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Rioles N, March C, Muñoz CE, Ilkowitz J, Ohmer A, Wolf RM. Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care. Endocrinol Metab Clin North Am 2024; 53:165-182. [PMID: 38272594 DOI: 10.1016/j.ecl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.
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Affiliation(s)
| | - Christine March
- Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia E Muñoz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Amy Ohmer
- International Children's Advisory Network, Atlanta, GA, USA
| | - Risa M Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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2
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Sangtani A, Owens L, Broome DT, Gogineni P, Herman WH, Harris LH, Oshman L. The Impact of New and Renewed Restrictive State Abortion Laws on Pregnancy-Capable People with Diabetes. Curr Diab Rep 2023; 23:175-184. [PMID: 37213059 DOI: 10.1007/s11892-023-01512-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE OF REVIEW When the Supreme Court handed down its decision in Dobbs v Jackson Women's Health Organization in June 2022, the constitutional right to abortion was no longer protected by Roe v Wade. Fifteen states now have total or near-total bans on abortion care or no clinics providing abortion services. We review how these restrictions affect the medical care of people with pregestational diabetes. RECENT FINDINGS Of the ten states with the highest percent of adult women living with diabetes, eight currently have complete or 6-week abortion bans. People with diabetes are at high risk of diabetes-related pregnancy complications and pregnancy-related diabetes complications and are disproportionately burdened by abortion bans. Abortion is an essential part of comprehensive, evidence-based diabetes care, yet no medical society has published guidelines on pregestational diabetes that explicitly discuss the importance and role of safe abortion care. Medical societies enacting standards for diabetes care and clinicians providing diabetes care must advocate for access to abortion to reduce pregnancy-related morbidity and mortality for pregnant people with diabetes.
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Affiliation(s)
- Ajleeta Sangtani
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - David T Broome
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Preethi Gogineni
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology and Department of Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Simkovich SM, Foeller ME, Tunçalp Ö, Papageorghiou A, Checkley W. Integrating non-communicable disease prevention and control into maternal and child health programmes. BMJ 2023; 381:e071072. [PMID: 37220922 PMCID: PMC10203824 DOI: 10.1136/bmj-2022-071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Suzanne M Simkovich
- Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA
- Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington USA
| | - Megan E Foeller
- Department of Obstetrics and Gynaecology, St Alphonsus Regional Medical Center, Boise, USA
| | - Özge Tunçalp
- UNDP, UNFPA, Unicef, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Aris Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
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Ivanisevic M, Marcinko D, Vuckovic-Rebrina S, Delmis J. Positive Association between Preserved C-Peptide and Cognitive Function in Pregnant Women with Type-1 Diabetes. Biomedicines 2022; 10:biomedicines10112785. [PMID: 36359305 PMCID: PMC9687841 DOI: 10.3390/biomedicines10112785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
This study focused on the cognitive function of women with type 1 diabetes in pregnancy. We investigated risk factors for a low cognitive score such as age, duration of Diabetes, BMI, subclinical hypothyroidism, cardiovascular autonomic neuropathy, the impact of hypo-/hyperglycemia, and C-peptide preservation. Material and methods. Seventy-eight pregnant women with type 1 diabetes (age 31.1 ± 5.4 years, diabetes duration 14.3 ± 8.9 years) were included in the study. Cognitive function was assessed in different domains, such as reasoning, memory, attention, coordination, and perception. Results. The cognitive test values ≥400 were considered high scores, and values <400 were considered low. Relative risks for low scores for general cognitive function were associated with increased BMI > 25 kg/m2 2.208 (95% CI 1.116−4.370), HbA1c > 6.5% RR 0.774 (95% CI 0.366−1.638), subclinical hypothyroidism RR 3.111 (95% CI 1.140−8.491), and impaired cardiovascular autonomic neuropathy RR 2.250 (95% CI 1.000−5.062). Pregnant women with a lower score for general cognitive function had higher BMI and higher leptin levels. Preserved C-peptide reduces the risk for cognitive impairment (RR 0.297 (95% CI 0.097−0.912)) in pregnant women with type 1 diabetes Conclusion. BMI > 25 kg/m2, subclinical hypothyroidism, and cardiovascular autonomic neuropathy are associated with increased risk, and postprandial C-peptide preservation with reduced risk for cognitive impairment in pregnant women with type 1 diabetes.
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Affiliation(s)
- Marina Ivanisevic
- Department of Obstetrics and Gynecology, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, 10000 Zagreb, Croatia
| | - Darko Marcinko
- Clinic for Psychiatry and Psychological Medicine, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, 10000 Zagreb, Croatia
| | - Sandra Vuckovic-Rebrina
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Josip Delmis
- Department of Obstetrics and Gynecology, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-98-460-485
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Silva CM, Arnegard ME, Maric-Bilkan C. Dysglycemia in Pregnancy and Maternal/Fetal Outcomes. J Womens Health (Larchmt) 2020; 30:187-193. [PMID: 33147099 PMCID: PMC8020552 DOI: 10.1089/jwh.2020.8853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Maternal dysglycemia-including diabetes, impaired glucose tolerance, and impaired fasting glucose-affects one in six pregnancies worldwide and represents a significant health risk to the mother and the fetus. Maternal dysglycemia is an independent risk factor for perinatal mortality, major congenital anomalies, and miscarriages. Furthermore, it increases the longer-term risk of type 2 diabetes mellitus, metabolic syndrome, cardiovascular morbidity, malignancies, and ophthalmic, psychiatric, and renal diseases in the mother. The most commonly encountered form of maternal dysglycemia is gestational diabetes. Currently, international consensus does not exist for diagnostic criteria defining gestational diabetes at 24-28 weeks gestation, and potential diagnostic glucose thresholds earlier in gestation require further investigation. Likewise, recommendations regarding the timing and modality (e.g., lifestyle or pharmacological) of treatment vary greatly. Because a precise diagnosis determines the appropriate treatment and outcome of the pregnancy, it is imperative that a better definition of maternal dysglycemia and its treatment be achieved. This article will address some of the controversies related to diagnosing and managing maternal dysglycemia. In addition, the article will discuss the impact of maternal dysglycemia on complications experienced by the mother and infant, both at birth and in later life.
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Affiliation(s)
- Corinne M Silva
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew E Arnegard
- Office of Research on Women's Health, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Maric-Bilkan
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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