Gestational diabetes: after the ACHOIS trial

Prevalence of non-alcoholic fatty liver disease and its associated factors in individuals with type 1 diabetes: a cross-sectional study in a tertiary care center in Brazil

BACKGROUND

Data on non-alcoholic fatty liver disease (NAFLD) in individuals with type 1 diabetes (T1D) is controversial and so far, there are no published data on the Brazilian population. We investigated the prevalence of steatosis and hepatic fibrosis in a population with T1D from a tertiary care center in Brazil and its associated factors.

METHODS

Ninety-five participants with T1D, aged 39 ± 13 years, with disease duration of 21 ± 9 years, being 55 (57.9%) females, from a university hospital in Rio de Janeiro, were screened for NAFLD with hepatic ultrasound (US) and transient elastography (TE).

RESULTS

Prevalence of steatosis was, respectively, 12.6% and 16.8% when US and TE were used for diagnosis of NAFLD. Fibrosis was present in 8.4% of participants. A total of 31.6% of participants had at least one of the hepatic exams altered, which was associated with higher body mass index, waist circumference, hip circumference and waist-to-hip ratio,, presence of metabolic syndrome and higher triglycerides levels, even within the normal range. After multivariate analysis, presence of steatosis was only associated with metabolic syndrome and its component, triglycerides.

CONCLUSION

In our study, prevalence of NAFLD in ultrasound approximates the one found with TE. Fibrosis was not frequent. Screening should be reserved for participants with T1D and metabolic syndrome, as this was the main factor associated with NAFLD. Triglycerides levels were the only component of metabolic syndrome associated with steatosis. Further studies are necessary to determine the best screening strategy for NAFLD in individuals with T1D. Also, predisposing factors for development in fibrosis in T1D should be further explored in prospective studies.

The IDEAL study: investigation of dietary advice and lifestyle for women with borderline gestational diabetes: a randomised controlled trial - study protocol

BACKGROUND

The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) showed that treatment of pregnant women with mild gestational diabetes mellitus is beneficial for both women and their infants. It is still uncertain whether there are benefits of similar treatment for women with borderline gestational diabetes.This trial aims to assess whether dietary and lifestyle advice and treatment given to pregnant women who screen for borderline gestational diabetes reduces neonatal complications and maternal morbidities.

METHODS/DESIGN

DESIGN

Multicentre, randomised controlled trial.

INCLUSION CRITERIA

Women between 240 and 346 weeks gestation with a singleton pregnancy, a positive oral glucose challenge test (venous plasma glucose ≥7.8 mmol/L) and a normal oral 75 gram glucose tolerance test (fasting venous plasma glucose <5.5 mmol/L and a 2 hour glucose <7.8 mmol/L) with written, informed consent.Trial entry and randomisation: Women with an abnormal oral glucose tolerance test (fasting venous plasma glucose ≥5.5 mmol/L or 2 hour glucose ≥7.8 mmol/L) will not be eligible and will be offered treatment for gestational diabetes, consistent with recommendations based on results of the ACHOIS trial. Eligible women will be randomised into either the 'Routine Care Group' or the 'Intervention Group'.Study groups: Women in the 'Routine Care Group' will receive routine obstetric care reflecting current clinical practice in Australian hospitals. Women in the 'Intervention Group' will receive obstetric care, which will include dietary and lifestyle advice, monitoring of blood glucose and further medical treatment for hyperglycaemia as appropriate.Primary study outcome: Incidence of large for gestational age infants.

SAMPLE SIZE

A sample size of 682 women will be sufficient to show a 50% reduction in the risk of large for gestational age infants (alpha 0.05 two-tailed, 80% power, 4% loss to follow up) from 14% to 7% with dietary and lifestyle advice and treatment.

DISCUSSION

A conclusive trial outcome will provide reliable evidence of relevance for the care of women with borderline glucose intolerance in pregnancy and their infants.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry - ACTRN12607000174482.

Gestational diabetes: relevance of diagnostic criteria and preventive strategies for Type 2 diabetes mellitus

OBJECTIVE

Women with gestational diabetes mellitus (GDM) are at risk to develop Type 2 diabetes mellitus (DM(2)). The aim of this study was to compare the effect of three international diagnostic criteria on the prevalence of GDM with its implications for prevention of DM(2 )in the population.

MATERIALS AND METHODS

One thousand one hundred and seventy-two pregnant women, who underwent the 75-g oral glucose tolerance test for routine, antenatal GDM screening, were classified using the criteria of the American Diabetes Association (ADA), the World Health Organization (WHO) and Australasian Diabetes in Pregnancy Society (ADIPS). The population-attributable risk, (PAR) was used to estimate the proportion of women with DM(2) in the community, who may have been identified much in advance for intervention, by a GDM pregnancy.

RESULTS

Using the ADA, WHO and ADPIS criteria, respectively: (a) the prevalence of GDM was 166 (14.2%), 242 (20.6%) and 271 (23.1%) (p < 0.0001); (b) The PAR (95% CI) was 42% (31-52%); 51% (39-62%) and 54% (42-64%). Overall, by all three criteria, 132 (11.3%) women had GDM while 859 (73.3%) were without GDM; the remaining 181 (15.4%) women had classification differences between them.

CONCLUSION

The universal acceptance and the ability of the WHO criteria to detect over half the women with DM(2) earlier during pregnancy, makes it ideally suited to identify women with GDM.