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Mohan S, Egan AM. Diagnosis and Treatment of Hyperglycemia in Pregnancy: Type 2 Diabetes Mellitus and Gestational Diabetes. Endocrinol Metab Clin North Am 2024; 53:335-347. [PMID: 39084811 PMCID: PMC11296496 DOI: 10.1016/j.ecl.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Hyperglycemia in pregnancy due to pre-existing Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) is rising globally with increasing rates of risk factors for metabolic disease. This review summarizes current evidence and recommendations from national and international guidelines for diagnosis and management of T2DM and GDM to optimize maternal and neonatal outcomes.
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Affiliation(s)
- Sneha Mohan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/SnehaMohanEndo
| | - Aoife M Egan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Gómez-Peralta F, Leiva-Gea I, Duque N, Artime E, Rubio de Santos M. Impact of Continuous Glucose Monitoring and its Glucometrics in Clinical Practice in Spain and Future Perspectives: A Narrative Review. Adv Ther 2024:10.1007/s12325-024-02943-5. [PMID: 39093492 DOI: 10.1007/s12325-024-02943-5] [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: 03/15/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Continuous glucose monitoring (CGM) devices allow for 24-h real-time measurement of interstitial glucose levels and have changed the interaction between people with diabetes and their health care providers. The large amount of data generated by CGM can be analyzed and evaluated using a set of standardized parameters, collectively named glucometrics. This review aims to provide a summary of the existing evidence on the use of glucometrics data and its impact on clinical practice based on published studies involving adults and children with type 1 diabetes (T1D) in Spain. METHODS The PubMed and MEDES (Spanish Medical literature) databases were searched covering the years 2018-2022 and including clinical and observational studies, consensus guidelines, and meta-analyses on CGM and glucometrics conducted in Spain. RESULTS A total of 16 observational studies were found on the use of CGM in Spain, which have shown that cases of severe hypoglycemia in children with T1D were greatly reduced after the introduction of CGM, resulting in a significant reduction in costs. Real-world data from Spain shows that CGM is associated with improved glycemic markers (increased time in range, reduced time below and above range, and glycemic variability), and that there is a relationship between glycemic variability and hypoglycemia. Also, CGM and analysis of glucometrics proved highly useful during the COVID-19 pandemic. New glucometrics, such as the glycemic risk index, or new mathematical approaches to the analysis of CGM-derived glucose data, such as "glucodensities," could help patients to achieve better glycemic control in the future. CONCLUSION By using glucometrics in clinical practice, clinicians can better assess glycemic control and a patient's individual response to treatment.
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Affiliation(s)
| | - Isabel Leiva-Gea
- Pediatric Endocrinology Service, Hospital Regional de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Natalia Duque
- Eli Lilly and Company, Av. de la Industria 30, Alcobendas, 28108, Madrid, Spain.
| | - Esther Artime
- Eli Lilly and Company, Av. de la Industria 30, Alcobendas, 28108, Madrid, Spain
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3
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Bovee LB, Hirsch IB. Should We Bury HbA1c? Diabetes Technol Ther 2024; 26:509-513. [PMID: 38350127 DOI: 10.1089/dia.2024.0028] [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] [Indexed: 02/15/2024]
Affiliation(s)
- Laura B Bovee
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Irl B Hirsch
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
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Dodesini AR, Ciriello E, Bellante R, Corsi A, Giunta MR, Scaranna C, Albizzi M, Lepore G, Trevisan R. Maternal glycaemic levels are associated with incidence of large for gestational age neonates in type 1 diabetic women in pregnancy. Nutr Metab Cardiovasc Dis 2024; 34:2018-2019. [PMID: 38744582 DOI: 10.1016/j.numecd.2024.03.029] [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: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Affiliation(s)
| | - Elena Ciriello
- Gynaecology and Obstetrics Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Rosalia Bellante
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Corsi
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Cristiana Scaranna
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mascia Albizzi
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giuseppe Lepore
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Trevisan
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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Søholm JC, Nørgaard SK, Nørgaard K, Clausen TD, Damm P, Mathiesen ER, Ringholm L. Mean Glucose and Gestational Weight Gain as Predictors of Large-for-Gestational-Age Infants in Pregnant Women with Type 1 Diabetes Using Continuous Glucose Monitoring. Diabetes Technol Ther 2024; 26:536-546. [PMID: 38417013 DOI: 10.1089/dia.2023.0583] [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] [Indexed: 03/01/2024]
Abstract
Aims/hypothesis: To compare glycemic metrics during pregnancy between women with type 1 diabetes (T1D) delivering large-for-gestational-age (LGA) and appropriate-for-gestational-age (AGA) infants, and to identify predictors of LGA infants. Materials and Methods: A cohort study including 111 women with T1D using intermittently scanned continuous glucose monitoring from conception until delivery. Average sensor-derived metrics: mean glucose, time in range in pregnancy (TIRp), time above range in pregnancy, time below range in pregnancy, and coefficient of variation throughout pregnancy and in pregnancy intervals of 0-10, 11-21, 22-33, and 34-37 weeks were compared between women delivering LGA and AGA infants. Predictors of LGA infants were sought for. Infant growth was followed until 3 months postdelivery. Results: In total, 53% (n = 59) delivered LGA infants. Mean glucose decreased during pregnancy in both groups, with women delivering LGA infants having a 0.4 mmol/L higher mean glucose from 11-33 weeks (P = 0.01) compared with women delivering AGA infants. Mean TIRp >70% was obtained from 34 weeks in women delivering LGA infants and from 22-33 weeks in women delivering AGA infants. Independent predictors for delivering LGA infants were mean glucose throughout pregnancy and gestational weight gain. At 3 months postdelivery, infant weight was higher in infants born LGA compared with infants born AGA (6360 g ± 784 and 5988 ± 894, P = 0.04). Conclusions/interpretations: Women with T1D delivering LGA infants achieved glycemic targets later than women delivering AGA infants. Mean glucose and gestational weight gain were independent predictors for delivering LGA infants. Infants born LGA remained larger postdelivery compared with infants born AGA.
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Affiliation(s)
- Julie Carstens Søholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Sidse K Nørgaard
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kirsten Nørgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Tine D Clausen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lene Ringholm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Koefoed AS, Knorr S, Fuglsang J, Leth-Møller M, Hulman A, Jensen DM, Andersen LLT, Rosbach AE, Damm P, Mathiesen ER, Sørensen A, Christensen TT, McIntyre HD, Ovesen P, Kampmann U. Hemoglobin A1c Trajectories During Pregnancy and Adverse Outcomes in Women With Type 2 Diabetes: A Danish National Population-Based Cohort Study. Diabetes Care 2024; 47:1211-1219. [PMID: 38771955 DOI: 10.2337/dc23-2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/19/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To identify and characterize groups of pregnant women with type 2 diabetes with distinct hemoglobin A1c (HbA1c) trajectories across gestation and to examine the association with adverse obstetric and perinatal outcomes. RESEARCH DESIGN AND METHODS This was a retrospective Danish national cohort study including all singleton pregnancies in women with type 2 diabetes, giving birth to a liveborn infant, between 2004 and 2019. HbA1c trajectories were identified using latent class linear mixed-model analysis. Associations with adverse outcomes were examined with logistic regression models. RESULTS A total of 1,129 pregnancies were included. Three HbA1c trajectory groups were identified and named according to the glycemic control in early pregnancy (good, 59%; moderate, 32%; and poor, 9%). According to the model, all groups attained an estimated HbA1c <6.5% (48 mmol/mol) during pregnancy, with no differences between groups in the 3rd trimester. Women with poor glycemic control in early pregnancy had lower odds of having an infant with large-for-gestational-age (LGA) birth weight (adjusted odds ratio [aOR] 0.57, 95% CI 0.40-0.83), and higher odds of having an infant with small-for-gestational age (SGA) birth weight (aOR 2.49, 95% CI 2.00-3.10) and congenital malformation (CM) (aOR 4.60 95% CI 3.39-6.26) compared with women with good glycemic control. There was no evidence of a difference in odds of preeclampsia, preterm birth, and caesarean section between groups. CONCLUSIONS Women with poor glycemic control in early pregnancy have lower odds of having an infant with LGA birth weight, but higher odds of having an infant with SGA birth weight and CM.
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Affiliation(s)
- Anna S Koefoed
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sine Knorr
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Magnus Leth-Møller
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Lise Lotte T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - A Emilie Rosbach
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Department of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Trine T Christensen
- Steno Diabetes Center Aalborg, Aalborg University Hospital, Aalborg, Denmark
| | - H David McIntyre
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Per Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulla Kampmann
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ragsdale HB, Lee NR, Kuzawa CW. Evidence that highly canalized fetal traits are sensitive to intergenerational effects of maternal developmental nutrition. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 183:e24883. [PMID: 38018347 DOI: 10.1002/ajpa.24883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES Maternal experiences before pregnancy predict birth outcomes, a key indicator of health trajectories, but the timing and pathways for these effects are poorly understood. Here we test the hypothesis that maternal pre-adult growth patterns predict pregnancy glucose and offspring fetal growth in Cebu, Philippines. METHODS Using multiple regression and path analysis, gestational age-adjusted birthweight and variables reflecting infancy, childhood, and post-childhood/adolescent weight gain (conditional weights) were used to predict pregnancy HbA1c and offspring birth outcomes among participants in the Cebu Longitudinal Health and Nutrition Survey. RESULTS Maternal early/mid-childhood weight gain predicted birth weight, length, and head circumference in female offspring. Late-childhood/adolescent weight gain predicted birth length, birth weight, skinfold thickness, and head circumference in female offspring, and head circumference in male offspring. Pregnancy HbA1c did not mediate relationships between maternal growth and birth size parameters. DISCUSSION In Cebu, maternal growth patterns throughout infancy, childhood, and adolescence predict fetal growth via a pathway independent of circulating glucose, with stronger impacts on female than male offspring, consistent with a role of developmental nutrition on offspring fetal growth. Notably, the strength of relationships followed a pattern opposite to what occurs in response to acute pregnancy stress, with strongest effects on head circumference and birth length and weakest on skinfolds. We speculate that developmental sensitivities are reversed for stable, long-term nutritional cues that reflect average local environments. These findings are relevant to public health and life-history theory as further evidence of developmental influences on health and resource allocation across the life course.
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Affiliation(s)
- Haley B Ragsdale
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines
| | - Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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Renda S, Freeman J. You may delay, but time will not. Beta cells lost are never found again: a case for timely initiation of basal insulin in type 2 diabetes. Postgrad Med 2024; 136:150-161. [PMID: 38465574 DOI: 10.1080/00325481.2024.2328511] [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] [Received: 07/20/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Since its first use just over a century ago, insulin treatment has evolved dramatically, such that the molecules are physiologic in nature, and treatment can now closely resemble the natural hormone response over 24 hours. Newer, longer-acting basal insulin analogs have provided insulin therapies with improved characteristics and, therefore, ease of use, and can readily be incorporated as part of routine treatment for type 2 diabetes (T2D), but evidence suggests that insulin remains underused in people with T2D. We review the barriers to initiation of basal insulin and the education needed to address these barriers, and we provide practical pointers, supported by evidence, for primary care physicians and advanced practice providers to facilitate timely initiation of basal insulin in the people with T2D who will benefit from such treatment.
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Affiliation(s)
- Susan Renda
- Johns Hopkins Comprehensive Diabetes Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jeffrey Freeman
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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Nisar MI, das S, Khanam R, Khalid J, Chetia S, Hasan T, Shahid S, Marijani ML, Ahmed S, Khalid F, Ali SM, Chowdhury NH, Mehmood U, Dutta A, Rahman S, Qazi MF, Deb S, Mitra DK, Usmani AA, Dhingra U, Raqib R, Manu A, Yoshida S, Minckas N, Bahl R, Baqui AH, Sazawal S, Jehan F. Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa. BMC Pregnancy Childbirth 2024; 24:66. [PMID: 38225559 PMCID: PMC10789021 DOI: 10.1186/s12884-023-06241-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/31/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Hyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa. METHODS We performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2-3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders. RESULTS A total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8-6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9-10.6). CONCLUSION Maternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.
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Affiliation(s)
- Muhammad Imran Nisar
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sayan das
- Center for Public Health Kinetics, New Delhi, India
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, Baltimore, USA
| | - Javairia Khalid
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | - Tarik Hasan
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Shahira Shahid
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | | | - Farah Khalid
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | | | - Usma Mehmood
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Arup Dutta
- Center for Public Health Kinetics, New Delhi, India
| | - Sayedur Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Muhammad Farrukh Qazi
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Saikat Deb
- Center for Public Health Kinetics, New Delhi, India
- Public Health Laboratory-IDC, Pemba, Tanzania
| | - Dipak Kumar Mitra
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | - Asra Abeer Usmani
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Usha Dhingra
- Center for Public Health Kinetics, New Delhi, India
| | - Rubhana Raqib
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Alexander Manu
- London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Sachiyo Yoshida
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland.
| | - Nicole Minckas
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland
| | - Rajiv Bahl
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization (MCA/MRD), Avenue Appia 20, Geneva, 1211, Switzerland
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland, Baltimore, USA
| | | | - Fyezah Jehan
- Department of Pediatrics and Child Health, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S282-S294. [PMID: 38078583 PMCID: PMC10725801 DOI: 10.2337/dc24-s015] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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Guibert C, Amoura L, Rakotoarisoa L, Plat F, Sonnet E, Lablanche S, Tréglia C, Sarde E, Leca V, Rimareix F, Melki V, Baucher F, Betari B, Meyer L, Kessler L. MiniMed TM 780G Advanced Hybrid Closed-Loop System Study in Pregnant Women with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:893-901. [PMID: 37956265 DOI: 10.1089/dia.2023.0267] [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] [Indexed: 11/15/2023]
Abstract
Background: Evaluate the impact of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system on the glucose profile of pregnant women with type 1 diabetes (T1D) and maternal-neonatal complications. Methods: From April 2021 to September 2022, pregnant women with T1D treated with the AHCL system were included in an observational multicenter retrospective study. Continuous glucose monitoring parameters were analyzed monthly during pregnancy as well as maternal-neonatal complications. Results: Thirteen pregnant women, including a twin pregnancy (age: 33 ± 3 years, hemoglobin A1c [HbA1c]: 7.3% ± 0.7%, insulin doses: 0.72 ± 0.21 U/kg/day) were analyzed. At delivery, gestational age was 37 ± 2 weeks. During first 2 weeks of pregnancy, time in range (TIR, 63-140 mg/dL) was 46% (34-55) and increased to 54% (51-59) (P < 0.01), 64% (48-68) (P < 0.01), and 66% (60-70) (P < 0.001) during the first, second, and third trimester, respectively. During the night, TIR (63-140 mg/dL) was >70% throughout pregnancy. Time below the range <63 mg/dL increased from 0.5% (0-2) to 1.3% (0.7-2.2), 2% (1.2-3.5) (P < 0.05), and 1.3% (1.31-3) (P < 0.05) during the first, second, and third trimester, respectively. At delivery, insulin doses increased to 0.89 ± 0.35 IU/kg/day (P < 0.01), and HbA1c decreased to 6.4% ± 0.6% (P = 0.005). The reported carbohydrate amount increased from 167 ± 363 g/d during early pregnancy to 243 ± 106 g/d (P < 0.01) at delivery. The birthweight was 3134 ± 711 g, with 5/14 macrosomia and 2/14 neonatal hypoglycemia. Moreover, 5/13 patients had a preeclampsia and 9/13 a cesarean section, including three cases of scarred uterus. The Clinical Trial Registration number is: CE-2022-55. Conclusion: The AHCL system provided good glucose control during pregnancy and recommendation targets were reached during the nocturnal period only. The maternal and neonatal complications remained high.
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Affiliation(s)
- Clara Guibert
- Obstetrics and Gynecology Department, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
| | - Lamia Amoura
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
| | - Luc Rakotoarisoa
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
- Regenerative Nanomedicine, Inserm UMR 1260, University of Strasbourg, Strasbourg, France
| | - Francoise Plat
- Department of Endocrinology and Metabolic Diseases, Hospital of Avignon, Avignon, France
| | - Emmanuel Sonnet
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Clémence Tréglia
- Department of Endocrinology, Conception Hospital, Marseille University Hospital, Marseille, France
| | - Elisa Sarde
- Endocrinology, Diabetes, and Nutrition Department, Hospital of Rayettes, Martigues, France
| | - Viviane Leca
- Endocrinology, Diabetes, and Nutrition Department, Hospital of Rayettes, Martigues, France
| | - Frédérique Rimareix
- Department of Endocrinology and Metabolic Diseases, Rangueil University Hospital, Toulouse, France
| | - Vincent Melki
- Department of Endocrinology and Metabolic Diseases, Rangueil University Hospital, Toulouse, France
| | - Franciane Baucher
- Department of Endocrinology, Saint Roch Medical Center, Cabestany, France
| | - Bouchra Betari
- Department of Endocrinology, Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Laurent Meyer
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
| | - Laurence Kessler
- Endocrinology, Diabetes, and Nutrition Department, University Hospital of Strasbourg, Strasbourg, France
- Regenerative Nanomedicine, Inserm UMR 1260, University of Strasbourg, Strasbourg, France
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12
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Bailey SC, Pack AP, Wismer G, Calderon N, Velazquez E, Batio S, Ekong A, Eggleston A, Wallia A, Wolf MS, Schauer JM, Tenfelde S, Liebovitz DM, Grobman WA. Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes. BMJ Open 2023; 13:e078282. [PMID: 37940161 PMCID: PMC10632823 DOI: 10.1136/bmjopen-2023-078282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive planning and patient education on: (1) the importance of achieving glycaemic control before pregnancy, (2) using effective contraception until pregnancy is desired, (3) discontinuing teratogenic medications if pregnancy could occur, (4) taking folic acid, and (5) managing cardiovascular and other risks. Despite its importance, few women with T2DM receive recommended preconception care. METHODS AND ANALYSIS We are conducting a two-arm, clinic-randomised trial at 51 primary care practices in Chicago, Illinois to evaluate a technology-based strategy to 'hardwire' preconception care for women of reproductive age with T2DM (the PREPARED (Promoting REproductive Planning And REadiness in Diabetes) strategy) versus usual care. PREPARED leverages electronic health record (EHR) technology before and during primary care visits to: (1) promote medication safety, (2) prompt preconception counselling and reproductive planning, and (3) deliver patient-friendly educational tools to reinforce counselling. Post-visit, text messaging is used to: (4) encourage healthy lifestyle behaviours. English and Spanish-speaking women, aged 18-44 years, with T2DM will be enrolled (N=840; n=420 per arm) and will receive either PREPARED or usual care based on their clinic's assignment. Data will be collected from patient interviews and the EHR. Outcomes include haemoglobin A1c (primary), reproductive knowledge and self-management behaviours. We will use generalised linear mixed-effects models (GLMMs) to evaluate the impact of PREPARED on these outcomes. GLMMs will include a fixed effect for treatment assignment (PREPARED vs usual care) and random clinic effects. ETHICS AND DISSEMINATION This study was approved by the Northwestern University Institutional Review Board (STU00214604). Study results will be published in journals with summaries shared online and with participants upon request. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04976881).
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Affiliation(s)
- Stacy C Bailey
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Allison P Pack
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Norma Calderon
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Evelyn Velazquez
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stephanie Batio
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - Amisha Wallia
- Division of Endocrinology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacob M Schauer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sandi Tenfelde
- Family and Community Health Department, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
| | - David M Liebovitz
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
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13
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Aung NL. A1C: Episode 1. Clin Diabetes 2023; 42:165-168. [PMID: 38230343 PMCID: PMC10788652 DOI: 10.2337/cd23-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
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14
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Yoo JH, Kim JH. The Benefits Of Continuous Glucose Monitoring In Pregnancy. Endocrinol Metab (Seoul) 2023; 38:472-481. [PMID: 37821081 PMCID: PMC10613771 DOI: 10.3803/enm.2023.1805] [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] [Received: 08/18/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
Previous studies have consistently demonstrated the positive effects of continuous glucose monitoring (CGM) on glycemic outcomes and complications of diabetes in people with type 1 diabetes. Guidelines now consider CGM to be an essential and cost-effective device for managing type 1 diabetes. As a result, insurance coverage for it is available. Evidence supporting CGM continues to grow and expand to broader populations, such as pregnant people with type 1 diabetes, people with type 2 diabetes treated only with basal insulin therapy, and even type 2 diabetes that does not require insulin treatment. However, despite the significant risk of hyperglycemia in pregnancy, which leads to complications in more than half of affected newborns, CGM indications and insurance coverage for those patients are unresolved. In this review article, we discuss the latest evidence for using CGM to offer glycemic control and reduce perinatal complications, along with its cost-effectiveness in pregestational type 1 and type 2 diabetes and gestational diabetes mellitus. In addition, we discuss future prospects for CGM coverage and indications based on this evidence.
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Affiliation(s)
- Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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15
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Field C, Bank TC, Spees CK, Germann K, Landon MB, Gabbe S, Grobman WA, Costantine MM, Venkatesh KK. Association between glycemic control and group B streptococcus colonization among pregnant individuals with pregestational diabetes. Am J Reprod Immunol 2023; 90:e13779. [PMID: 37766411 DOI: 10.1111/aji.13779] [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] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
PROBLEM Pregestational diabetes increases the risk of group B streptococcus (GBS) colonization in pregnancy. Whether glycemic control is associated with differences in this risk is unknown. We examined the association between glycemic control and GBS colonization among pregnant individuals with pregestational diabetes. METHOD OF STUDY A retrospective cohort of pregnant individuals with pregestational diabetes at a tertiary care center. The exposure was glycemic control, measured as hemoglobin A1c (A1c) at >20 weeks and assessed categorically at thresholds of <6.5% and <6.0%, and secondarily, as a continuous percentage. The outcome was maternal GBS colonization. Multivariable logistic regression was used and adjusted for age, parity, race, and ethnicity as a social determinant, body mass index, type of diabetes, and gestational age at A1c assessment. RESULTS Among 305 individuals (33% Type 1, 67% type 2), 45.0% (n = 140) were colonized with GBS. Individuals with an A1c < 6.5% were half as likely to be colonized with GBS compared with those with a A1c ≥ 6.5% (38.8% vs. 53.9%; adjusted odds ratio, AOR: 0.55; 95% CI: 0.33-0.91). Results were unchanged at an A1c threshold of <6.0% (35.7% vs. 48.5%; AOR: 0.60; 95% CI: 0.36-0.98). Individuals with a higher A1c as a continuous measure (%) were more likely to be colonized (AOR: 1.57 per 1%; 95% CI: 1.25-1.97). CONCLUSIONS Pregnant individuals with pregestational diabetes with worse glycemic control were at an increased risk of GBS colonization. Further study is needed to understand if improved glycemic control leads to lower risk of GBS colonization.
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Affiliation(s)
- Christine Field
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - T Caroline Bank
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Colleen K Spees
- School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | | | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Steven Gabbe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
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Deng Y, Cheng D, Liao G, Tan X, Yang J. Trimester-specific reference intervals for hemoglobin A1c in non-diabetic pregnancy in a Chinese population. BMC Pregnancy Childbirth 2023; 23:671. [PMID: 37726666 PMCID: PMC10507880 DOI: 10.1186/s12884-023-05980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Physiological glycated hemoglobin (HbA1c) values in each trimester are not well defined. This study aimed to determine trimester-specific reference intervals for HbA1c levels in non-diabetic pregnant women in China. METHODS In this cross-sectional study, 5,042 Chinese pregnant women from 6 to 41 weeks of gestation were screened. An inclusion of 4,134 non-diabetic women was made to determine the reference intervals, they were divided into three trimesters: trimester 1 (T1), 6 weeks to 13 weeks + 6 days, trimester 2 (T2), 14 weeks to 27 weeks + 6 days, and trimester 3 (T3), 28 weeks to 41 weeks + 6 days. A total of 4,134 women (T1 n = 760, T2 n = 1,953, and T3 n = 1,421) provided blood samples which were analyzed for HbA1c concentrations. HbA1c was measured using high-performance liquid chromatography. The median and percentile (2.5th to 97.5th) for the HbA1c reference intervals were calculated for each trimester. RESULTS In total, 8,732 HbA1c measurements were taken. Reference intervals for HbA1c expressed as median and percentile (2.5th to 97.5th) for each trimester were: T1: 4.7 (4.0-5.5%), T2: 4.5 (3.9-5.3%), and T3: 4.8 (4.1-5.7%) respectively. The HbA1c levels were significantly lower in the second trimester compared to those in the first trimester (p < 0.0001), and higher in the third trimester compared to the second trimester (p < 0.0001). CONCLUSIONS The reference intervals for HbA1c levels were 3.9-5.7% with upper limits of 5.5% in the first trimester, 5.3% in the second trimester, and 5.7% in the third trimester. These findings highlight the importance of considering trimester-specific reference intervals for HbA1c in non-diabetic pregnant women to promote maternal and fetal health.
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Affiliation(s)
- Yuguo Deng
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Danling Cheng
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Guilian Liao
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Xiaoyu Tan
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Jinying Yang
- Department of Obstetrics, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China.
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Boswell L, Perea V, Amor AJ, Seguí N, Bellart J, Roca D, Giménez M, Conget I, Vinagre I. Impaired hypoglycaemia awareness in early pregnancy increases risk of severe hypoglycaemia in the mid-long term postpartum irrespective of breastfeeding status in women with type 1 diabetes. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:18-26. [PMID: 37268354 DOI: 10.1016/j.endien.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/14/2022] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Information regarding the postpartum period in women with type 1 diabetes (T1D) is scarce. We aim to evaluate the relation of impaired hypoglycaemia awareness (IAH) in early pregnancy and breastfeeding status (its presence and duration) with severe postpartum hypoglycaemia (SH). MATERIALS AND METHODS Retrospective cohort study of women with T1D followed during pregnancy between 2012 and 2019. Data on SH were recorded before and during pregnancy. IAH was evaluated at the first antenatal visit. Data on breastfeeding and the long-term postpartum period were collected by questionnaire and from medical records. RESULTS A total of 89 women with T1D were included with a median follow-up after pregnancy of 19.2 [8.7-30.5] months. Twenty-eight (32%) women had IAH at the first antenatal visit. At discharge, 74 (83%) started breastfeeding during a median of 8 [4.4-15] months. A total of 18 (22%) women experienced ≥1 SH during postpartum. The incidence of SH significantly increased from pregestational to the gestational and post-partum period (0.09, 0.15 and 0.25 episodes/patient-year, respectively). Postpartum SH rates were comparable in breastfeeding and non-breastfeeding women (21.4% vs. 25%, respectively, p>0.05). Clarke test score at the first antenatal visit was associated with postpartum SH (for each 1-point increase: OR 1.53; 95% CI, 1.06-2.21) adjusted for confounders. No other diabetes and pregnancy-related variables were identified as predictors of SH in this period. CONCLUSIONS SH are common in the long-term postpartum period independently of breastfeeding. Assessing IAH in early pregnancy could identify those at an increased risk of SH in the postpartum period.
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Affiliation(s)
- Laura Boswell
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain
| | - Verónica Perea
- Endocrinology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Seguí
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Bellart
- Obstetrics and Gynecology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daria Roca
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marga Giménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Conget
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene Vinagre
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain.
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María Gómez Medina A, Juliana Soto Chávez M, Cristina Henao Carrillo D, Camilo Salgado Sánchez J, Alberto Gómez González J, Grassi B, Mauricio Muñoz Velandia O. Determination of Time in Range Associated with HbA1c ≤6.5% in Latin American pregnant women diagnosed with type 1 diabetes mellitus using an automated insulin delivery system. Diabetes Res Clin Pract 2023; 200:110713. [PMID: 37187225 DOI: 10.1016/j.diabres.2023.110713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/22/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
AIMS To determine the correlation between %TIR and HbA1c in pregnant women with type 1 diabetes mellitus (DM1). METHODS Diagnostic test study in a prospective cohort of pregnant patients with DM1 using automated insulin delivery system (AID)in Colombia and Chile. RESULTS Fifty-two patients were included [mean age 31.8±6.2 years, pregestational HbA1c 7.2% [interquartile range (IQR), 6.5-8.2]. During follow-up, we found a better metabolic control during the second (HbA1c 6.40%, IQR 5.9,7.1) and third trimesters (HbA1c 6.25%;IQR 5.9,6.8). A weak and negative correlation between %TIR and HbA1c was found for all the gestation (Spearman's rank correlation coefficient:-0.22, p:0.0329), and in the second (r :-0.13, p: 0.38) and third trimesters (r:-0.26, p=0.08). %TIR had poor discriminating capacity for predicting HbA1c <6% (area under the curve [AUC], 0.59; 95% confidence interval [CI],0.46-0.72) and for predicting HbA1c <6.5% (AUC, 0.57;95% CI,0.44-0.70). The optimal cutoff points for %TIR were >66.1% for predicting HbA1c <6% (65% sensitivity, 62% specificity) and %TIR >61.1% for HbA1c <6.5% (59% sensitivity, 54% specificity). CONCLUSION The correlation between HbA1c and %TIR during pregnancy was weak. The optimal cutoff points for identifying patients with HbA1c <6.0% and <6.5% were %TIR >66.1% and >61.1%, respectively, with moderate sensitivity and specificity.
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Affiliation(s)
- Ana María Gómez Medina
- Endocrinology Unit - Hospital Universitario San Ignacio; Department of Internal Medicine, Pontificia Universidad Javeriana.
| | | | - Diana Cristina Henao Carrillo
- Endocrinology Unit - Hospital Universitario San Ignacio; Department of Internal Medicine, Pontificia Universidad Javeriana
| | - Juan Camilo Salgado Sánchez
- Endocrinology Unit - Hospital Universitario San Ignacio; Department of Internal Medicine, Pontificia Universidad Javeriana
| | | | - Bruno Grassi
- Department of Nutrition, diabetes and metabolism - Pontificia Universidad Católica de Chile
| | - Oscar Mauricio Muñoz Velandia
- Department of Internal Medicine, Pontificia Universidad Javeriana; Department of Internal Medicine - Hospital Universitario San Ignacio
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Jin X, Yang X, Xu Y, Liang J, Liu C, Guo Q, Wang W, Feng Z, Yuan Y, Zhou H, Zhang Z, Jiang W, Liang Y, Lu B, Shao J, Zhong Y, Gu P. Differential correlation between time in range and eGFR or albuminuria in type 2 diabetes. Diabetol Metab Syndr 2023; 15:92. [PMID: 37386515 DOI: 10.1186/s13098-023-01071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION As a CGM-derived indicator, 'time in range' (TIR) is emerging as a key indicator for accurate assessment of glycaemic control. However, there is few report focusing on the correlation of TIR with albumuria and renal fuction. The aim of this work was to investigate whether TIR, as well as nocturnal TIR and hypoglycaemic events is related to the presence and severity of albuminuria and decrease of eGFR in type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 823 patients were enrolled in this study. All patients received continuous glucose monitoring, TIR indicating the percentage of time that blood glucose was in the range of 3.9-10.0 mmol/L. The Spearman analysis was applied to analyze the relationship between TIR (or nocturnal TIR) and ACR. Logistic regression was used to explore whether TIR (or nocturnal TIR) is an independent risk factor for albuminuria. RESULTS The prevalence of albuminuria decreased with increasing TIR quartiles. Binary logistic regression revealed that TIR as well as nocturnal TIR was obviously related to the presence of albuminuria. Multiple regression analysis found that only nocturnal TIR was obviously related to the severity of albuminuria. In our study, eGFR was significantly associated with the number of hypoglycemic events. CONCLUSIONS In T2DM patients, TIR and nocturnal TIR is associated with the presence of albuminuria independent of HbA1c and GV metrics. Nocturnal TIR shows better correlation than TIR. The role of TIR especially nocturnal TIR in the evaluation of diabetes kidney disease should be emphasized.
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Affiliation(s)
- Xuguang Jin
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xinyi Yang
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Yixin Xu
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Jingjing Liang
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Chunyan Liu
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Qingyu Guo
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Wei Wang
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Zhouqin Feng
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Yanyu Yuan
- Department of Endocrinology, the affiliated Jinling Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Zhou
- Department of Endocrinology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Zhen Zhang
- Department of Endocrinology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Wenwen Jiang
- Department of Endocrinology, the affiliated Jinling Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yue Liang
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Bin Lu
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Jiaqing Shao
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
| | - Yong Zhong
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
| | - Ping Gu
- Medical School, Affiliated Jinling Hospital, Department of Endocrinology, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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Field C, Lynch CD, Fareed N, Joseph JJ, Wu J, Thung SF, Gabbe SG, Landon MB, Grobman WA, Venkatesh KK. Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus. Am J Obstet Gynecol MFM 2023; 5:100898. [PMID: 36787839 DOI: 10.1016/j.ajogmf.2023.100898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Neighborhood walkability is a community-level social determinant of health that measures whether people who live in a neighborhood walk as a mode of transportation. Whether neighborhood walkability is associated with glycemic control among pregnant individuals with pregestational diabetes remains to be defined. OBJECTIVE This study aimed to evaluate the association between community-level neighborhood walkability and glycemic control as measured by hemoglobin A1c (A1C) among pregnant individuals with pregestational diabetes. STUDY DESIGN This was a retrospective analysis of pregnant individuals with pregestational diabetes enrolled in an integrated prenatal and diabetes care program from 2012 to 2016. Participant addresses were geocoded and linked at the census-tract level. The exposure was community walkability, defined by the US Environmental Protection Agency National Walkability Index (score range 1-20), which incorporates intersection density (design), proximity to transit stops (distance), and a mix of employment and household types (diversity). Individuals from neighborhoods that were the most walkable (score, 15.26-20.0) were compared with those from neighborhoods that were less walkable (score <15.26), as defined per national Environmental Protection Agency recommendations. The outcomes were glycemic control, including A1C <6.0% and <6.5%, measured both in early and late pregnancy, and mean change in A1C across pregnancy. Modified Poisson regression and linear regression were used, respectively, and adjusted for maternal age, body mass index at delivery, parity, race and ethnicity as a social determinant of health, insurance status, baseline A1C, gestational age at A1C measurement in early and late pregnancy, and diabetes type. RESULTS Among 417 pregnant individuals (33% type 1, 67% type 2 diabetes mellitus), 10% were living in the most walkable communities. All 417 individuals underwent A1C assessment in early pregnancy (median gestational age, 9.7 weeks; interquartile range, 7.4-14.1), and 376 underwent another A1C assessment in late pregnancy (median gestational age, 30.4 weeks; interquartile range, 27.8-33.6). Pregnant individuals living in the most walkable communities were more likely to have an A1C <6.0% in early pregnancy (15% vs 8%; adjusted relative risk, 1.46; 95% confidence interval, 1.00-2.16), and an A1C <6.5% in late pregnancy compared with those living in less walkable communities (13% vs 9%; adjusted relative risk, 1.33; 95% confidence interval, 1.08-1.63). For individuals living in the most walkable communities, the median A1C was 7.5 (interquartile range, 6.0-9.4) in early pregnancy and 5.9 (interquartile range, 5.4-6.4) in late pregnancy. For those living in less walkable communities, the median A1C was 7.3 (interquartile range, 6.2-9.2) in early pregnancy and 6.2 (interquartile range, 5.6-7.1) in late pregnancy. Change in A1C across pregnancy was not associated with walkability. CONCLUSION Pregnant individuals with pregestational diabetes mellitus living in more walkable communities had better glycemic control in both early and late pregnancy. Whether community-level interventions to enhance neighborhood walkability can improve glycemic control in pregnancy requires further study.
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Affiliation(s)
- Christine Field
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh).
| | - Courtney D Lynch
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Naleef Fareed
- Department of Biomedical Informatics, Ohio State University College of Medicine, Columbus, OH (Dr Fareed)
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH (Dr Joseph)
| | - Jiqiang Wu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Stephen F Thung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Steven G Gabbe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Mark B Landon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - William A Grobman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
| | - Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH (Drs Field and Lynch, Mr Wu, and Drs Thung, Gabbe, Landon, Grobman, and Venkatesh)
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21
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Affiliation(s)
- Satish Garg
- University of Colorado Denver, Barbara Davis Center for Childhood Diabetes, 1775 Aurora Court, A140, Aurora, Colorado, United States, 80045;
| | - Christopher G Parkin
- CGParkin Communications, Inc., 2352 Martinique Ave, Henderson, Nevada, United States, 89044
- United States;
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22
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Punnose J, Malhotra RK, Sukhija K, Rijhwani RM, Sharma A, Choudhary N, Vij P, Joseph R. Establishing Trimester-Specific Haemoglobin A1c Reference Intervals in Pregnant Women: A retrospective study of healthy South Asian women with normal pregnancy outcomes. Sultan Qaboos Univ Med J 2023; 23:81-89. [PMID: 36865418 PMCID: PMC9974038 DOI: 10.18295/squmj.3.2022.022] [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: 09/19/2021] [Revised: 12/05/2021] [Accepted: 02/20/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to define trimester-specific haemoglobin A1c (HbA1c) reference intervals in healthy, pregnant South Asian women. Methods This retrospective study was conducted at St. Stephen's Hospital, Delhi, India, between January 2011 and December 2016. Healthy pregnant women were compared to a control group of healthy non-pregnant women. Pregnant participants had term deliveries of babies with appropriate gestational weights. The HbA1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2) and third (T3) trimester groups. Statistical tests were used to obtain the normal HbA1c reference values and were considered significant when P <0.05. Results This study included a total of 1,357 healthy pregnant women and a control group of 67 healthy, non-pregnant women. Pregnant women had a median HbA1c of 4.8% (4-5.5%) or 32 mmol/mol (20-39 mmol/mol); non-pregnant women had a median HbA1c of 5.1% (4-5.7%) or 29 mmol/mol (20-37 mmol/mol; P <0.001). The HbA1c levels for the T1, T2 and T3 groups were 4.9% (4.1-5.5%) or 30 mmol/mol (21-37 mmol/mol), 4.8% (4.5-5.3%) or 29 mmol/mol (20-34 mmol/mol) and 4.8% (3.9-5.6%) or 29 mmol/mol (19-38 mmol/mol), respectively. The HbA1c values were significant when comparing T1 versus T2 (P <0.001), T1 versus T3 (P = 0.002) and T1 versus the non-pregnant group (P = 0.001). However, T2 versus T3 was not significant (P = 0.111). Conclusion Compared to non-pregnant women, HbA1c levels were lower in pregnant women, despite women in the T2 and T3 groups having a higher body mass index than the women in the T1 and non-pregnant groups. Further research is recommended to understand the factors responsible and validate these findings.
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Affiliation(s)
- John Punnose
- Department of Endocrinology, St. Stephen’s Hospital, New Delhi, India,Corresponding Author’s e-mail:
| | | | - Komal Sukhija
- Department of Endocrinology, St. Stephen’s Hospital, New Delhi, India
| | | | - Asha Sharma
- Department of Obstetrics & Gynecology, St. Stephen’s Hospital, New Delhi, India
| | - Naimaa Choudhary
- Department of Obstetrics & Gynecology, St. Stephen’s Hospital, New Delhi, India
| | - Prassan Vij
- Department of Reproductive Medicine, St. Stephen’s Hospital, New Delhi, India
| | - Renuka Joseph
- Department of Biochemistry, St. Stephen’s Hospital, New Delhi, India
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23
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Venkatesh KK, Joseph JJ, Clark A, Gabbe SG, Landon MB, Thung SF, Yee LM, Lynch CD, Grobman WA, Walker DM. Association of community-level food insecurity and glycemic control among pregnant individuals with pregestational diabetes. Prim Care Diabetes 2023; 17:73-78. [PMID: 36379871 PMCID: PMC10286113 DOI: 10.1016/j.pcd.2022.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
AIM To evaluate whether pregnant individuals with pregestational diabetes who live in a food-insecure community have worse glycemic control compared to those who do not live in a food-insecure community. METHODS A retrospective analysis of pregnant individuals with pregestational diabetes enrolled in a multidisciplinary prenatal and diabetes care program. The exposure was community-level food insecurity per the Food Access Research Atlas. The outcomes were hemoglobin A1c (A1c) < 6.0 % in early and late pregnancy, and an absolute decrease in A1c ≥ 2.0 % and mean change in A1c across pregnancy. RESULTS Among 418 assessed pregnant individuals with pregestational diabetes, those living in a food-insecure community were less likely to have an A1c < 6.0 % in early pregnancy compared to those living in a community without food insecurity [16 % vs. 30 %; adjusted risk ratio (aRR): 0.55; 95 % CI: 0.33-0.92]. Individuals living in a food-insecure community were more likely to achieve a decrease in A1c ≥ 2.0 % [35 % vs. 21 %; aRR: 1.55; 95 % CI: 1.06-2.28] and a larger mean decrease in A1c across pregnancy [mean: 1.46 vs. 1.00; adjusted beta: 0.47; 95 % CI: 0.06-0.87)]. CONCLUSIONS Pregnant individuals with pregestational diabetes who lived in a food-insecure community were less likely to enter pregnancy with glycemic control, but were more likely to have a reduction in A1c and achieve similar A1c status compared to those who lived in a community without food insecurity. Whether interventions that address food insecurity improve glycemic control and consequent perinatal outcomes remains to be studied.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America.
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, the United States of America
| | - Aaron Clark
- Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America
| | - Steven G Gabbe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America
| | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America; Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, the United States of America; Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, the United States of America
| | - Stephen F Thung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America; Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, the United States of America; Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, the United States of America
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, the United States of America
| | - Courtney D Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America
| | - Daniel M Walker
- Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America
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24
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Isabel C, Faro Rebecca V, Vrijkotte TGM, Theodorus Bartholomeus T. Early pregnancy triglycerides and not fructosamine are associated with birth weight (with foetal sexual dimorphism). Eur J Clin Invest 2023; 53:e13896. [PMID: 36327143 DOI: 10.1111/eci.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND We evaluated whether maternal triglycerides (TGs) or fructosamine (measured in early pregnancy) predominantly contribute to birth weight (BW), in a foetal sexual dimorphism. METHODS Analysis of data from the Amsterdam Born Children and their Development cohort study (total n = 3514). Maternal nonfasting TGs and fructosamine were determined in early gestation (median 13 weeks). Multivariable linear regression analysis was used to determine whether maternal TGs or fructosamine was associated with BW-small for gestational age (SGA)-large for gestational age (LGA) and whether it was sex-dependent. RESULTS With each 1 mmol/L increase in TGs, BW increased significantly by 81.7 g. This increase was larger with boys (107.3 g; 95% CI 66-148) than girls (60.5 g; 95% CI 23.6-97.4). No association was found with fructosamine. When including different covariates (gestational age at blood sampling, total duration of pregnancy, maternal height, age, parity, ethnicity, educational level, smoking, alcohol, and pre-pregnancy BMI), 29% of the variance in BW can be explained. Adding fructosamine to this model gave no added value in predicting BW, in contrast to adding TGs (R2 raised from 0.292 to 0.299, p < .001). The odds of a newborn LGA with higher maternal TG were increased (OR 1.6, 95% CI 1.3-2.0), in contrast to fructosamine. CONCLUSIONS Maternal TGs were more dominant (compared to fructosamine) in its association with BW (measured in early physiological pregnancy) and more prominently present when carrying a male foetus. These remarkable observations warrant more future research, especially in obese patients at risk for gestational diabetes.
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Affiliation(s)
- Clinck Isabel
- Department of Endocrinology, Diabetology and Metabolism, AZ Monica, Antwerp, Belgium.,Internal Medicine, University of Antwerp, Antwerp, Belgium
| | - Verelst Faro Rebecca
- Department of Endocrinology, Diabetology and Metabolism, AZ Monica, Antwerp, Belgium.,Internal Medicine, University of Antwerp, Antwerp, Belgium
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Twickler Theodorus Bartholomeus
- Department of Endocrinology, Diabetology and Metabolism, AZ Monica, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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25
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Kalra S, Unnikrishnan AG, Prasanna Kumar KM, Sahay R, Chandalia HB, Saboo B, Annamalai S, Kesavadev J, Shukla R, Wangnoo SK, Baruah MP, Jacob J, Arora S, Singla R, Sharma SK, Damodaran S, Bantwal G. Addendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India. Diabetes Ther 2023; 14:29-45. [PMID: 36380217 PMCID: PMC9880128 DOI: 10.1007/s13300-022-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
With the emerging complexities in chronic diseases and people's lifestyles, healthcare professionals (HCPs) need to update their methods to manage and educate patients with chronic lifestyle disorders, particularly diabetes. The insulin injection technique (IIT), along with various parameters, must also be updated with newer methods. Forum for Injection Technique and Therapy Expert Recommendations (FITTER), India, has updated its recommendations to cover newer ways of detecting hypoglycaemia and lipohypertrophy, preventing needlestick injuries (NSIs), discouraging the reuse of insulin needles and encouraging good disposal. FITTER, India, is also introducing recommendations to calculate insulin bolus dose. These updated recommendations will help HCPs better manage patients with diabetes and achieve improved outcomes.
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26
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Muhuza MPU, Zhang L, Wu Q, Qi L, Chen D, Liang Z. The association between maternal HbA1c and adverse outcomes in gestational diabetes. Front Endocrinol (Lausanne) 2023; 14:1105899. [PMID: 37008898 PMCID: PMC10060951 DOI: 10.3389/fendo.2023.1105899] [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] [Received: 11/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The role of HbA1c in women with gestational diabetes mellitus (GDM) is still unclear, particularly in the Asian population. AIM To investigate the association between HbA1c levels and adverse outcomes considering maternal age, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) in women with GDM. METHOD A retrospective study included 2048 women with GDM and singleton live births. Using logistic regression, the associations between HbA1c and adverse pregnancy outcomes were assessed. RESULT Compared to women with HbA1c ≤ 5.0%, HbA1c was significantly associated with macrosomia (aOR 2.63,95%CI1.61,4.31), pregnancy-induced hypertension (PIH, aOR 2.56,95%CI1.57,4.19), preterm birth (aOR 1.64,95%CI 1.05,2.55), and primary Cesarean section (primary C-section, aOR1.49,95%CI1.09,2.03) in GDM women with HbA1c ≥5.5% while significantly associated with PIH (aOR 1.91,95%CI1.24,2.94) in women with HbA1c 5.1-5.4%. The associations between HbA1c and adverse outcomes varied with maternal age, pre-pregnancy BMI, and GWG. In women aged ≤29 years, there's significant association between HbA1c and primary C-section when HbA1c was 5.1-5.4% and ≥5.5%. In women aged 29-34 years and HbA1c ≥5.5%, HbA1c was significantly associated with macrosomia. In women aged ≥35 years, there's significant association between HbA1c and preterm birth when HbA1c was 5.1-5.4% and macrosomia and PIH when HbA1c ≥5.5%. In pre-pregnant normal-weight women, HbA1c was significantly associated with macrosomia, preterm birth, primary C-section, and PIH when HbA1c ≥5.5% while HbA1c was significantly associated with PIH when HbA1c was 5.1-5.4% . In pre-pregnant underweight women with HbA1c 5.1-5.4%, HbA1c was significantly associated with primary C-section. HbA1c was significantly associated with macrosomia among women with inadequate GWG or excess GWG and HbA1c≥5.5%. In women with adequate GWG, there's significant association between HbA1c and PIH when HbA1c was 5.1-5.4% and ≥5.5% . CONCLUSION Conclusively, HbA1c at the time of diagnosis is significantly associated with macrosomia, preterm birth, PIH, and primary C-section in Chinese women with GDM.
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Affiliation(s)
| | - Lixia Zhang
- Obstetrical Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Wu
- Obstetrical Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Danqing Chen
- Obstetrical Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhaoxia Liang
- Obstetrical Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- *Correspondence: Zhaoxia Liang,
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Jeffrie Seley J, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S254-S266. [PMID: 36507645 PMCID: PMC9810465 DOI: 10.2337/dc23-s015] [Citation(s) in RCA: 108] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Rigon FA, Ronsoni MF, Vianna AGD, de Lucca Schiavon L, Hohl A, van de Sande-Lee S. Flash glucose monitoring system in special situations. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:883-894. [PMID: 35657123 PMCID: PMC10118756 DOI: 10.20945/2359-3997000000479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 02/04/2022] [Indexed: 02/08/2023]
Abstract
The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.
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Affiliation(s)
- Fernanda Augustini Rigon
- Programa de Pós-graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil,
| | - Marcelo Fernando Ronsoni
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - André Gustavo Daher Vianna
- Centro de Diabetes de Curitiba, Departamento de Doenças Endócrinas, Hospital Nossa Senhora das Graças, Curitiba, PR, Brasil
| | | | - Alexandre Hohl
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Simone van de Sande-Lee
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
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Dietary Advice to Support Glycaemic Control and Weight Management in Women with Type 1 Diabetes during Pregnancy and Breastfeeding. Nutrients 2022; 14:nu14224867. [PMID: 36432552 PMCID: PMC9692490 DOI: 10.3390/nu14224867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
In women with type 1 diabetes, the risk of adverse pregnancy outcomes, including congenital anomalies, preeclampsia, preterm delivery, foetal overgrowth and perinatal death is 2-4-fold increased compared to the background population. This review provides the present evidence supporting recommendations for the diet during pregnancy and breastfeeding in women with type 1 diabetes. The amount of carbohydrate consumed in a meal is the main dietary factor affecting the postprandial glucose response. Excessive gestational weight gain is emerging as another important risk factor for foetal overgrowth. Dietary advice to promote optimized glycaemic control and appropriate gestational weight gain is therefore important for normal foetal growth and pregnancy outcome. Dietary management should include advice to secure sufficient intake of micro- and macronutrients with a focus on limiting postprandial glucose excursions, preventing hypoglycaemia and promoting appropriate gestational weight gain and weight loss after delivery. Irrespective of pre-pregnancy BMI, a total daily intake of a minimum of 175 g of carbohydrate, mainly from low-glycaemic-index sources such as bread, whole grain, fruits, rice, potatoes, dairy products and pasta, is recommended during pregnancy. These food items are often available at a lower cost than ultra-processed foods, so this dietary advice is likely to be feasible also in women with low socioeconomic status. Individual counselling aiming at consistent timing of three main meals and 2-4 snacks daily, with focus on carbohydrate amount with pragmatic carbohydrate counting, is probably of value to prevent both hypoglycaemia and hyperglycaemia. The recommended gestational weight gain is dependent on maternal pre-pregnancy BMI and is lower when BMI is above 25 kg/m2. Daily folic acid supplementation should be initiated before conception and taken during the first 12 gestational weeks to minimize the risk of foetal malformations. Women with type 1 diabetes are encouraged to breastfeed. A total daily intake of a minimum of 210 g of carbohydrate is recommended in the breastfeeding period for all women irrespective of pre-pregnancy BMI to maintain acceptable glycaemic control while avoiding ketoacidosis and hypoglycaemia. During breastfeeding insulin requirements are reported approximately 20% lower than before pregnancy. Women should be encouraged to avoid weight retention after pregnancy in order to reduce the risk of overweight and obesity later in life. In conclusion, pregnant women with type 1 diabetes are recommended to follow the general dietary recommendations for pregnant and breastfeeding women with special emphasis on using carbohydrate counting to secure sufficient intake of carbohydrates and to avoid excessive gestational weight gain and weight retention after pregnancy.
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 152] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Chehab RF, Ferrara A, Greenberg MB, Ngo AL, Feng J, Zhu Y. Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes. JAMA Netw Open 2022; 5:e2233955. [PMID: 36173631 PMCID: PMC9523493 DOI: 10.1001/jamanetworkopen.2022.33955] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Glycemic control is the cornerstone of gestational diabetes management. Glycemic control trajectories account for differences in longitudinal patterns throughout pregnancy; however, studies on glycemic control trajectories are scarce. OBJECTIVE To examine whether glycemic control trajectories from gestational diabetes diagnosis to delivery were associated with differential risk of perinatal complications. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included individuals with gestational diabetes with longitudinal electronic health record data from preconception to delivery who received prenatal care at Kaiser Permanente Northern California (KPNC) and were enrolled in KPNC's telemedicine-based gestational diabetes care program between January 2007 and December 2017. Data analysis was conducted from September 2021 to January 2022. EXPOSURES Glycemic control trajectories were derived using latent class modeling based on the American Diabetes Association's recommended self-monitoring of blood glucose measurements. Optimal glycemic control was defined as at least 80% of all measurements meeting the targets at KPNC clinical settings. MAIN OUTCOMES AND MEASURES Multivariable Poisson regression models were used to estimate the associations of glycemic control trajectories with cesarean delivery, preterm birth, shoulder dystocia, large- and small-for-gestational-age, and neonatal intensive care unit admission and stay of 7 days or longer. RESULTS Among a total of 26 774 individuals (mean [SD] age, 32.9 [5.0] years; 11 196 Asian or Pacific Islander individuals [41.8%], 1083 Black individuals [4.0%], 7500 Hispanic individuals [28.0%], and 6049 White individuals [22.6%]), 4 glycemic control trajectories were identified: stably optimal (10 528 individuals [39.3%]), rapidly improving to optimal (9151 individuals [34.2%]), slowly improving to near-optimal (4161 individuals [15.5%]), and slowly improving to suboptimal (2934 individuals [11.0%]). In multivariable models with the rapidly improving to optimal trajectory group as the reference group, glycemic control trajectories were associated with perinatal complications with a gradient across stably optimal to slowly improving to suboptimal. For individuals in the stably optimal trajectory group, there were lower risks of cesarean delivery (adjusted relative risk [aRR], 0.93 [95% CI, 0.89-0.96]), shoulder dystocia (aRR, 0.75 [95% CI, 0.61-0.92]), large-for-gestational age (aRR, 0.74 [95% CI, 0.69-0.80]), and neonatal intensive care unit admission (aRR, 0.90 [95% CI, 0.83-0.97]), while for patients in the slowly improving to suboptimal glycemic control trajectory group, risks were higher for cesarean delivery (aRR, 1.18 [95% CI, 1.12-1.24]; (P for trend < .001), shoulder dystocia (aRR, 1.41 [95% CI, 1.12-1.78]; P for trend < .001), large-for-gestational-age (aRR, 1.42 [95% CI, 1.31-1.53]; P for trend < .001), and neonatal intensive care unit admission (aRR, 1.33 [95% CI, 1.20-1.47]; P for trend < .001). The risk of small-for-gestational-age was higher in patients in the stably optimal group (aRR, 1.10 [95% CI, 1.02-1.20]) and lower in the slowly improving to suboptimal group (aRR, 0.63 [95% CI, 0.53-0.75]). CONCLUSIONS AND RELEVANCE These findings suggest that slowly improving to near-optimal and slowly improving to suboptimal glycemic control trajectories were associated with increased risk of perinatal complications. Future interventions should help individuals achieve glycemic control early after gestational diabetes diagnosis and throughout pregnancy to decrease the risk of perinatal complications.
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Affiliation(s)
- Rana F Chehab
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mara B Greenberg
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara
| | - Amanda L Ngo
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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Perea V, Picón MJ, Megia A, Goya M, Wägner AM, Vega B, Seguí N, Montañez MD, Vinagre I. Addition of intermittently scanned continuous glucose monitoring to standard care in a cohort of pregnant women with type 1 diabetes: effect on glycaemic control and pregnancy outcomes. Diabetologia 2022; 65:1302-1314. [PMID: 35546211 DOI: 10.1007/s00125-022-05717-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess whether the addition of intermittently scanned continuous glucose monitoring (isCGM) to standard care (self-monitoring of blood glucose [SMBG] alone) improves glycaemic control and pregnancy outcomes in women with type 1 diabetes and multiple daily injections. METHODS This was a multicentre observational cohort study of 300 pregnant women with type 1 diabetes in Spain, including 168 women using SMBG (standard care) and 132 women using isCGM in addition to standard care. In addition to HbA1c, the time in range (TIR), time below range (TBR) and time above range (TAR) with regard to the pregnancy glucose target range (3.5-7.8 mmol/l) were also evaluated in women using isCGM. Logistic regression models were performed for adverse pregnancy outcomes adjusted for baseline maternal characteristics and centre. RESULTS The isCGM group had a lower median HbA1c in the second trimester than the SMBG group (41.0 [IQR 35.5-46.4] vs 43.2 [IQR 37.7-47.5] mmol/mol, 5.9% [IQR 5.4-6.4%] vs 6.1% [IQR 5.6-6.5%]; p=0.034), with no differences between the groups in the other trimesters (SMBG vs isCGM: first trimester 47.5 [IQR 42.1-54.1] vs 45.9 [IQR 39.9-51.9] mmol/mol, 6.5% [IQR 6.0-7.1%] vs 6.4% [IQR 5.8-6.9%]; third trimester 43.2 [IQR 39.9-47.5] vs 43.2 [IQR 39.9-47.5] mmol/mol, 6.1% [IQR 5.8-6.5%] vs 6.1% [IQR 5.7-6.5%]). The whole cohort showed a slight increase in HbA1c from the second to the third trimester, with a significantly higher rise in the isCGM group than in the SMBG group (median difference 2.2 vs 1.1 mmol/mol [0.2% vs 0.1%]; p=0.033). Regarding neonatal outcomes, newborns of women using isCGM were more likely to have neonatal hypoglycaemia than newborns of non-sensor users (27.4% vs 19.1%; ORadjusted 2.20 [95% CI 1.14, 4.30]), whereas there were no differences between the groups in large-for-gestational-age (LGA) infants (40.6% vs 45.1%; ORadjusted 0.73 [95% CI 0.42, 1.25]), Caesarean section (57.6% vs 48.8%; ORadjusted 1.33 [95% CI 0.78, 2.27]) or prematurity (27.3% vs 24.8%; ORadjusted 1.05 [95% CI 0.55, 1.99]) in the adjusted models. A sensitivity analysis in pregnancies without LGA infants or prematurity also showed that the use of isCGM was associated with a higher risk of neonatal hypoglycaemia (non-LGA: ORadjusted 2.63 [95% CI 1.01, 6.91]; non-prematurity: ORadjusted 2.52 [95% CI 1.12, 5.67]). For isCGM users, the risk of delivering an LGA infant was associated with TIR, TAR and TBR in the second trimester in the logistic regression analysis. CONCLUSIONS/INTERPRETATION isCGM use provided an initial improvement in glycaemic control that was not sustained. Furthermore, offspring of isCGM users were more likely to have neonatal hypoglycaemia, with similar rates of macrosomia and prematurity to those of women receiving standard care.
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Affiliation(s)
- Verónica Perea
- Endocrinology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
| | - Maria José Picón
- Endocrinology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Megia
- Endocrinology Department, Hospital Universitari Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria Goya
- Obstetrics and Gynaecology Department, Hospital Universitari Vall d' Hebrón, Barcelona, Spain
| | - Ana Maria Wägner
- Endocrinology Department, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Begoña Vega
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Obstetrics and Gynaecology Department, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Nuria Seguí
- Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Irene Vinagre
- Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
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Impaired hypoglycaemia awareness in early pregnancy increases risk of severe hypoglycaemia in the mid-long term postpartum irrespective of breastfeeding status in women with type 1 diabetes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hong JGS, Mohd. Noor AF, Tan PC. Three Days Compared to One Day Per Week of Self-Monitoring of Blood Glucose in Mild Gestational Diabetes: A Randomized Trial. J Clin Med 2022; 11:3770. [PMID: 35807057 PMCID: PMC9267312 DOI: 10.3390/jcm11133770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The International Diabetes Federation estimates that 16.2% of livebirths in 2017 were affected by hyperglycemia in pregnancy, with 85.1% due to gestational diabetes mellitus (GDM). Daily blood glucose monitoring compared with alternate day testing in mild GDM is associated with similar pregnancy outcomes. Data are sparse on the ideal frequency for self-monitoring of blood glucose (SMBG) in mild GDM for glycemic control. A higher HbA1c at late pregnancy is associated with adverse pregnancy outcomes. We sought to evaluate three days compared to one day per week of four-point self-monitoring of blood glucose (SMBG) in gestational diabetes mellitus (GDM) controlled by lifestyle changes for glycemic control. Methods: This randomized trial was conducted from February−December 2018. A total of 106 women with lifestyle-controlled GDM were randomized to three days (SMBG3) or one day (SMBG1) per week of four-point (fasting and two-hours post-meal) SMBG. The primary outcome was the change in the HbA1c level at recruitment and 36-weeks gestation within and across trial arms. The student t-test was used for between-arm analyses and a paired t-test for within-arm analyses. Results: The HbA1c level through pregnancy increased significantly in both trial arms: mean increase of 0.21% ± 0.26%, p < 0.001 (SMBG3), and 0.19% ± 0.24%, p < 0.001 (SMBG1), but the 0.02% difference across trial arms was not significant (p = 0.79). Maternal weight gain (3.1 ± 2.1 kg vs. 3.3 ± 3.0 kg, p = 0.72), cesarean delivery (24/52 (48%) vs. 23/53 (43%), RR 1.06, 95% CI: 0.69−1.62, p = 0.77), neonatal birthweight (3.1 ± 0.4 kg vs. 3.0 ± 0.4 kg, p = 0.53) and neonatal intensive care unit admission (4/52 (8%) vs. 3/53 (6%), RR 1.36, 95% CI: 0.32−5.78, p = 0.68) were not significantly different for SMBG3 vs. SMBG1, respectively. Other maternal and neonatal secondary outcomes were not significantly different. Conclusion: In mild GDM, three days compared to one day per week showed a similar HbA1c levels change at 36-weeks gestation. Maternal and neonatal outcomes were also not significantly different. Less frequent monitoring of SMBG as a standard of care in mild GDM deserves further study and consideration.
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Affiliation(s)
| | | | - Peng Chiong Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Malaysia; (J.G.S.H.); (A.F.M.N.)
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Venkatesh KK, Germann K, Joseph J, Kiefer M, Buschur E, Thung S, Costantine MM, Gabbe S, Grobman WA, Fareed N. Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes. Obstet Gynecol 2022; 139:1051-1060. [PMID: 35675602 PMCID: PMC10953616 DOI: 10.1097/aog.0000000000004727] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association between community-level social vulnerability and achieving glycemic control (defined as hemoglobin A1c [Hb A1c] less than 6.0% or less than 6.5%) among individuals with pregestational diabetes. METHODS We conducted a retrospective cohort of individuals with pregestational diabetes with singleton gestations from 2012 to 2016 at a tertiary care center. Addresses were geocoded using ArcGIS and then linked at the census tract to the Centers for Disease Control and Prevention's 2018 SVI (Social Vulnerability Index), which incorporates 15 Census variables to produce a composite score and four scores across thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). Scores range from 0 to 1, with higher values indicating greater community-level social vulnerability. The primary outcome was Hb A1c less than 6.0%, and, secondarily, Hb A1c less than 6.5%, in the second or third trimesters. Multivariable Poisson regression with robust error variance was used to evaluate the association between SVI score as a continuous measure and target Hb A1c. RESULTS Among 418 assessed pregnant individuals (33.0% type 1; 67.0% type 2 diabetes), 41.4% (173/418) achieved Hb A1c less than 6.0%, and 56.7% (237/418) Hb A1c less than 6.5% at a mean gestational age of 29.5 weeks (SD 5.78). Pregnant individuals with a higher SVI score were less likely to achieve Hb A1c less than 6.0% compared with those with a lower SVI score. For each 0.1-unit increase in SVI score, the risk of achieving Hb A1c less than 6.0% decreased by nearly 50% (adjusted risk ratio [aRR] 0.53; 95% CI 0.36-0.77), and by more than 30% for Hb A1c less than 6.5% (adjusted odds ratio 0.67; 95% CI 0.51-0.88). With regard to specific SVI domains, those who scored higher on socioeconomic status (aRR 0.50; 95% CI 0.35-0.71) as well as on household composition and disability (aRR 0.55; 95% CI 0.38-0.79) were less likely to achieve Hb A1c less than 6.0%. CONCLUSION Pregnant individuals with pregestational diabetes living in an area with higher social vulnerability were less likely to achieve glycemic control, as measured by HgbA1c levels. Interventions are needed to assess whether addressing social determinants of health can improve glycemic control in pregnancy.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the College of Medicine, the Division of Endocrinology, Department of Medicine, and the Department of Bioinformatics, The Ohio State University, Columbus, Ohio
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Thakkar A, Hailu T, Blumenthal RS, Martin SS, Harrington CM, Yeh DD, French KA, Sharma G. Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention. Curr Atheroscler Rep 2022; 24:493-507. [PMID: 35524915 PMCID: PMC9076812 DOI: 10.1007/s11883-022-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/05/2022]
Abstract
Purpose of Review Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention. Recent Findings Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the “fourth trimester,” 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. Summary While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.
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Affiliation(s)
- Aarti Thakkar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Tigist Hailu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Colleen M Harrington
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare, Worcester, MA, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharine A French
- Lifespan Cardiovascular Institute, Division of Cardiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Shuang W, Hui X, Ling L, Ping L. Time in range measurements for hyperglycemia management during pregnancy. Clin Chim Acta 2022; 531:56-61. [PMID: 35339452 DOI: 10.1016/j.cca.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
The prevalence of adverse pregnancy outcomes associated with poor glycemic control are increasing. Accordingly, effective blood glucose monitoring during pregnancy has become a subject of intense interest. Continuous glucose monitoring (CGM) displays dynamic changes in blood glucose by using probes to measure glucose concentration in the interstitial fluid, and the rapid development of CGM has enabled the investigation of time in range (TIR) in the glucose target range as a new parameter to evaluate blood glucose. International guidelines have identified TIR as an important blood glucose assessment method for pregnant patients with type 1 diabetes mellitus that overcomes the limitations of conventional gestational blood glucose monitoring, better reflects fluctuation in blood glucose during pregnancy, and effectively improves maternal and neonatal outcomes. However, there is little clinical evidence for the use of TIR in pregnant women with gestational diabetes mellitus and those with pre-pregnant type 2 diabetes mellitus. TIR is expected to become a critical indicator of blood glucose control and management in hyperglycemic pregnant patients. We review the research progress of TIR to help clinicians understand the field of blood glucose monitoring in pregnant women with hyperglycemia.
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Affiliation(s)
- Wang Shuang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shen-yang, Liao Ning 110000, China
| | - Xin Hui
- Department of Endocrinology and Metabolism, Shenyang 242 Hospital ,Shen-yang, Liao Ning 110000, China
| | - Li Ling
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shen-yang, Liao Ning 110000, China
| | - Li Ping
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shen-yang, Liao Ning 110000, China.
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Liabsuetrakul T, Sriwimol W, Jandee K, Suksai M, Dyereg J. Relationship of anthropometric measurements with glycated hemoglobin and 1-h blood glucose after 50 g glucose challenge test in pregnant women: A longitudinal cohort study in Southern Thailand. J Obstet Gynaecol Res 2022; 48:1337-1347. [PMID: 35261106 DOI: 10.1111/jog.15213] [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: 09/29/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
AIMS To assess correlations of anthropometric measurements with glycated hemoglobin (HbA1c) and 1-h blood glucose after a 50 g glucose challenge test during the first and late second trimesters and explore their relationships of anthropometric measurements with neonatal birth weight. METHODS A longitudinal study was conducted among pregnant Thai women with gestational age ≤14 weeks. Anthropometric measurements, using body mass index, body compositions, and circumferences, and skinfold thickness, were measured at four-time points: ≤14, 18-22, 24-28, and 30-34 weeks of gestation. HbA1c and 1-h blood glucose were examined at ≤14 and 24-28 weeks. Neonatal birth weight was recorded. RESULTS Of 312 women, HbA1c was more correlated with anthropometric measurements during pregnancy than 1-h blood glucose. At 24-28 weeks, women with high/very high body fat percentage were more likely to have higher HbA1c. Women with high subscapular skinfold thickness were more likely to have higher 1-h blood glucose at ≤14 and 24-28 weeks. High hip circumference significantly increased neonatal birth weights. CONCLUSION Anthropometric measurements were longitudinally correlated with HbA1c and 1-h blood glucose, higher in the late second than first trimesters, as well as neonatal birth weight. The mechanisms to explain the relationship of different anthropometric measurements are required to be further studied.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wilaiwan Sriwimol
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kasemsak Jandee
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Department of Community Public Health, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Manaphat Suksai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jaeuddress Dyereg
- Obstetrics and Gynecology Division, Naradhiwas Rajanagarindra Hospital, Narathiwat, Thailand
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Valadan M, Bahramnezhad Z, Golshahi F, Feizabad E. The role of first-trimester HbA1c in the early detection of gestational diabetes. BMC Pregnancy Childbirth 2022; 22:71. [PMID: 35086491 PMCID: PMC8793236 DOI: 10.1186/s12884-021-04330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background We aimed to assess the utility of HbA1c in the early detection of gestational diabetes (GDM) in the first trimester. Methods This prospective study was performed on 700 pregnant women in the perinatology clinic at a tertiary university hospital from March 2018 to March 2020. For all pregnant women, HbA1c and fasting blood glucose (FBG) levels were examined during the first trimester. Then, a GDM screening test was done within 24–28 weeks of pregnancy using a 100 g oral glucose tolerance test (OGTT) as the gold standard test. The GDM diagnosis was made according to the American Diabetes Association (ADA) criteria. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of HbA1c and FBG were calculated using the receiver operating characteristic (ROC) curve. Results Of 700 participants, one hundred and fifteen (16.4%) women had GDM. The GDM patients were significantly older and had a higher pre-gestational body mass index and pregnancy weight gain compared to the non-GDM participants. The sensitivity and specificity for ruling out GDM at an HbA1c cut-off value of 4.85% was 92.2 and 32.8%, respectively, with a 95.5% NPV and a 21.2% PPV. Furthermore, sensitivity and specificity for diagnosing GDM at an HbA1c cut-off value of 5.45% was 54.8 and 96.8%, respectively, with a 91.5% NPV and a 76.8% PPV. Using HbA1c could decline OGTT in 40.4% of the pregnant women (28.7% with HbA1c < 4.85 and 11.7% with HbA1c ≥ 5.45%). Conclusion It seems that the first-trimester HbA1c cannot replace OGTT for the diagnosis of GDM because of its insufficient sensitivity and specificity. However, women with higher first-trimester HbA1c had a high risk for GDM incidence.
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Affiliation(s)
- Mehrnaz Valadan
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Bahramnezhad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Golshahi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Yas Hospital, Tehran, Iran
| | - Elham Feizabad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Nguyen Q, Iyyavoo AA, Parkin CG. Use of Retrospective Continuous Glucose Monitoring Data Is Underrated and Underused. J Diabetes Sci Technol 2022; 17:843-849. [PMID: 35043701 DOI: 10.1177/19322968211070837] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Access to real-time glucose data in real time allows users to make informed decisions about their insulin dosages, appropriate carbohydrate intake, exercise, and other health behaviors. Programmable alarms and alerts warn users about current and/or impending acute glycemic events. However, the value and utility of retrospective data analysis for clinical decision-making have gone mostly unrecognized. This article presents a series of patient case examples that illustrate how our use of retrospective data enables us to identify and effectively address patterns of problematic glycemia.
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Carlsen EØ, Harmon Q, Magnus MC, Meltzer HM, Erlund I, Stene LC, Håberg SE, Wilcox AJ. Glycated haemoglobin (HbA1c) in mid-pregnancy and perinatal outcomes. Int J Epidemiol 2022; 51:759-768. [PMID: 34993542 PMCID: PMC9189945 DOI: 10.1093/ije/dyab270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Maternal diabetes is a well-known risk factor for pregnancy complications. Possible links between long-term maternal blood sugar in the normal range and pregnancy complications are less well described. Methods We assayed glycated haemoglobin (HbA1c) in blood samples collected around the 18th week of pregnancy for 2937 singleton pregnancies in the Norwegian Mother, Father and Child Cohort Study (2000–09). Perinatal outcomes (gestational length, birthweight, birth length and head circumference, large-for-gestational age, small-for-gestational age, congenital malformations, preterm delivery and preeclampsia) were obtained from medical records. We tested associations using linear and log-binomial regression, adjusting for maternal age, body mass index (BMI) and smoking. Results Size at birth increased modestly but linearly with HbA1c. Birthweight rose 0.10 standard deviations [95% confidence interval (CI): 0.03, 0.16], for each 5-mmol/mol unit increase in HbA1c, corresponding to about 40 g at 40 weeks of gestation. Large-for-gestational age rose 23% (95% CI: 1%, 50%) per five-unit increase. Other pregnancy complications increased in non-linear fashion, with strongest associations within the top quartile of HbA1c (>35 mmol/mol or >5.4%). Per unit HbA1c within the top quartile, preterm delivery increased by 14% (95% CI: 1%, 31%), preeclampsia increased by 20% (95% CI: 5%, 37%) and gestational duration decreased by 0.7 days (95% CI: −1.0, −0.3). Conclusions Among women with no recorded diabetes, higher HbA1c levels at 18 gestational weeks were associated with important perinatal outcomes independent of mother’s age, smoking or BMI.
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Affiliation(s)
- Ellen Ø Carlsen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Quaker Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Helle M Meltzer
- Division of Climate and Environment, Environment and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Iris Erlund
- Department of Government Services (Biomarkers Team), Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lars C Stene
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Allen J Wilcox
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
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Tripathy S, Murugesan A, Natarajan K, Ramraj B, Mohapatra S. Early screening biomarker HbA1c and Hematocrit for gestational diabetes mellitus. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mahmood K, Al-Rasol EA. The effect of Vit B12 deficiency, homocystein, and lipid metabolism in association with increased risk of gestational diabetes mellitus. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Flekač M. Time in range: new parameter to evaluate blood glucose control. VNITRNI LEKARSTVI 2022; 68:315-323. [PMID: 36283823 DOI: 10.36290/vnl.2022.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Continuous glucose monitoring became more common in everyday clinical practice. New parameters have been created as a standard for assessing the degree of control for people with diabetes and can be used more clearly than glycated haemoglobin. The new parameter time in range represents a significant benefit not only for diabetologists, but also an important tool to help the patients in their daily lives with diabetes.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Shah VN, Snell-Bergeon JK, Demmitt JK, Joshee P, Garcetti R, Pyle L, Polsky S. Relationship Between Time-in-Range, HbA1c, and the Glucose Management Indicator in Pregnancies Complicated by Type 1 Diabetes. Diabetes Technol Ther 2021; 23:783-790. [PMID: 34524020 PMCID: PMC9009593 DOI: 10.1089/dia.2021.0093] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: We aimed to evaluate relationships between time-in-range (TIR 63-140 mg/dL), glycated hemoglobin A1c (HbA1c) level, and the glucose management indicator (GMI) in pregnant women with type 1 diabetes. Research Design and Methods: Continuous glucose monitoring (CGM) data from 27 women with type 1 diabetes were collected prospectively throughout pregnancy. Up to 90-days of CGM data were correlated with point-of-care HbA1c levels measured in the clinic at each trimester. GMI levels were calculated using a published regression formula. Liner models were used to compare TIR, HbA1c, and GMI by each trimester. Results: There was a significant negative correlation between TIR and HbA1c; each 10% increase in TIR was associated with a 0.3% reduction in HbA1c. The correlation between TIR and HbA1c was stronger (r = -0.8) during the second and third trimesters than during the first trimester (r = -0.4). There was good correlation between TIR and GMI during each trimester (r = 0.9 for each trimester). The relationship between GMI and HbA1c especially during second (r = 0.8) and third trimesters (r = 0.8) was strong. Conclusion: In the first trimester, the correlation between HbA1c level and TIR was relatively small, while that of TIR and GMI was very strong, thus GMI may better reflect glycemic control than HbA1c in early pregnancy. Each 10% increase in TIR was associated with a 0.3% reduction in HbA1c throughout pregnancy, which was lower than other published studies in nonpregnant populations reporting a 0.5%-0.8% reduction in HbA1c. Further studies are needed to understand the relationship between TIR and GMI and how GMI may affect maternal and fetal complications. Clinical Trial Registration number: NCT02556554.
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Affiliation(s)
- Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Jamie K. Demmitt
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Prakriti Joshee
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Rachel Garcetti
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Address correspondence to: Sarit Polsky, MD, MPH, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, MS A140, Aurora, CO 80045, USA
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Jeraiby M. Awareness of Preconception Care and Its Related Factors Among Women of Childbearing Age with Type 1 Diabetes in the South of Saudi Arabia: A Cross-Sectional Survey Study. Int J Gen Med 2021; 14:8583-8589. [PMID: 34849003 PMCID: PMC8627196 DOI: 10.2147/ijgm.s335914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pregnancies in women with type 1 diabetes mellitus (T1DM) are associated with an increased risk of poor outcomes for mothers and their infants. OBJECTIVE To assess the awareness of preconception care among women with T1DM and their self-management status in the southern region of Saudi Arabia. METHODS This study is a cross-sectional study that was done on 187 women participated of childbearing age with T1DM who were seen in diabetic centers between June 2019 and September 2020. Pre-pregnancy care and disease management were assessed via a questionnaire. RESULTS The prevalence of preconception awareness of diabetes management was 66.9%. Several factors significantly influenced the level of awareness, including education level (P= 0.001) and HbA1c (P= 0.014). In multivariate analysis, the lower educational level turns out to be a significant risk factor for low awareness (OR = 3.71, 95% CI [1.65, 8.31], P= 0.001). Additionally, compared to controlled DM, uncontrolled diabetes had a twofold increased risk of low awareness (OR = 2.03, 95% CI [1.08, 3.81], P= 0.027). CONCLUSION The awareness level was significantly correlated with a high educational level and better glycemic control. Meanwhile, it was not significantly correlated with diabetes duration.
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Affiliation(s)
- Mohammed Jeraiby
- Department of Biochemistry, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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Gomes-Filho IS, Trindade SC, da Cruz SS, Figueiredo ACMG, Hintz AM, Adan LFF, Cerqueira EDMM, Passos-Soares JDS, Vianna MIP, Coelho JMF, Alves CMC, Barreto ML, Seymour GJ, Loomer PM, Scannapieco FA. Mothers' high glycemic levels and the association between periodontitis and low birth weight. J Periodontol 2021; 93:954-965. [PMID: 34792204 DOI: 10.1002/jper.21-0406] [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] [Received: 07/17/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW). METHODS 732 women took part in this case-control study; 172 were mothers of children with LBW <2,500g, and 560 were mothers of children with BW ≥2,500g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within seven days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating Odds Ratios (OR) with 95% confidence intervals (95%CI). RESULTS In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the ORadjusted was 1.55; 95%CI: 1.04-2.31; using the Gomes-Filho et al. criteria the ORadjusted was 1.91; 95%CI: 1.06-3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW. CONCLUSION Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Soraya Castro Trindade
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
| | - Simone Seixas da Cruz
- Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil
- Health Sciences Center, Federal University of Recôncavo of Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | | | | | | | | | | | | | | | | | - Maurício Lima Barreto
- Center for Data and Knowledge Integration for Health, CIDACS, Oswaldo Cruz Foundation, FIOCRUZ, Salvador, Bahia, Brazil
| | - Gregory John Seymour
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Michael Loomer
- School of Dentistry, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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49
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Buschur EO, Campbell K, Pyle L, Garcetti R, Joshee P, Demmitt JK, Snell-Bergeon JK, Polsky S. Exploratory Analysis of Glycemic Control and Variability Over Gestation Among Pregnant Women with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:768-772. [PMID: 34115946 PMCID: PMC9009588 DOI: 10.1089/dia.2021.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with lower glycemic measures, including estimated HbA1c (eHbA1c) (0.14% decrease in HbA1c per 1-week greater gestational age, P = 0.0035), mean sensor glucose (-3.9 mg/dL P = 0.0039), time spent >140 mg/dL (-3.1%, P = 0.0029), and higher time in range (TIR) of 63-140 mg/dL (3.2%, P = 0.0029). Third trimester measured HbA1c was significantly associated with gestational age at delivery (P = 0.0081). Preeclampsia was associated with less TIR in first (50.5% vs. 69.9%, P = 0.0034) and second trimesters (47.1% vs. 66.7%, P = 0.0025), but not with measured HbA1c. There were significant differences in other markers of GV (continuous overall net glycemic action, high blood glucose index, J-index, mean amplitude of glycemic excursions) with infant birth weight and gestational age at delivery. Thus, multiple markers of glycemia and GV were associated with gestational health outcomes in T1D pregnancies in this pilot study. Clinical Trial Registration number: NCT02556554.
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Affiliation(s)
- Elizabeth O. Buschur
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen Campbell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel Garcetti
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Prakriti Joshee
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jamie K. Demmitt
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
- Address correspondence to: Sarit Polsky, MD, MPH, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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50
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Ling P, Yang D, Gu N, Xiao X, Lu J, Liu F, Zhou Z, Huang Q, Zhao J, Zhang M, Hu J, Luo S, Weng J, Yan J, Zheng X. Achieving the HbA1c Target Requires Longer Time in Range in Pregnant Women With Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:e4309-e4317. [PMID: 34244734 PMCID: PMC8530704 DOI: 10.1210/clinem/dgab502] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Continuous glucose monitoring (CGM) overcomes the limitations of glycated hemoglobin (HbA1c). OBJECTIVE This study aimed to investigate the relationship between CGM metrics and laboratory HbA1c in pregnant women with type 1 diabetes. METHODS An observational study enrolled pregnant women with type 1 diabetes who wore CGM devices during pregnancy and postpartum from 11 hospitals in China from January 2015 to June 2019. CGM data were collected to calculate time in range (TIR), time above range (TAR), time below range (TBR), and glycemic variability parameters. Relationships between the CGM metrics and HbA1c were explored. Linear and curvilinear regressions were conducted to investigate the best-fitting model to clarify the influence of HbA1c on the TIR-HbA1c relationship during pregnancy. RESULTS A total of 272 CGM data and corresponding HbA1c from 98 pregnant women with type 1 diabetes and their clinical characteristics were analyzed in this study. Mean HbA1c and TIR were 6.49 ± 1.29% and 76.16 ± 17.97% during pregnancy, respectively. HbA1c was moderately correlated with TIR3.5-7.8(R = -0.429, P = .001), mean glucose (R = 0.405, P = .001) and TAR7.8 (R = 0.435, P = .001), but was weakly correlated with TBR3.5 (R = 0.034, P = .001) during pregnancy. On average, a 1% (11 mmol/mol) decrease in HbA1c corresponded to an 8.5% increase in TIR3.5-7.8. During pregnancy, HbA1c of 6.0%, 6.5%, and 7.0% were equivalent to a TIR3.5-7.8 of 78%, 74%, and 69%, respectively. CONCLUSION We found there was a moderate correlation between HbA1c and TIR3.5-7.8 during pregnancy. To achieve the HbA1c target of less than 6.0%, pregnant women with type 1 diabetes should strive for a TIR3.5-7.8 of greater than 78% (18 hours 43 minutes) during pregnancy.
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Affiliation(s)
- Ping Ling
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Nan Gu
- Department of Endocrinology and Metabolism, Peking University First Hospital, Beijing 100034, China
| | - Xinhua Xiao
- Department of Endocrinology and Metabolism, Peking Union Medical College Hospital, Beijing 100005, China
| | - Jing Lu
- Department of Endocrinology and Metabolism, Nanjing Drum Tower Hospital, Nanjing 210008, China
| | - Fang Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
| | - Zhiguang Zhou
- Department of Endocrinology and Metabolism, The Second Xiangya Hospital of Central University, Changsha 410007, China
| | - Qin Huang
- Department of Endocrinology and Metabolism, Changhai Hospital, Shanghai 200433, China
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital, Jinan 250021, China
| | - Mei Zhang
- Department of Endocrinology and Metabolism, Jiangsu Province Hospital, Nanjing 210029, China
| | - Ji Hu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Sihui Luo
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xueying Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
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