vascular conductance was calculated (CVC=flux/MAP) and standardized to maximum (%CVC max; 28mM SNP + 43°C). Subjects with GDM had attenuated insulin-mediated vasodilation (GDM:16.0 ± 3.0 vs. HC: 31.3 ± 4.7 %CVCmax; p= 0.02) at the control site. L-NAME attenuated insulin-mediated dilation in HC (14.7 ± 3.5 %CVCmax, p=0.004) but not in GDM (12.2 ± 1.9 %CVCmax, p=0.48). Local ascorbate perfusion increased insulin-mediated dilation in GDM (27.6 ± 7.2 %CVCmax; p=0.04) but had no effect in HC (p=0.85). These data suggest that women with a history of GDM have attenuated microvascular vasodilation responses to insulin, and that this attenuation is mediated, in part, by increased oxidative stress. Supported by The UI Fraternal Order of Eagles Diabetes Research Center This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A comparison in women with newly diagnosed diabetes between those with and without a history of gestational diabetes: a new perspective

AimsPrevious gestational diabetes mellitus (GDM) entails increased risk of future diabetes. We describe the characteristics of women with previous GDM and compare with no previous GDM from the cohort Diabetes in Kalmar and Kronoberg (DKK) of 1248 adults, 40% women, with new diabetes, and factors affecting age and C-peptide levels at diagnosis of diabetes.MethodsAge-at-diagnosis of diabetes, BMI, hypertension, hyperlipidemia, smoking, physical activity, and pre-existing myocardial infarction, stroke, or peripheral arterial insufficiency were registered at ordinary care visits close to diagnosis of diabetes, for the 43 women (9.4% of 456 from DKK with complete data for this analysis) with self-reported previous GDM (yes/no) and 86 controls without it, matched for date of diagnosis of diabetes. Blood samples were centrally analyzed for GADA and C-peptide for classification of diabetes.ResultsWomen with previous GDM had lower mean age-at-diagnosis of diabetes, 53.4 vs 65.0 years, lower systolic blood pressure (SBP), 131.2 vs 137.5 mmHg, and fewer had pre-existing hypertension than without previous GDM (p < 0.001–0.05). Among antibody negative women with previous GDM, BMI (p = 0.024), hypertension (p = 0.023) and hyperlipidemia (p < 0.001) were associated with higher levels of C-peptide, while physical activity was inversely associated (p = 0.035), and SBP (p = 0.02) and hypertension (p = 0.016) were associated with age-at-diagnosis of diabetes.ConclusionsWomen with previous GDM were a decade younger and had lower prevalence of hypertension at diagnosis of diabetes; C-peptide levels were associated with BMI, hypertension, and hyperlipidemia and showed a tendency to be lower, possibly indicating a phenotype with higher risk of overt cardiovascular disease later in life.

Carbohydrate Intake and Oral Glucose Tolerance Test Results in the Postpartum Period.

The American Diabetes Association (ADA) recommends a 3-day preparatory diet prior to a diagnostic oral glucose tolerance test (OGTT), a test often recommended in postpartum individuals with a history of gestational diabetes (GDM). Evaluate the relationship between carbohydrate intake and OGTT glucose in 2 cohorts of postpartum individuals. We performed analyses of postpartum individuals from 2 prospective studies with recent GDM (Balance after Baby Intervention, BABI, n = 177) or risk factors for GDM (Study of Pregnancy Regulation of INsulin and Glucose, SPRING, n = 104) .We measured carbohydrate intake using 24-hour dietary recalls (SPRING) or Food Frequency Questionnaire (BABI) and performed 2-hour 75-g OGTTs. The main outcome measure was 120-minute post-OGTT glucose. There was no relationship between carbohydrate intake and 120-minute post-OGTT glucose level in either study population (SPRING: β = 0.03, [-5.5, 5.5] mg/dL, P = .99; BABI: β = -3.1, [-9.5, 3.4] mg/dL, P = .35). Adding breastfeeding status to the model did not change results (SPRING β = -0.14, [-5.7, 5.5] mg/dL, P = .95; BABI β = -3.9, [-10.4, 2.7] mg/dL, P = .25). There was, however, an inverse relationship between glycemic index and 120-minute post OGTT glucose (BABI: β = -1.1, [-2.2, -0.03] mg/dL, P = .04). Carbohydrate intake is not associated with post-OGTT glucose levels among postpartum individuals. Dietary preparation prior to the OGTT may not be necessary in this population.

History of gestational diabetes and incident nonalcoholic fatty liver disease: The Kangbuk Samsung Health Study.

We examined the relationship between a prior history of gestational diabetes mellitus (pGDM) and risk of incident nonalcoholic fatty liver disease (NAFLD) and investigated the effect of insulin resistance or development of diabetes as mediators of any association. We performed a retrospective cohort study of 64,397 Korean parous women without NAFLD. The presence of, and the severity of NAFLD at baseline and follow-up were assessed using liver ultrasonography. Cox proportional hazards models were used to determine adjusted hazard ratios (aHRs) for incident NAFLD according to a self-reported GDM history, adjusting for confounders as time-dependent variables. Mediation analyses were performed to examine whether diabetes or insulin resistance may mediate the association between pGDM and incident NAFLD. During a median follow-up of 3.7 years, 6,032 women developed incident NAFLD (of whom 343 had moderate-to-severe NAFLD). Multivariable aHRs (95% confidence intervals) comparing women with time-dependent pGDM to the reference group (no pGDM) was 1.46 (1.33-1.59) and 1.75 (1.25-2.44) for incident overall NAFLD and moderate-to-severe NAFLD, respectively. These associations remained significant in analyses restricted to women with normal fasting glucose <100 mg/dl or that excluded women with prevalent diabetes at baseline or incident diabetes during follow-up. Diabetes and insulin resistance (HOMA-IR) each mediated <10% of the association between pGDM and overall NAFLD development. A prior history of GDM is an independent risk factor for NAFLD development. Insulin resistance, measured by HOMA-IR, and development of diabetes each explained only <10% of the association between GDM and incident NAFLD.

Lactation duration and lifetime progression to metabolic syndrome in women according to their history of gestational diabetes: a prospective longitudinal community-based cohort study

BackgroundDespite the many signs of progress in pharmacotherapies, metabolic syndrome (MetS) is one of the main public-health burdens worldwide. Our study aimed to compare the effect of breastfeeding (BF) in women with and without gestational diabetes mellitus (GDM) on MetS incidence.MethodsOf females who participated in the Tehran Lipid and glucose study, women who met our inclusion criteria were selected. The Cox proportional hazards regression model, with adjustment of potential confounders, was done to evaluate the relationship between duration of BF and incident of MetS in women with a GDM history compared to non-GDM.ResultsOut of 1176 women, there were 1001 non-GDM and 175 GDM. The median follow-up was 16.3 (11.9, 19.3) years. Results of the adjusted model illustrated that the total BF duration was negatively associated with MetS incidence risk (hazard ratio (HR) 0.98, 95% CI 0.98–0.99) in total participants indicating that per one-month increase of BF duration, the hazard of MetS reduced by 2%. The HR of MetS in Comparison between GDM and non-GDM women demonstrated significantly more reduced MetS incidence with a longer duration of exclusive BF (HR 0.93, 95% CI 0.88–0.98).ConclusionsOur findings illustrated the protective effect of BF, especially exclusive BF, on MetS incidence risk. BF is more effective in reducing the risk of MetS among women with a history of GDM than among women without such a history.

A Case of Mody 2 - Associated Hyperglycemia Diagnosed as Gestational Diabetes.

Maturity-onset diabetes of the young (MODY) is the most common monogenic form of diabetes, accounting for 1-2% of all diabetes cases. At least 14 different MODY subtypes have been identified the most common of which is MODY 2 caused by mutations in the glucokinase (GSK) gene. The mild hyperglycemia of MODY 2 is often first detected during pregnancy. Patients with MODY are usually misdiagnosed as either idiopathic type 1 or type 2 diabetes. The recognition of MODY 2 during pregnancy has important clinical implications as the management of hyperglycemia may differ from the established algorithm in gestational diabetes. Fetus development could be seriously affected in case it has inherited the GSK mutation and maternal hyperglycemia is insulin treated to the pregnancy adopted glycemic targets. The case report describes the stepwise diagnostic approach to a 43-year-old woman with a history of gestational diabetes and persistent prediabetes who was found to be a carrier of a heterozygous pathogenic variant in GSK (c.184G>A) and discusses the possible genotype of her two children according to their birth weight.

IDF2022-0788 Low conformity in women with a history of gestational diabetes

IDF2022-0788 Low conformity in women with a history of gestational diabetes

Abstract P324: Female Reproductive Factors and Risk of Type 2 Diabetes and Cardiovascular Disease Among Women With a History of Gestational Diabetes

Introduction: The link between gestational diabetes mellitus (GDM) and long-term risk of type 2 diabetes (T2D) and cardiovascular disease (CVD) is well established; however, risk factors underlying the progression of disease remain uncertain. Hypothesis: Female reproductive factors including ages at menarche, menopause, and first birth, number of live births, and surgically-induced menopause (uni- or bilateral oophorectomy or hysterectomy) are associated with higher risk of progression, while breastfeeding is associated with lower risk of progression from GDM to T2D/CVD. Methods: Participants in the Nurses’ Health Study II reported reproductive history at cohort baseline and over follow-up, including 5346 women with a history of GDM. Self-reported incident T2D or CVD (myocardial infarction, coronary revascularization or stroke) were confirmed via questionnaire or medical records. We estimated the hazard ratios (HR [95%]) across quintiles of each reproductive factor with incident T2D and CVD using Cox models adjusting for age, race/ethnicity, smoking, BMI at 18 years, physical activity, family history of T2D or CVD, alcohol intake, menopausal status, aspirin use, and Alternate Healthy Eating Index. Results: We documented 988 incident T2D and 149 CVD cases over 25 years of follow-up. In adjusted models, higher total lactation duration was associated with lower risk of T2D (5 categories: 0, 1-6, 7-12, 13-24, &gt;24 months, p for trend=0.01; highest vs. lowest category: HR 0.77 [95%CI: 0.60, 0.98]) and CVD (p for trend=0.03, HR 0.39 [95%CI: 0.19, 0.80]). Early age at menarche was linearly associated with higher risk of T2D (5 categories: ≤11, 12, 13, 14, &gt;14 y: p for trend &lt;0.0001), lowest (≤11 y) vs. reference (13 y) category: HR 1.28 [95%CI: 1.06, 1.53], while no trend could be observed for CVD outcomes (p for trend=0.48). Higher age at 1 st birth was associated with lower CVD risk (5 categories: &lt;23, 23-25 [reference], 26-29, 30-34, ≥35 y, p for trend=0.001; highest vs reference category: HR 0.17 [95%CI: 0.05, 0.57]), but not T2D). Compared with natural menopause, surgically induced menopause was associated with higher T2D risk: 1.32 (1.00, 1.73). Number of live births and age at menopause were not associated with T2D or CVD among women with GDM history. Conclusions: Breastfeeding was associated with lower T2D and CVD risks among women with GDM history, suggesting some shared risk factors or etiologies across reproductive lifespan and long-term cardiometabolic health. Ages at menarche and 1 st birth showed differential associations with T2D and CVD.

Trends in Screening for Diabetes in Early Pregnancy in the United States.

Objective: The aim of this study was to characterize current diabetes screening practices in the first trimester of pregnancy in the United States, evaluate patient characteristics and risk factors associated with early diabetes screening, and compare perinatal outcomes by early diabetes screening. Methods: This was a retrospective cohort study of US medical claims data of persons diagnosed with a viable intrauterine pregnancy and who presented for care with private insurance before 14 weeks of gestation, without pre-existing pregestational diabetes, from the IBM MarketScan® database for the period January 1, 2016, to December 31, 2018. Univariate and multivariate analyses were used to evaluate perinatal outcomes. Results: A total of 400,588 pregnancies were identified as eligible for inclusion, with 18.0% of persons receiving early screening for diabetes. Of those with laboratory order claims, 53.1% underwent hemoglobin A1c testing, 30.0% underwent fasting glucose testing, and 16.9% underwent oral glucose tolerance testing. Compared with those who did not undergo early diabetes screening, those who did were more likely to be older; obese; having a history of gestational diabetes, chronic hypertension, polycystic ovarian syndrome, or hyperlipidemia; and having a family history of diabetes. In adjusted logistic regression, history of gestational diabetes (adjusted odds ratio 3.99; 95% confidence interval 3.73-4.26) had the strongest association with early diabetes screening. Adverse perinatal outcomes, including a higher rate of cesarean delivery, preterm delivery, preeclampsia, and gestational diabetes, occurred more frequently among women who underwent early diabetes screening. Conclusions: First-trimester early diabetes screening was mostly commonly performed by hemoglobin A1c evaluation, and persons who underwent early diabetes screening were more likely to experience adverse perinatal outcomes.

Self-Efficacy and Readiness to Change Among Women with Recent Gestational Diabetes Engaging in a Web-Based Lifestyle Intervention: The Balance After Baby Intervention Trial

Few evidence-based programs exist to help women with a history of gestational diabetes reduce their risk of developing type 2 diabetes. In secondary analyses from a randomized clinical trial of a web-based lifestyle intervention program for postpartum women with recent gestational diabetes, we studied changes in self-efficacy for diet and physical activity and readiness to change health behaviors. Women were randomized at ∼6 weeks postpartum and completed questionnaires at 6 weeks and 6, 12, 18, and 24 months. Our study included 181 women (mean age 32.4 ± 5.2 years; 48% White, 19% Asian, 14% Black or African American, 17% other/mixed race; 34% Hispanic). In a linear mixed effects model, women in the intervention had significantly greater improvement in overall self-efficacy scores for physical activity compared with the control group at 24 months (difference in change scores between groups .35, 95% CI: .03 to .67, P = .03). The intervention group also demonstrated significantly greater improvement in self-efficacy scores for both physical activity subdomains, specifically “sticking to it” at 24 months and “making time” at 12 months. Participants in the intervention did not experience a significant difference in change in self-efficacy for diet or readiness to change compared with those in the control arm.

The Outcome of Obesity in Pregnancy: A Cross-Sectional Study

Objective: To find out fetal and maternal outcomes among obese pregnant females.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital Rawalpindi, from Jun 2020 to Jun 2021.&#x0D; Methodology: A total of 124 pregnant obese women (BMI more than 30kg/m2), gestational age between 13-24 months, having fasting blood glucose and blood pressure within normal limits were enrolled in the study and were subsequently followed throughout pregnancy upon antenatal visits scheduled as per guidelines. Participants with diabetes mellitus or hypertension,above 40 years of age, family or previous history of gestational diabetes, and pre-eclampsia were also excluded from the study. Fetal and maternal outcomes were noted.&#x0D; Results: One hundred and twenty-four (124) pregnant obese women were enrolled in the study with a mean age of 33.7±4.1 years (21 -38 years). Out of which, 86(69.4%) had cesarean section primarily due to pre-eclampsia, prolonged or dysfunctional labour causing fetal distress. There were 8 cases of miscarriage and 3 cases of stillbirth. 26(21.0%) women presented with gestational diabetes mellitus, 31(25.0%) with pre-eclampsia and 12(9.7%) developed both conditions. There were 7(5.6%) participants who delivered babies with macrosomia, 1(0.8%) anencephaly, 3(2.4%) congenital deafness and 1(0.8%) cleft lip.&#x0D; Conclusion: Obesity in pregnancy can lead to serious maternal and fetal outcomes ranging from abortions to neonatal anomalies and fetal death. A high index of suspicion is required to diagnose and manage these difficult conditions.

PS-C05-10: INDIVIDUALS WITH PRE-IMPAIRED GLUCOSE TOLERANCE (PRE-IGT) HAVE ALREADY ENDOTHELIAL DYSFUNCTION BUT WITH NO SIGNIFICANT IDENTIFIABLE CARDIOVASCULAR RISK FACTORS

Objective: Pre-impaired glucose tolerance (pre-IGT), characterized as normoglycemia with hyperinsulinemia, is the earliest stage of dysmetabolism in type 2 diabetes mellitus (DM). C-peptide, which is equimolar to insulin, has been shown to cause intima-media thickening when present in increased amounts. This study aims to determine the prevalence of endothelial dysfunction among individuals with pre-IGT and to determine the cardiovascular risk factors for developing endothelial dysfunction. Design and method: We employed a cross-sectional analytical study of adult patients with risk factors for developing diabetes [first-degree relative with type 2 DM, obesity, history of gestational diabetes (GDM), and polycystic ovary syndrome (PCOS)]. Brachial artery flow-mediated dilatation (FMD) was performed on pre-IGT patients to test for the presence of endothelial dysfunction. Cardiovascular risk factors evaluated were age, 2-hr insulin and glucose level after 75 gms OGTT, BMI, lipids, and systolic and diastolic blood pressure. Binary logistic regression was used to determine the significant risk factors affecting endothelial dysfunction, Results: Of the 67 subjects, 41 had pre-IGT with a prevalence of 61%. Among the pre-IGT who had FMD studies (31/41), seven had FMD (+) with a prevalence of 22.58%. Although statistically not significant, FMD (+) vs. FMD (-) subjects were respectively, older (mean 28.86 (SD 4.34) vs. 25.96 years (SD 25.96), p = 0.112), more obese (mean (SD) 26.87 (4.36) vs. 25.18 kg/m2 (4.83), p = 0.257), had higher 2nd hr glucose and HbA1c (mean (SD) 2-hr glucose; 106.34 (13.36) vs. 105 mg/dL (17.55), p = 0.620, mean (SD) HbA1c; 5.30 (0.37) vs. 5.23% (0.37), p = 0.669), and higher total cholesterol and LDL (mean (SD) cholesterol; 182.13 (21.51) vs.177.07 mg/dL (20.70), p = 0.620, mean (SD) LDL; 105.68 (3.77) vs. 98.58 mg/dL (19.25), p = 0.357). Conversely, FMD (+) vs. FMD (-) subjects had respectively, lower values of the following; 2nd hour insulin levels (mean (SD) 101.32 (76.10) vs. 122.44 uIU/mL (101.83), p = 0.450), mean (SD) systolic BP (109.71 (11.40) vs.110.67 mmHg (13.10), p = 0.886), and mean (SD) diastolic BP (71 (9.11) vs. 74.13 mmHg (10.60), p = 0.683). Similarly, the difference was not statistically significant. Comparative analyses also yielded no significant difference in the demographics (family history, GDM, PCOS) of the two groups. Conclusion: Endothelial dysfunction is already present among individuals with pre-IGT. The study did not demonstrate any significant difference in the previously reported cardiovascular risk factors contributing to endothelial function abnormality.

Measuring Diabetes Complications, Risk Factors and Capacity for Managing Diabetes: An Initial Step to Improve Diabetes Care at The Primary Health Centre in Tonga

Background: The small Pacific Island nation like Tonga has faced a crisis for decades due to premature loss of lives and disabilities due to diabetes. However, there is limited peer-reviewed literatures on the rates of diabetes complications and capacity for providing quality diabetes care in Tonga. The lack of adequate information in local context triggers significant challenges to make informed decision, proper planning, and effective implementation to improve diabetes care. Aim: This study aims to determine the prevalence of diabetes complications and associated risk factors among people with diabetes, and the capacity for managing diabetes as an initial step towards strengthening diabetes care at the primary health care setting in Tonga. Methods: This cross-sectional study was conducted on a sample of 207 people with diabetes from the primary health care centre in Tonga. People with diabetes were screened by qualified health professional using a standardised protocol, and the capacity of diabetes care was assessed by a standardised assessment form. Results: Of the 207 people with diabetes aged between 20 and 80 years screened for diabetes related complications, 135 (74%) had family history of diabetes, 57 (28%) female subjects had history of gestational diabetes, and 28 (14%) subjects were current smokers. The prevalence of overweight was 51%, obese was 38% and hypertension was 44%. The percentage of subjects with high cholesterol was 42%. HbA1c was measured and subjects with good, poor, and very poor blood glucose control were 15%, 49% and 36% respectively. The percentage of people with diabetes who had retinopathy was 18% and who were at risk of developing diabetic foot ulcer was 14%. This study also found that people with diabetes did not attend regular follow-up visits at the health care centre and the capacity to provide quality diabetes care services is limited. Conclusion: This study highlighted the urgent need to improve the quality and accessibility of diabetes care to reduce diabetes complications. The findings also provided a timely reminder to government and development partners to invest additional resources to effectively manage diabetes at the primary health care level. Tonga will require to strengthen a resilient health system to improve screening for early detecting of diabetes complications and enhance management services at the primary health care setting.

The risk of developing type 2 diabetes after gestational diabetes: A registry study from Finland

AimsWomen with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes (T2DM). We studied the risk for T2DM in women with and without GDM in relation to body mass index (BMI) and examined whether insulin treatment for GDM associates with the risk of developing T2DM. In addition, we investigated whether the risk of developing T2DM after GDM had changed in 15 years. MethodsWe used data by linking four registers; Medical Birth Register, Hospital Discharge Register and Primary Care Register run by THL Finnish Institute for Health and Welfare, and Medical Reimbursement Statistics run by the Social Insurance Institution of Finland (Kela). Registry data were collected from 2005 to 2020. The follow-up started from woman's delivery in 2006-2020 and ended to the diagnosis of T2DM or December 2020. Cox proportional hazard modelling was used to estimate the effect of GDM exposure to T2DM. To assess whether the risk of developing T2DM after GDM had changed in 15 years, we compared the HR between years 2006-2008 and 2018-2020. ResultsIn total, 462 401 women were included in the study: 96 353 (21%) women had previous GDM. There were 5370 (1.2%) women who developed T2DM after childbirth during the follow-up. Among women with prior GDM, 3995 (4.1%) developed T2DM, while 1375 (0.4%) women without prior GDM developed T2DM during follow-up. The mean follow-up was 6.86 years (SD 4.21) for women with GDM and 9.07 years (SD 4.35) for women without GDM. The hazard ratio (HR) for developing T2DM after GDM was 18.49 (95% CI 17.39-19.67). The incidence of T2DM in women with a history of GDM began to rise almost steadily from the first year of follow-up. As BMI increased, T2DM incidence increased in both women with and without prior GDM but more in women with prior GDM. Insulin treatment had an independent association with increased risk of T2DM (HR 3.81, 95% CI 3.57-4.07). We did not observe any difference in HR between years 2006-2008 and 2018-2020. ConclusionsThe relative risk for T2DM was 11-fold for women with previous GDM compared to women without previous GDM. A higher BMI and insulin treatment increased the risk of future diabetes. All measures to prevent the conversion of GDM to T2DM should be taken especially among women with overweight or obesity.

Habitual coffee consumption and subsequent risk of type 2 diabetes in individuals with a history of gestational diabetes – a prospective study

Females with a history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes mellitus (T2D) later in life. This study prospectively examined whether greater habitual coffee consumption was related to a lower risk of T2D among females with a history of GDM. We followed 4522 participants with a history of GDM in the NHS II for incident T2D between 1991 and 2017. Demographic, lifestyle factors including diet, and disease outcomes were updated every 2-4 y. Participants reported consumption of caffeinated and decaffeinated coffee on validated FFQs. Fasting blood samples were collected in 2012-2014 from a subset of participants free of diabetes to measure glucose metabolism biomarkers (HbA1c, insulin, C-peptide; n=518). We used multivariable Cox regression models to calculate adjusted HRs and 95% CIs for the risk of T2D. We estimated the least squares mean of glucose metabolic biomarkers according to coffee consumption. A total of 979 participants developed T2D. Caffeinated coffee consumption was inversely associated with the risk of T2D. Adjusted HR (95% CI) for≤1 (nonzero), 2-3, and 4+cups/d compared with 0 cup/d (reference) was 0.91 (0.78, 1.06), 0.83 (0.69, 1.01), and 0.46 (0.28, 0.76), respectively (P-trend=0.004). Replacement of 1 serving/d of sugar-sweetened beverage and artificially sweetened beverage with 1 cup/d of caffeinated coffee was associated with a 17% (risk ratio [RR]=0.83, 95% CI: 0.75, 0.93) and 9% (RR=0.91, 95% CI: 0.84, 0.99) lower risk of T2D, respectively. Greater caffeinated coffee consumption was associated with lower fasting insulin and C-peptide concentrations (all P-trend<0.05). Decaffeinated coffee intake was not significantly related to T2D but was inversely associated with C-peptide concentrations (P-trend=0.003). Among predominantly Caucasian females with a history of GDM, greater consumption of caffeinated coffee was associated with a lower risk of T2D and a more favorable metabolic profile.

Association of maternal diabetes during pregnancy with attention deficit hyperactivity disorder in offspring in an Iranian population: A case-control study

Background and aims: Gestational diabetes has long-term adverse consequences for both the mother and child and seems to be a risk factor for attention deficit hyperactivity disorder (ADHD) in children. However, no research has been conducted in this regard in Iran. Methods: This was a case-control study. The sample consisted of 225 children who were referred to the general and psychiatric clinic of Besat Hospital in Sanandaj and were evaluated for a history of maternal diabetes in the fetal period. The diagnosis of ADHD in children was based on a structured clinical interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) by a psychiatrist and a short and revised form of Conners’ parent scale. The data were analyzed using Stata 14. Results: The results showed that 25.3% of the mothers of children with ADHD had gestational diabetes during pregnancy, and 17.3% were taking diabetes medication. However, the results revealed that there is no statistically significant relationship between the history of gestational diabetes and ADHD (P=0.427). Furthermore, the logistic regression results demonstrated that the place of residence (P&lt;0.027, OR=8.351) increases the probability of suffering from ADHD in children, while the age of the mother during pregnancy (P&lt;0.031, OR=0.907) decreases the probability of the child suffering from ADHD. Conclusion: Although cohort studies have associated gestational diabetes with an increased risk of ADHD in children, the results of this case-control study do not support this association.

PSUN264 Insulin Edema: A rare side effect of Intensive Insulin Therapy

Abstract Insulin therapy associated generalized edema is a rare entity. The true incidence is unknown. It has been reported mostly in patients with poorly controlled diabetes mellitus started on intensive insulin regimens. The severity ranges from mild lower extremity swelling to anasarca. Management is primarily supportive with salt restrictions, diuretics and if possible, reduction of insulin doses. We present a case of a 39-year-old African American woman who developed generalized edema after initiation of insulin. She had history of gestational diabetes and presented to the endocrinology clinic to establish care after being hospitalized with Diabetic Ketoacidosis (DKA). She was diagnosed with diabetes mellitus initially during her pregnancy two years prior and was treated with insulin. After pregnancy, she was lost to follow up. She was then admitted to the hospital with severe DKA and was discharged on multiple daily injections of insulin. On the initial encounter in clinic, the patient endorsed developing abdominal distension and lower extremity swelling with insulin use previously so she was not using insulin consistently. Her physical examination was unremarkable. Lab work was significant for hemoglobin A1C of &amp;gt;15%, C-peptide 0.9 ng/mL (1.1-4.4 ng/mL), islet cell antibody 0.09 nmol/L (&amp;lt;0.02 nmol/L), glutamic acid decarboxylase antibody 0.40 nmol/L (&amp;lt;0.02 nmol/L). Her kidney and liver function were normal. She had normal thyroid function and cortisol levels. Her echocardiogram revealed normal cardiac function and she had non proliferative diabetic retinopathy on retinal exam. The patient was started on insulin and a continuous glucose monitor was placed to assess her glycemic patterns. Three days after starting insulin, she developed generalized body swelling involving face, abdomen, and lower extremities. The patient was advised to cut back on salt and started on low dose furosemide. On follow up one month later, her abdominal swelling had improved however she still had pitting lower extremity edema. On follow up two months later the edema completely resolved. Clinicians should be aware of the presentation and management of insulin induced edema. In most of the cases in literature, insulin induced edema started after starting insulin in newly diagnosed Type 1 diabetes or uncontrolled Type 2 diabetes. The pathophysiology is unclear. There is some evidence that insulin deficiency causes a catabolic state and hyperglycemia increases tissue capillary permeability. Re-introduction of insulin causes free water retention and renal excretion of sodium. This along with increased capillary permeability can lead to insulin edema. Water retention caused by the effect of counter regulatory hormones can also play a role. Insulin edema needs to be differentiated from other causes of diffuse edema. Management is generally supportive including temporarily decreasing insulin doses, salt restriction and diuretics as needed. Patient reassurance is important as well to aid in adherence to the prescribed insulin regimen. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.