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Mattsson K, Nilsson-Condori E, Elmerstig E, Vassard D, Schmidt L, Ziebe S, Jöud A. Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study. Fertil Steril 2021; 116:505-513. [PMID: 34353572 DOI: 10.1016/j.fertnstert.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/12/2021] [Accepted: 02/05/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey. DESIGN Register-based cohort study using the Skåne Healthcare Register SETTING: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years PATIENT(S): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcare-seeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434). INTERVENTION(S) None MAIN OUTCOME MEASURE(S): Childbirth, miscarriage, and infertility diagnosis RESULT(S): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity. CONCLUSION(S) Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment.
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Affiliation(s)
- Kristina Mattsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden; Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
| | | | - Eva Elmerstig
- Center for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren Ziebe
- The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
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Ek AE, Samuelsson U, Janson A, Carlsson A, Elimam A, Marcus C. Microalbuminuria and retinopathy in adolescents and young adults with type 1 and type 2 diabetes. Pediatr Diabetes 2020; 21:1310-1321. [PMID: 32613727 DOI: 10.1111/pedi.13074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/26/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022] Open
Abstract
AIM To estimate the occurrence of complications related to early-onset type 2 diabetes compared with type 1 diabetes. METHODS All individuals registered in the Swedish Pediatric Quality Diabetes Register and the Swedish National Diabetes Register with type 2 diabetes diagnosis at 10 to 25 years of age between 1996 and 2014 (n = 1413) were included. As controls, individuals with type 1 diabetes were randomly selected from the same registers and were matched for age, sex, and year-of-onset (n = 3748). RESULTS Of the adolescents with type 2 diabetes in the pediatric register, 7.7% had microalbuminuria and 24.6% had signs of retinopathy 5 years after diagnosis, whereas the adolescents with type 1 diabetes 3.8% had microalbuminuria and 19.2% had retinopathy. Among the young adults with type 2 diabetes from the adult diabetes register 10 years after diagnosis 15.2% had microalbuminuria and 39.7% retinopathy, whereas the young adults with type 1 diabetes 4.8% had microalbuminuria and 43.8% retinopathy. After adjustment for established risk factors measured over time in the whole combined cohort, individuals with type 2 diabetes had significantly higher risk of microalbuminuria with a hazard ratio (HR) of 3.32 (95% confidence interval, CI 2.86-3.85, P < .001), and retinopathy with a HR of 1.17 (95% CI 1.06-1.30, P 0.04). CONCLUSIONS The prevalence of complications and comorbidities was higher among those with type 2 diabetes compared with type 1 diabetes, although prevalent in both groups. Early monitoring and more active treatment of type 2 diabetes in young individuals is required.
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Affiliation(s)
- Anna E Ek
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden.,Pediatric Endocrinology and Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Annika Janson
- Pediatric Endocrinology and Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.,National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden.,Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Annelie Carlsson
- Pediatrics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Amira Elimam
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden.,Pediatric Endocrinology and Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
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Tojjar J, Norström F, Myléus A, Carlsson A. The Impact of Parental Diabetes on the Prevalence of Childhood Obesity. Child Obes 2020; 16:258-264. [PMID: 32271617 DOI: 10.1089/chi.2019.0278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Obesity among children and adolescents is a worldwide public health concern. Type 1 diabetes (T1D) and type 2 diabetes (T2D) incidence are increasing, with heredity and socioeconomic status as possible risk factors. How these factors affect the risk of childhood obesity remains unclear. The aim of this study was to investigate the association between obesity and parental diabetes among 12-year-olds in Sweden, and how it relates to parental education level. Methods: We used data collected within the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a cross-sectional multicenter national screening study for celiac disease in 12-year-old children. Relative risk (RR) and confidence interval (CI) were calculated for the association between parental diabetes and obesity, also stratifying for gender and highest parental education. Results: Among 11,050 children, for both children with parental T1D and T2D, 31% of the children were overweight or obese, compared with 21% among other children. Comparing those with parental T1D with those without parental T1D within gender, boys had a statistically significant higher risk [RR 1.6 (95% CI 1.3-2.0)], and girls had a nonsignificant increased risk [RR 1.3 (95% CI 0.95-1.8)], of being overweight. For children with parental T2D, both boys and girls had a statistically significant increased risk of 1.5. Parental education showed no sign of influencing the RRs. Conclusions: Parental diabetes is associated with an increased risk of overweight among children, independent of parental education. Concomitant parental diabetes and overweight should be particularly alarming criteria when prioritizing preventive interventions at an early age.
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Affiliation(s)
- Jasaman Tojjar
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health and Family Medicine, Umeå University, Umeå, Sweden
| | - Anna Myléus
- Department of Epidemiology and Global Health and Family Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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Reinehr T. Type 2 Diabetes Mellitus in Adolescents: Should We Reconsider Screening? Horm Res Paediatr 2019; 89:56-57. [PMID: 29084400 DOI: 10.1159/000481912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Ehehalt S, Wiegand S, Körner A, Schweizer R, Liesenkötter KP, Partsch CJ, Blumenstock G, Spielau U, Denzer C, Ranke MB, Neu A, Binder G, Wabitsch M, Kiess W, Reinehr T. Diabetes screening in overweight and obese children and adolescents: choosing the right test. Eur J Pediatr 2017; 176:89-97. [PMID: 27888412 DOI: 10.1007/s00431-016-2807-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 01/11/2023]
Abstract
UNLABELLED Type 2 diabetes can occur without any symptoms, and health problems associated with the disease are serious. Screening tests allowing an early diagnosis are desirable. However, optimal screening tests for diabetes in obese youth are discussed controversially. We performed an observational multicenter analysis including 4848 (2668 female) overweight and obese children aged 7 to 17 years without previously known diabetes. Using HbA1c and OGTT as diagnostic criteria, 2.4% (n = 115, 55 female) could be classified as having diabetes. Within this group, 68.7% had HbA1c levels ≥48 mmol/mol (≥6.5%). FPG ≥126 mg/dl (≥7.0 mmol/l) and/or 2-h glucose levels ≥200 mg/dl (≥11.1 mmol/l) were found in 46.1%. Out of the 115 cases fulfilling the OGTT and/or HbA1c criteria for diabetes, diabetes was confirmed in 43.5%. For FPG, the ROC analysis revealed an optimal threshold of 98 mg/dl (5.4 mmol/l) (sensitivity 70%, specificity 88%). For HbA1c, the best cut-off value was 42 mmol/mol (6.0%) (sensitivity 94%, specificity 93%). CONCLUSIONS HbA1c seems to be more reliable than OGTT for diabetes screening in overweight and obese children and adolescents. The optimal HbA1c threshold for identifying patients with diabetes was found to be 42 mmol/mol (6.0%). What is Known: • The prevalence of obesity is increasing and health problems related to type 2 DM can be serious. However, an optimal screening test for diabetes in obese youth seems to be controversial in the literature. What is New: • In our study, the ROC analysis revealed for FPG an optimal threshold of 98 mg/dl (5.4 mmol/l, sensitivity 70%, specificity 88%) and for HbA1c a best cut-off value of 42 mmol/mol (6.0%, sensitivity 94%, specificity 93%) to detect diabetes. Thus, in overweight and obese children and adolescents, HbA1c seems to be a more reliable screening tool than OGTT.
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Affiliation(s)
- Stefan Ehehalt
- Public Health Department of Stuttgart, Department of Pediatrics, Dental Health Care, Health Promotion and Social Services, Schloßstraße 91, 70176, Stuttgart, Germany.,Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany.
| | - Antje Körner
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany
| | - Roland Schweizer
- Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Klaus-Peter Liesenkötter
- Endokrinologikum Berlin am Gendarmenmarkt, Friedrichstraße 76, Jägerstraße 61, 10117, Berlin, Germany
| | | | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - Ulrike Spielau
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Eythstr. 24, D-89073, Ulm, Germany
| | - Michael B Ranke
- Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Andreas Neu
- Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Gerhard Binder
- Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Eythstr. 24, D-89073, Ulm, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital, University Witten/Herdecke, Dr. F. Steiner Str. 5, D-45711, Datteln, Germany
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Helminen O, Pokka T, Tossavainen P, Ilonen J, Knip M, Veijola R. Continuous glucose monitoring and HbA1c in the evaluation of glucose metabolism in children at high risk for type 1 diabetes mellitus. Diabetes Res Clin Pract 2016; 120:89-96. [PMID: 27525364 DOI: 10.1016/j.diabres.2016.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/03/2016] [Accepted: 07/30/2016] [Indexed: 11/21/2022]
Abstract
AIMS Continuous glucose monitoring (CGM) parameters, self-monitored blood glucose (SMBG), HbA1c and oral glucose tolerance test (OGTT) were studied during preclinical type 1 diabetes mellitus. METHODS Ten asymptomatic children with multiple (⩾2) islet autoantibodies (cases) and 10 age and sex-matched autoantibody-negative controls from the Type 1 Diabetes Prediction and Prevention (DIPP) Study were invited to 7-day CGM with Dexcom G4 Platinum Sensor. HbA1c and two daily SMBG values (morning and evening) were analyzed. Five-point OGTTs were performed and carbohydrate intake was assessed by food records. The matched pairs were compared with the paired sample t-test. RESULTS The cases showed higher mean values and higher variation in glucose levels during CGM compared to the controls. The time spent ⩾7.8mmol/l was 5.8% in the cases compared to 0.4% in the controls (p=0.040). Postprandial CGM values were similar except after the dinner (6.6mmol/l in cases vs. 6.1mmol/l in controls; p=0.023). When analyzing the SMBG values higher mean level, higher evening levels, as well as higher variation were observed in the cases when compared to the controls. HbA1c was significantly higher in the cases [5.7% (39mmol/mol) vs. 5.3% (34mmol/mol); p=0.045]. No differences were observed in glucose or C-peptide levels during OGTT. Daily carbohydrate intake was slightly higher in the cases (254.2g vs. 217.7g; p=0.034). CONCLUSIONS Glucose levels measured by CGM and SMBG are useful indicators of dysglycemia during preclinical type 1 diabetes mellitus. Increased evening glucose values seem to be common in children with preclinical type 1 diabetes mellitus.
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Affiliation(s)
- Olli Helminen
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Tytti Pokka
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Päivi Tossavainen
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, University of Turku and Turku University Hospital, Turku, Finland
| | - Mikael Knip
- Tampere Centre for Child Health Research, Tampere University Hospital, Tampere, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Riitta Veijola
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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