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Ngwezi DP, Savu A, Yeung RO, Butalia S, Kaul P. Temporal Trends in Type 1, Type 2, and Gestational Diabetes in Pregnancy: Impact of Rural Residence, Ethnicity, and Material Deprivation. Can J Diabetes 2023; 47:672-679.e3. [PMID: 37474099 DOI: 10.1016/j.jcjd.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/24/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Our aim in this study was to implement a newly validated algorithm to identify pregnant women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM), and to identify temporal trends in rates over the last decade. We also compared obstetric and neonatal outcomes of pregnancies with and without diabetes mellitus (DM). METHODS Among women with live births between 2005 and 2018 in Alberta, we calculated yearly rates of T1DM, T2DM, and GDM, overall, and stratified by ethnicity, urban or rural residence, material deprivation score, and maternal age. RESULTS Between 2005 and 2018, GDM rates increased from 42.3 to 101.8 per 1,000 deliveries (p<0.0001), T2DM rates increased from 2.6 to 6.4 per 1,000 deliveries (p<0.0001), whereas T1DM remained constant at 3.0 per 1,000 deliveries each year (p=0.4301). Higher GDM and T2DM rates were observed among Chinese and South Asian women, respectively, and among women who were materially deprived and living in urban areas. Women with T2DM were older and had the highest rates of pre-existing hypertension (16%). In contrast, women with T1DM were younger and had the highest rates of gestational hypertension (12%), pre-eclampsia (12%), and cesarean section deliveries (62%). Children of women with T1DM had the highest rates of large for gestational age (46%), neonatal hypoglycemia (41.1%), respiratory distress syndrome (7.7%), and jaundice (29.3%). CONCLUSIONS Diabetes-in-pregnancy rates have more than doubled over the last decade, driven primarily by increases in GDM and T2DM. These trends may have significant implications for the future health of mothers and children in Alberta.
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Affiliation(s)
- Deliwe P Ngwezi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, Edmonton, Alberta, Canada
| | - Anamaria Savu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Padma Kaul
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, Edmonton, Alberta, Canada.
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Physical activity and health-related quality of life among high-risk women for type 2 diabetes in the early years after pregnancy. BMC Womens Health 2022; 22:84. [PMID: 35313870 PMCID: PMC8939162 DOI: 10.1186/s12905-022-01664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous studies have shown that physical activity (PA) correlates positively with health-related quality of life (HRQoL) in the general population. Few studies have investigated associations between device-measured PA and HRQoL among premenopausal women at risk for type 2 diabetes (T2D). In addition to physical well-being, general well-being improved by PA has been suggested to strengthen PA’s benefits in reducing metabolic diseases. The aim of this study was to examine the associations between PA and HRQoL (general and dimensions) among high-risk women in the early post-pregnancy years when T2D risk is highest and to estimate whether current obesity or prior gestational diabetes (GDM) modified these associations. Methods This cross-sectional study of high-risk women [body mass index (BMI) ≥ 30 kg/m2 and/or prior GDM)]4–6 years after delivery measured sleep, sedentary time, daily steps, and light (LPA), moderate-to-vigorous (MVPA), and vigorous PA (VPA) with the SenseWear ArmbandTM accelerometer for seven days and HRQoL with the 15D instrument. Results The analyses included 204 women with a median (IQR) age of 39 (6.0) years and a median BMI of 31.1 kg/m2 (10.9). 54% were currently obese (BMI ≥ 30 kg/m2), and 70% had prior gestational diabetes (GDM+). Women with obesity had lower PA levels than women with normal weight or overweight (p < 0.001) but there was no difference between the GDM+ or GDM− women. Women with both current obesity and GDM+ had highest sedentary time and lowest PA levels. The whole sample’s median 15D score was 0.934 (IQR 0.092), lower among women with obesity compared to the others (p < 0.001), but not different between GDM+ or GDM−. There was a positive correlation between VPA (adjusted rs = 0.262 p = 0.001) and the 15D score. After grouping according to BMI (< and ≥ 30 kg/m2), the associations remained significant only in women without obesity. Among them, sleep, total steps, MVPA, and VPA were positively associated with 15D. Conclusions Higher PA levels are associated with better HRQoL among high-risk women with normal weight and overweight but no differences were found among women affected by obesity in the early years after pregnancy. Trial registration Ethics committees of Helsinki University Hospital (Dnro 300/e9/06) and South Karelian Central Hospital (Dnro 06/08).
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Haschka SJ, Gar C, Sacco V, Banning F, Ferrari U, Freibothe I, Kern-Matschilles S, Potzel AL, Rauch B, Fueessl LU, Meisel M, Benz I, Then C, Seissler J, Lechner A. Pre-diabetes, diabetes and fluctuations of glucose tolerance after gestational diabetes mellitus: 5-year follow-up of a contemporary, prospective study in Germany. BMJ Open Diabetes Res Care 2022; 10:10/2/e002621. [PMID: 35241429 PMCID: PMC8895937 DOI: 10.1136/bmjdrc-2021-002621] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/29/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Ten years ago, Germany started offering screening for gestational diabetes mellitus (GDM) to all pregnant women. This approach revealed more but also, on average, less severe cases of GDM than the risk-based screening practiced previously. We now examined the incidence of pre-diabetes and diabetes following a GDM diagnosis in the era of universal screening in Germany and compared our results with studies in the previous period. Additionally, we examined the year-to-year fluctuations of glucose tolerance after a pregnancy complicated by GDM. RESEARCH DESIGN AND METHODS We report 5-year follow-up data from 202 women in the prospective, monocenter, postpartum study PPSDiab. Consecutive recruitment took place in Munich, Germany between 2011 and 2016. In the study, we conducted yearly examinations that included anthropometrics, laboratory chemistry and oral glucose tolerance testing. RESULTS During the first 5 years post partum, 111 (55%) and 12 (6%) of the women developed pre-diabetes and type 2 diabetes, respectively, while 2 (1%) developed type 1 diabetes. Impaired fasting glucose (IFG) was the most common first manifestation of disturbed glucose tolerance, followed by impaired glucose tolerance (IGT), the combination of IFG and IGT, and diabetes. Glucose tolerance did not deteriorate steadily in most women but fluctuated from year to year. CONCLUSIONS In our analysis, the incidence of diabetes, both type 1 and type 2, after GDM diagnosed in universal screening was substantially lower than in studies from the previous period of risk-based screening. Nevertheless, the high incidence of pre-diabetes we observed after GDM still confirms the importance of this diagnosis as a risk marker. Additionally, we documented frequent fluctuations of glucose tolerance from 1 year to the next. Therefore, a single postpartum glucose tolerance test, as currently practiced in routine care, may be insufficient for reliable risk stratification after GDM.
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Affiliation(s)
- Stefanie J Haschka
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Christina Gar
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Vanessa Sacco
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Friederike Banning
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Uta Ferrari
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Ines Freibothe
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Stefanie Kern-Matschilles
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Anne L Potzel
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Barbara Rauch
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Louise U Fueessl
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Mandy Meisel
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Irina Benz
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Cornelia Then
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Andreas Lechner
- Diabetes Research Group, LMU Klinikum; Medizinische Klinik und Poliklinik IV, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München; German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Metabolic syndrome in women with previous gestational diabetes. Sci Rep 2021; 11:11558. [PMID: 34078945 PMCID: PMC8172609 DOI: 10.1038/s41598-021-90832-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
To evaluate the incidence and timing of the diagnosis of metabolic syndrome in a cohort of Danish women after a pregnancy with gestational diabetes (GDM) to estimate the optimum time for preventative actions in relation to metabolic syndrome (MetS). In this follow-up study, 435 women were included from a consecutive cohort with prior history of GDM. Data on dyslipidemia, hypertension and other cardiovascular disorders (CVD) were extracted from the electronic patient journal. Any antidiabetic, cardiovascular and cholesterol-lowering medicine was ascertained in the national prescription database. Similarly, any blood test taken was evaluated. We defined a patient having MetS if the criteria of the WHO based definition of diabetes or impaired glucose regulation were met. Further, we added as alternative for glucose intolerance, a glycosylated hemoglobin (HbA1c) > 44 mmol/mol or the former level ≥ 6.5%. Further, dyslipidemia, lipid lowering medications, BMI > 30 kg/m2 or antihypertensive treatment were used. For MetS outcome, diagnosis or medication for CVD was registered. All women were followed for median 5.7 years (range 0; 9). The incidence of MetS was 28%. Thirteen percent of these qualified already within one year after pregnancy for the diagnosis of MetS. Postpartum MetS was detected after a median of 3 years (range 0; 7 years); further, 36 (8%) had been diagnosed with manifest diabetes after pregnancy. The diagnosis of postpartum MetS was strongly associated with the prevalence of manifest diabetes. Six years after pregnancy the rate of metabolic syndrome was more than tripled (25 vs. 89%, no DM vs manifest DM, RR: 6.7; 95% CI 2.7–17, p < 0.001). At 40 years the MetS rate nearly tripled if manifest DM was diagnosed (26 vs. 78%, no DM vs. manifest DM, RR: 3.3, 95% CI 1.8–6, p < 0.001). We found that GDM and later on manifest DM in women increase the risk of metabolic syndrome. There seems to be a window of opportunity before the early thirties where it would be especially beneficial to begin preventive efforts in women with GDM.
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Versace VL, Beks H, Wesley H, McNamara K, Hague W, Anjana RM, Mohan V, Khunti K, Dunbar JA. Metformin for Preventing Type 2 Diabetes Mellitus in Women with a Previous Diagnosis of Gestational Diabetes: A Narrative Review. Semin Reprod Med 2021; 38:366-376. [PMID: 33860488 DOI: 10.1055/s-0041-1727203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at greater risk of developing type 2 diabetes mellitus (T2DM) when compared with women who have not had GDM. To delay or prevent T2DM, guidelines recommend regular screening in the primary care setting and lifestyle interventions that are largely focused on dietary and physical activity modifications. As the postpartum period can be challenging for women, uptake and engagement in screening and lifestyle interventions have been poor. Poor uptake and engagement places women with a history of GDM at heightened risk for future morbidity and development of T2DM. Metformin has been a longstanding and safe treatment for the control of blood glucose in people with T2DM. Research has supported the efficacy of metformin, used as an adjunct to a lifestyle intervention or as a stand-alone treatment, in preventing T2DM in people at high risk of T2DM. Findings from longitudinal studies have demonstrated the potential for metformin to reduce conversion to T2DM when used by women with a previous diagnosis of GDM. This review examines the potential effectiveness of metformin to reduce the incidence of T2DM among women with a previous diagnosis of GDM in the "real-world" setting.
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Affiliation(s)
| | - Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | - Hannah Wesley
- School of Medicine, Deakin University, Geelong, Australia.,Madras Diabetes Research Foundation, Chennai, India
| | - Kevin McNamara
- School of Medicine, Deakin University, Geelong, Australia
| | - William Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - James A Dunbar
- School of Medicine, Deakin University, Geelong, Australia
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