Frequency of diabetes in family members of probands with non-insulin-dependent diabetes mellitus

Self-management action and motivation of Pacific adults in New Zealand with end-stage renal disease

AIMS

To explore actions and motivations for self-management practices of Pacific adults following diagnosis of end stage renal disease (ESRD).

METHODS

Focused ethnography using in-depth interviews with 16 Pacific people on haemodialysis for diabetic ESRD, in Auckland, New Zealand. Study participants were of Samoan, Cook Islander, Tongan, Niuean, or Tokelauan ethnicity and aged between 30 to 69 years old. Thematic analysis was used to code and identify emergent themes.

RESULTS

All participants assumed active responsibility for their self-management following their diagnosis of ESRD. They reported positive differences in their current self-management behaviours, compared to pre-ESRD diagnosis. In the face of their terminal diagnosis, participant's motivations to self-manage their health were fuelled by hope; the hope to live long enough to change their family legacy of diabetes and ESRD. To achieve this, there was a dependency upon family members as a resource for self-management support. Yet at the same time, family members also had health concerns (including diabetes), and several participants themselves were carers for sick or elderly family members.

CONCLUSION

The growing number of members (within family units) progressing from moderate to late-stage diabetes raises concerns about the sustainability of future family support in Pacific families in New Zealand with histories of diabetes, ESRD, and other chronic diseases. While the burden upon informal carers (family) has been well documented throughout the past few decades, the dynamics of bi-directional carer support between (two or more) sick family members and their families have had less exposure. This has potentially significant implications for Pacific peoples in New Zealand, considering the increases in diabetes prevalence within their families.

Early life influences on cardio-metabolic disease risk in aboriginal populations--what is the evidence? A systematic review of longitudinal and case-control studies

BACKGROUND

We systematically reviewed the published evidence for the developmental origins of health and disease hypothesis among aboriginal populations from Australia, Canada, New Zealand and the USA.

METHODS

Medline, EMBASE and the Informit Health databases were systematically searched (March 2012) using medical subject headings and keywords for studies that examined the effect of prenatal factors and birth outcomes on later life (≥3 years) cardio-metabolic diseases. Quality of studies was independently assessed by two reviewers using a risk of bias assessment tool; main findings from studies with a low to moderate risk of bias were summarised qualitatively.

RESULTS

In all, 844 studies were found; 50 were included in the review of which 41 had a low-moderate risk of bias. There was strong evidence for an association between birth weight and type 2 diabetes (6/7 studies), impaired kidney function (6/7 studies) and high blood pressure (5/6 studies), whereas there was limited evidence for an association with metabolic abnormalities (4/7 studies) and adiposity (4/7). Exposure to maternal diabetes was strongly associated with type 2 diabetes (9/10 studies) and metabolic abnormalities (5/7 studies), whereas the association with adiposity was low (3/9 studies); the limited number of studies, to date, also show a relationship with high blood pressure (2/2 studies).

CONCLUSIONS

This review highlights that interventions to reduce the burden of cardio-metabolic disease among aboriginal populations should focus on improving maternal health, particularly by reducing the prevalence of diabetes in pregnancy. Future research should also be directed towards potential protective actions, such as breastfeeding.

Clinical Characteristics of Type 2 Diabetes Patients according to Family History of Diabetes

Background

Type 2 diabetes mellitus (T2DM) has a strong genetic component, and its prevalence is notably increased in the family members of T2DM patients. However, there are few studies about the family history of T2DM. We carried out this study to assess the influences of family history on clinical characteristics in T2DM patients.

Methods

This is a cross-sectional study involving 651 T2DM patients. Patient history and physical examination were performed and fasting blood was taken. If any first degree relative was diabetic, a family history of diabetes was considered to exist.

Results

Among the total 621 patients, 38.4% had a family history of diabetes. Patients with a family history had a younger age, higher weight, younger age at diagnosis and higher triglyceride level than did those without a family history. Dyslipidemia medication and metabolic syndrome were more prevalent in familial diabetes. Sex, blood pressure, previous treatment for diabetes, HbA1c, C-peptide, total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol were not different between familial and non-familial diabetes. Upon multiple linear regression analysis, the family history of diabetes remained significantly associated with serum triglyceride level.

Conclusion

In T2DM patients with a family history of diabetes, the disease tended to develop earlier. Metabolic syndrome and cardiovascular risk factors are more prevalent in familial T2DM than they were in non-familial T2DM. These results support the necessity of earlier screening for diabetes in family members of T2DM patients and more active prevention against cardiovascular disease in T2DM patients with a family history.

Prevalence of diabetes mellitus in a sample of the elderly population of the city of Catania

The prevalence of diabetes mellitus is increasing world-wide, even if it varies markedly in the geographical areas and populations investigated. This study is part of the Progetto Finalizzato Invecchiamento (Aging Project) of the Italian NCR (National Research Council) and is aimed at investigating the prevalence of diabetes and selected clinical characteristics in a study sample aged between 65 and 84 years of age resident in Catania (Italy). The prevalence rate for type II diabetes was 22.8% and it is certainly among the highest values recorded to date in other areas of Italy and abroad. We distinguished between two forms of diabetes in subjects >70 years of age: aged diabetes with onset in middle age (AD); and diabetes of senescence with onset after 70 years of age (DS). Prevalence rate was 18% for AD and 4.8% for DS, respectively. The age-specific rates of AD and DS show the progressive lower prevalence rates of the former and the higher rates of the latter. We assume that DS is mainly caused by atherosclerotic processes and represents the typical form of diabetes in the elderly.

The effect of paternal and maternal history of diabetes mellitus on the development of gestational diabetes mellitus

BACKGROUND

There is an ongoing debate whether maternal diabetes is a more important risk factor for gestational diabetes (GDM) development than paternal diabetes.

AIM

To describe the risk of GDM associated with paternal and maternal diabetes, and to further characterise GDM women with maternal diabetes.

SUBJECTS AND METHODS

Case-control study within a population-based GDM screening program in an urban area of Hungary in 2002-2003. All GDM women (no.=133) and an age-matched control group (no.=135) with a mean age of 31 years was evaluated. Blood pressure, anthropometric data, and blood glucose values from a 75 g Oral Glucose Tolerance Test (OGTT) were recorded at 24-28 weeks of gestation. Family history data were by self-report.

RESULTS

Known paternal diabetes was not related to GDM risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.35-2.00]. Known maternal diabetes (OR 2.90, 95% CI 0.99-8.49) and diabetes in the maternal line (OR 2.83, 95% CI 1.16-6.89) were both related to GDM after adjustment for body mass index (BMI). GDM women with known maternal diabetes had a higher BMI, 31.6 [9.1] kg/m2 median [interquartile range], than GDM women with or without diabetes in the maternal line, 26.1 [4.9] and 26.3 [6.1] kg/m2, respectively, while figures for fasting glucose during OGTT were 5.2 [0.7] vs 4.4 [1.1] vs 4.9 [0.8] mmol/l respectively (all p<0.05).

CONCLUSIONS

Maternal history of diabetes and history of diabetes in the maternal line seems to be a stronger predictor of GDM than paternal history.

Genetic liability to schizophrenia in Oceanic Palau: a search in the affected and maternal generation

While liability to schizophrenia (Scz) is due to genetic and environmental factors, specific factors are largely unknown. We postulate a two-hit model for Scz, in which initial liability is generated during fetal brain development: this "hit" is precipitated by environmental stressors biologically interacting with maternal genetic vulnerability to the stress. Additional liability to Scz is generated by individual genetic vulnerability. To evaluate these putative levels of vulnerability, we search in the genome of both affected individuals and their mothers for variation that differs, statistically, from that in the general population. For parental analyses, mothers were treated as "affected," rather than their offspring, and the fathers were treated as "controls". We used a sample from the Palauan population: 175 individuals diagnosed with Scz, broadly defined; 87 mothers and 45 fathers of affected individuals. Pedigree and diagnostic data were available on 2,953 living and deceased subjects. DNA from 553 individuals was genotyped for short tandem repeats (STR) spaced approximately every 10 cM across the genome. We tested for association between affection status and STR alleles; such an approach was reasonable, despite the widely spaced markers, because this population has far-ranging linkage disequilibrium (LD). Results for the truly affected individuals were modest, whereas results from the maternal generation were promising. For a recessive model and a test for excess allele matching across mothers, significant findings occurred for D20S481, D10S1221, D6S1021, D13S317, and D18S976. Regions in which at least two adjacent markers produced substantial association statistics include 2p12-11.2, 2q24.1-32.1, 6q12-14.1, 10q23.2-24.21, 12q23.2-24.21 and 17q23.2-23.3.

Inverse changes in fetal insulin-like growth factor (IGF)-1 and IGF binding protein-1 in association with higher birth weight in maternal diabetes

OBJECTIVE

The insulin like growth factor (IGF) system plays a key role in regulating fetal growth, is metabolically regulated, and may influence development of increased birth weight in offspring of mothers with diabetes. We examined IGF-1 and IGF binding protein-1 (IGFBP-1) concentrations in cord blood samples from offspring of mothers with gestational and type 2 diabetes.

DESIGN AND PATIENTS

Case-control study of Maori and Pacific Island mothers recruited prospectively at Middlemore Hospital, South Auckland, New Zealand.

MEASUREMENTS

Cord blood (for insulin, IGF-1 and IGFBP-1) was taken from umbilical vein at birth from singleton babies born after 32 weeks of gestation from138 mothers with gestational diabetes (GDM), 39 mothers with type 2 diabetes (T2DM) and 95 control mothers.

RESULTS

Babies born to mothers with both GDM and T2DM had significantly increased birth weight (Z-score birth weight mean +/- SD: GDM 0.94 +/- 1.31, T2DM 0.53 +/- 1.1) compared to controls (Z-score birth weight -0.08 +/- 1.10). IGFBP-1 was significantly reduced in both diabetic groups (median interquartile range: GDM 67(31-137) ng/ml, T2DM 59(29-105) ng/ml, control 114(56-249) ng/ml). Cord IGF-1 was significantly increased in cord blood of infants of mothers with GDM (42.2 +/- 16.3 ng/ml vs. control 34.7 +/- 18.5 ng/ml) but not T2DM (38.7 +/- 17.4 ng/ml). In all offspring, IGF-1 and IGFBP-1 were positively and negatively correlated with birth weight, respectively.

CONCLUSIONS

Maternal diabetes results in inverse changes of circulating fetal IGF-1 and IGFBP-1 at birth. A decrease in circulating IGFBP-1 and to a lesser extent an increase in circulating IGF-1 may present an important mechanism that contributes to increased birth weight in diabetic pregnancies.

Maternal transmission of diabetes

Type 2 diabetes mellitus represents a heterogeneous group of conditions characterized by impaired glucose homeostasis. The disorder runs in families but the mechanism underlying this is unknown. Many, but not all, studies have suggested that mothers are excessively implicated in the transmission of the disorder. A number of possible genetic phenomena could explain this observation, including the exclusively maternal transmission of mitochondrial DNA (mtDNA). It is now apparent that mutations in mtDNA can indeed result in maternally inherited diabetes. Although several mutations have been implicated, the strongest evidence relates to a point substitution at nucleotide position 3243 (A to G) in the mitochondrial tRNA(leu(UUR)) gene. Mitochondrial diabetes is commonly associated with nerve deafness and often presents with progressive non-autoimmune beta-cell failure. Specific treatment with Coenzyme Q10 or L-carnitine may be beneficial. Several rodent models of mitochondrial diabetes have been developed, including one in which mtDNA is specifically depleted in the pancreatic islets. Apart from severe, pathogenic mtDNA mutations, common polymorphisms in mtDNA may contribute to variations of insulin secretory capacity in normal individuals. Mitochondrial diabetes accounts for less than 1% of all diabetes and other mechanisms must underlie the maternal transmission of Type 2 diabetes. Possibilities include the role of maternally controlled environments, imprinted genes and epigenetic phenomena.

Can inaccuracy of reported parental history of diabetes explain the maternal transmission hypothesis for diabetes?

BACKGROUND

The mode of inheritance of type 2 diabetes mellitus is still under discussion. Several studies have suggested an excess maternal transmission, however, more recent studies could not always confirm these findings.

METHODS

We investigated the frequency of a maternal and paternal history of diabetes among diabetic and non-diabetic subjects and assessed the association between diabetes and a parental history of diabetes among participants of the MONICA Augsburg study. As an extension to previous studies, unknown parental status was taken into account.

RESULTS

Of the 542 diabetic probands, 25.3% reported a positive maternal history of diabetes and 10.9% reported a positive paternal history of diabetes. Among the 12,209 non-diabetic participants a positive maternal history was also more common than a positive paternal history (12.5% versus 7.1%). Conversely, an unknown paternal status was more common than an unknown maternal status in both groups (diabetic subjects: 27.9% versus 16.8%, non-diabetic subjects: 16.8% versus 8.4%). Adjusted odds ratios (OR) for the association between a parental history of diabetes and diabetes status were similar for a positive maternal (OR = 2.9, 95% CI : 2.3-3.6) and paternal history (OR = 2.8, 95% CI : 2.1-3.8) and for an unknown maternal (OR = 1.3, 95% CI : 1.0-1.8) and paternal history (OR = 1.5, 95% CI : 1.2-1.9).

CONCLUSION

Our findings do not support a strong excess maternal transmission of diabetes. Epidemiological biases and failure to account for 'don't know' responses may in part explain the previously observed predominance of a maternal history of diabetes.

Type 2 diabetes in children and adolescents: an emerging disease

The incidence of type 2 diabetes is increasing in the United States, and minority populations in particular seem to be affected. In the past, it was thought that type 2 diabetes occurred only in adults. However, an alarming epidemic has emerged, and children as young as 8 years of age are now being diagnosed with the disease. The purpose of this article is to present pediatric nurse practitioners with the most recent information about type 2 diabetes in children and adolescents, summarize current understanding about diagnosis, and outline treatment options.

Polynesians: prone to obesity and Type 2 diabetes mellitus but not hyperinsulinaemia

AIMS

To compare the extent of hyperinsulinaemia among New Zealand Europeans and Polynesians (an ethnic group at high risk of Type 2 diabetes mellitus).

METHODS

A cross-sectional survey from randomly selected households was conducted in inner urban South Auckland. Subjects were either European, Maori or Pacific Islands Polynesians aged 40-79 years and were screened for diabetes using a random blood glucose. Those with an elevated result, and 20% randomly selected from those with a normal screening result, were invited to a 75-g glucose tolerance test. WHO criteria (1998) for diabetes were used.

RESULTS

In those aged 40-59 years, total prevalence of diabetes was 7.5 (6.2-9.0)% in Europeans but 21.1 (16.6-25.6)% among Maori and 25.0 (19.8-30.1)% among Pacific peoples; obesity (body mass index >or= 31.0 kg/m2) was present in 26% Europeans, 63% Maori and 69% Pacific peoples. Non-diabetic Polynesians were relatively hyperglycaemic and hyperinsulinaemic. After adjusting for the degree of obesity, Polynesians had similar insulin levels to Europeans.

CONCLUSIONS

These findings indicate that Polynesians are not intrinsically insulin resistant as a group, a prerequisite found in most other ethnic groups at high risk of Type 2 diabetes mellitus. The high prevalence of Type 2 diabetes in Polynesians could be the result of their high prevalence of obesity.

Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS

OBJECTIVE

To determine the rate of clinically evident polycystic ovary syndrome (PCOS) among first-degree female relatives within families with a proband affected by PCOS.

DESIGN

Clinical and biochemical evaluation of the mothers and sisters of 93 patients with PCOS. The diagnosis of PCOS was established by: [1] a history of oligomenorrhea, [2] clinical evidence (i.e., hirsutism) or biochemical evidence (i.e., elevated total or free T) of hyperandrogenism, and [3] the exclusion of related disorders.

SETTING

Tertiary care university.

PATIENT(S)

Patients with PCOS and their mothers and sisters.

INTERVENTION(S)

Interview, physical examination, and hormonal testing on blood samples were performed for all subjects.

MAIN OUTCOME MEASURE(S)

The presence of hirsutism and hyperandrogenemia was determined in the mothers and sisters of the patients with PCOS.

RESULT(S)

Of the 78 mothers and 50 sisters evaluated clinically, 19 (24%) and 16 (32%) were affected with PCOS, respectively. A higher rate of PCOS was observed when only premenopausal women not taking hormones (i.e., untreated) were considered (i.e., 35% of mothers and 40% of sisters), consistent with amelioration of symptoms with hormonal therapy or aging. These rates of PCOS are significantly higher than that observed in our general population (approximately 4%) and suggest the involvement of a major genetic component in the disorder.

CONCLUSION(S)

The rates of PCOS in mothers and sisters of patients with PCOS were 24% and 32%, respectively, although the risk was higher when considering untreated premenopausal women only.

Influence of a familial history of diabetes on the clinical characteristics of patients with Type 2 diabetes mellitus

AIMS

To evaluate the roles of maternal and paternal diabetes and diabetes in relatives other than parents on the clinical characteristics in Type 2 diabetes mellitus.

METHODS

A total of 2,113 Type 2 diabetic patients were recruited, and those with diabetic mothers, diabetic fathers, diabetic relatives other than parents and no known diabetic relatives, were considered separately.

RESULTS

The prevalence of diabetes in the mother, father and other relatives was 25.5, 6.5 and 21.2%, respectively. No difference in the clinical characteristics was found in patients with diabetes in the mother or father. Patients with parental diabetes were significantly younger, with higher LDL-cholesterol, prevalence of retinopathy and lower age at diabetes diagnosis than those without familial diabetes; on multiple logistic regression, only age (P = 0.0003), age at diabetes diagnosis (P = 0.0014) (inverse association), and LDL-cholesterol (P = 0.030) remained significantly associated with parental diabetes. Patients with diabetic relatives other than parents displayed significantly higher total and LDL-cholesterol, prevalence of retinopathy and lower age at diabetes diagnosis that those with no known diabetic relatives; on multiple logistic regression, only age at diabetes diagnosis was inversely associated with diabetes in relatives other than parents (P = 0.013).

CONCLUSIONS

The data do not indicate a different influence of maternal and paternal diabetes on the clinical characteristics of Type 2 diabetic patients, while there is evidence that parental diabetes brings to an earlier onset of the disease and higher LDL-cholesterol values; the presence of diabetes in relatives other than parents constituted a small risk for earlier manifestation of the disease.

Perinatal mortality in Type 2 diabetes mellitus

AIMS

In many parts of the world the number of pregnancies in women with Type 2 diabetes mellitus (DM) now exceeds that in women with Type 1 DM, but there are few data published on perinatal mortality in Type 2 DM. This study reports observational data on perinatal mortality in Type 2 DM from a population with a high background rate of this disorder.

METHODS

Over a 12-year period (1985-1997) at the Diabetes Clinic at National Women's Hospital, Auckland, there were 434 pregnancies in women with Type 2 DM (256 known and 178 diagnosed with gestational diabetes mellitus (GDM), but confirmed to have Type 2 DM early post-partum), 160 pregnancies in women with Type 1 DM and 932 in women with GDM. Perinatal mortality was classified as either intermediate fetal death (20-28 weeks' gestation), late fetal death (28 weeks' gestation to term) or early neonatal death (up to 1 month post-partum).

RESULTS

The perinatal mortality in Type 2DM was 46.1/1,000, significantly higher than the rates for the general population (12.5), Type 1 DM (12.5) and GDM (8.9) (P < 0.0001). Congenital malformations accounted for only 10% of the perinatal mortality. There was a seven-fold increase in the rate of late fetal death and 2.5-fold increase in the rates of intermediate fetal and late neonatal death. Subjects with Type 2 DM were significantly older and more obese than subjects with Type 1 DM, and presented later to the diabetes service.

CONCLUSIONS

Perinatal mortality in Type 2 DM is significantly increased, mainly owing to an excess of late fetal death. Maternal factors such as obesity may be important contributors to the high perinatal mortality. Women diagnosed with GDM who have unrecognized Type 2 DM are also at high risk, but perinatal mortality is low in women with milder degrees of glucose intolerance in pregnancy.

Community development through partnership: promoting health in an urban indigenous community in New Zealand

Indigenous people who have been dispossessed of their lands and resources bear a disproportionate burden of health problems. Programmes aimed at improving their health status must operate within the context of colonisation history and the contemporary cultural renaissance whereby indigenous populations are asserting their rights to self-determination. Community development strategies incorporating empowerment as both means and end are consistent with the aspirations of the renaissance and reflect the principles of the Ottawa Charter for Health Promotion. This paper describes a formative and process evaluation of a community development partnership for health promotion between a health group and an urban Maori community in New Zealand. Key issues encountered related to trust, prioritisation of health, and appropriate research paradigms. Most significant among these was trust, or more specifically, distrust among Maori engendered by historical and contemporaneous experiences of contact with Europeans. Ultimately, the partnership achieved what it set out to do when the Maori partners took over the running of their own health groups and health programme. Building upon a detailed literature review and data from the evaluation, the paper offers a list of recommended procedures for the development of partnerships, applicable to health and other domains. Recommendations encompass preparatory steps, the formation of a partnership committee, programme planning and development, and the appointment of a community-based liaison worker. A conclusion of the research and premise underpinning the recommendations is that devolution of power is a key aspect of organisational process underlying successful partnerships involving professional groups and indigenous people.

Ethnic differences in diabetes care in a multiethnic community in New Zealand

Residents of two districts of South Auckland, New Zealand with a high proportion of Maori and Pacific Islands people were visited door to door to ascertain the prevalence of known diabetes and its tissue damage. The household survey canvassed 55,518 residents in 12,770 (91%) of 14,002 residences. Diabetes interviews were available for 176,214 (82%) Europeans, 286,336 (85%) Maori and 495,585 (85%) Pacific Islands diabetic patients. Europeans were older than Maori and Pacific Islands patients currently and at diagnosis. When compared with Europeans, Maori and Pacific Islands patients had a higher chance of having had their diabetes diagnosed in pregnancy, were least likely to be receiving antihypertensive or insulin therapy, were more likely to be blind, and were more likely to have received retinal photocoagulation. There were no ethnic differences in either the proportion of those receiving no ongoing care or in the proportion seen at least once by the diabetes services. Maori people were most likely to be current smokers, were most likely to have defaulted from the diabetic diet and to be dissatisfied with the diabetes service. Pacific Islands people were least likely to have neuropathic symptoms in their feet or to report a known myocardial infarction. Significant ethnic differences in diabetes and its care exist in South Auckland.