There is general consensus that children of women with pre-existing diabetes mellitus (PDM) have an increased risk of malformations and neurodevelopmental problems. Whether this is also true for children of women with gestational diabetes mellitus (GDM) is a matter of debate. This study investigated inpatient hospital care up to 10 y of age of children born to GDM and PDM women as a rough estimate of child morbidity. Hospital care of children born to 82,684 GDM women, 3,874 PDM women and 1,213,957 controls was compared by linking the Swedish Medical Birth Registry with the Hospital Discharge Registry. Similar comparisons were performed in a local well-controlled group of 326 children born to GDM women in the Lund area. Children of PDM women and to a lesser degree children of GDM women had a statistically significant increase in hospitalizations, evident at least up to 10 y of age. Significantly increased risks of hospitalization were found for neurological/developmental disorders [odds ratio (OR) 2.30 and 1.36 for PDM and GDM, respectively)], malformations (OR 2.05 and 1.23), infections (OR 1.56 and 1.20) and accidents (OR 1.32 and 1.14). CONCLUSION: The high hospitalization rates of these children indicate an increased morbidity, including neurodevelopmental disorders.
Circulating levels of the inflammatory marker YKL-40 are elevated in cardiovascular disease and obesity-related type 2 diabetes (T2D), and serum YKL-40 levels are related to elements of dyslipidaemia.
We aimed to investigate the associations between serum YKL-40 and obesity-related traits in a Danish sample of non-diabetic relatives to T2D patients and, furthermore, to estimate the heritability of YKL-40.
324 non-diabetic individuals with family relation to a T2D patient were included in the study. The participants underwent oral- and intravenous glucose tolerance tests for estimation of glucose tolerance and surrogate measures of insulin sensitivity. Anthropometric measures were retrieved and biochemical measures of the plasma lipid profile and serum YKL-40 levels were obtained. Association-analyses between serum YKL-40 and obesity-related traits and estimates of the narrow sense heritability of YKL-40 were based on a polygenic variance component model.
Fasting serum levels of YKL-40 were positively associated with waist-hip-ratio (p
The optimal blood pressure (BP) in persons with type-2 diabetes is debated. We investigated shapes of the associations of SBP and DBP levels with risk of cardiovascular events and mortality in a large primary care-based sample of diabetic patients.
We investigated all 34?009 consecutive cardiovascular disease-free type-2 diabetes patients aged 35 years or older (mean age 64 years) at 84 primary care centers in central Sweden between 1999 and 2008. We followed this cohort until the end of 2009 in national registries for the incidence of major cardiovascular events (a composite endpoint of myocardial infarction, stroke, heart failure, or cardiovascular mortality) or total mortality.
During up to 11 years of follow-up, 6344 patients (18.7%) had a first cardiovascular event, and 6235 died (18.3%). The associations of annually updated SBP and DBP with risk of major cardiovascular events were U-shaped. The lowest risk of cardiovascular events was observed at a SBP of 135-139?mmHg and a DBP of 74-76?mmHg, and the lowest mortality risk at a SBP of 142-150?mmHg and a DBP of 78-79?mmHg, in both antihypertensive drug-untreated and drug-treated persons.
In a large primary care-based sample of patients with type-2 diabetes, associations of SBP and DBP with risk of major cardiovascular events and mortality were U-shaped. This may have implications for risk stratification of persons with diabetes.
To assess the causes of death and cause-specific standardized mortality ratios in two nationwide, population-based cohorts diagnosed with Type 1 diabetes during the periods 1973-1982 and 1989-2012, and to evaluate changes in causes of death during the follow-up period.
The objective of this study was to determine whether peer recommendations made in response to user queries about non-insulin dependent type II diabetes in an online health forum for retired persons were in agreement with diabetes clinical practice guidelines. A content analysis was conducted on type II diabetes conversations occurring in an online health forum for Canadian retired persons from 1 January to 31 December 2006. Recommendations responding to posted questions about diabetes were compared with published Canadian diabetes clinical practice guidelines. Seven diabetes-related questions generated 17 responses and 35 recommendations. Comparison of recommendations with evidence-based sources indicated that 91% (32/35) were in agreement with the best practice clinical guidelines for type II diabetes. Discussion themes included diabetic signs and symptoms, glycemic control, neuropathy, retinopathy, diet and physical activity recommendations and interactions of prednisone with glucose control. Concerns about the accuracy of online peer recommendations about type II diabetes care and management have not supported these results. This forum presents information sharing among a group of knowledgeable older adults with high interactive health literacy skills. Future research is needed to determine whether deviations from 'accurate' online information are truly harmful or represent lay expert adaptations to self-care routines.
Youth-onset type 2 diabetes is a serious public health problem for Indigenous people throughout the world. This article reviews the epidemiology, disease burden, treatment, and challenges in achieving successful clinical management of this disorder in Indigenous youth. Screening criteria and the complications and comorbidities of type 2 diabetes are also reviewed.
INTRODUCTION: This study's aim was to project the long-term clinical and economic outcomes of continuous subcutaneous insulin infusion (CSII) treatment compared to multiple daily injections (MDI) in type 1 diabetes patients in Denmark. MATERIAL AND METHODS: The CORE diabetes model was used to project life expectancy, quality-adjusted life expectancy, cumulative incidence of diabetes-related complications and costs over patient lifetimes. The simulated cohort was based upon a recent meta-analysis of CSII treatment from over 50 studies. Direct and indirect costs (human capital approach) from a healthcare payer perspective were accounted in year 2005 local currency. Outcomes were discounted according to recommendations and simulations performed over a 60 year time horizon. RESULTS: CSII treatment was associated with improved life expectancy, quality-adjusted life expectancy and reduced incidence of most diabetes-related complications compared to MDI. In the base case analysis, lifetime costs were higher for CSII than for MDI with incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained within the range generally considered good value for money. Sensitivity analyses revealed that the findings were most sensitive to variation in assumptions regarding time horizon and hypoglycaemic event rate. CONCLUSION: CSII led to improved long-term clinical outcomes due to improved glycaemic control versus MDI. Evaluation of the economic impact of CSII treatment versus MDI demonstrated that it would be likely to represent good value for money by currently accepted standards.
To describe the state of diabetes care among Alberta First Nations individuals with diabetes living on reserves.
Survey and screening for diabetes-related complications.
Forty-three Alberta First Nations communities.
A total of 743 self-referred First Nations individuals with known diabetes.
Clinical measurements (glycated hemoglobin A(1c) levels, body mass index, waist circumference, total cholesterol, blood pressure, and the presence of kidney complications or proteinuria, retinopathy, and foot abnormalities), self-reported health services utilization, clinical history, and knowledge of and satisfaction with diabetes services.
Female participants tended to be more obese (P
Cites: Diabetes Res Clin Pract. 2004 Mar;63(3):195-20314757291
The art of obstetrics is not a subject which is often discussed in the pages of Diabetologia. However, as the care of the diabetic mother and her offspring is rightly an interdisciplinary responsibility between obstetrician, diabetologist and neonatologist, it is important that each has a close understanding of the various problems. Dr. M.I. Drury (Dublin), speaking as an internist, raises a question on the optimum time and method of delivery of the baby; this has more than purely obstetrical implications. Drs. L. Mølsted-Pedersen (Copenhagen) and C. Kühl (Copenhagen and Klampenborg), obstetrician and internist from the longest-established joint obstetric/diabetic service in the world, present a Scandinavian view on the management of pregnancy. Both centres have distinguished records in the management of diabetic pregnancy. The different viewpoints in Denmark and in Ireland are clear - in Copenhagen, therapeutic abortion is practiced in a pregnancy at risk of severe congenital malformation; in Dublin it is not. Dr. Drury quotes a perinatal loss of 13 of 285 pregnancies (4.5%) in the past 5 years, but does not include the recognised spontaneous abortions which, on his overall figures, are about 10% of conceptions. Dr. Mølsted-Pedersen reports a perinatal loss of 3 of 201 infants (1.5%), excluding 17 spontaneous and 9 induced abortions. If these 9 aborted pregnancies, which were performed due to a risk of severe congenital malformation, were included as fatalities, the Copenhagen figure would be 12 of 210 (5.5%). Of course, we do not know if all those 9 fetuses were affected. The spontaneous abortion rate was 17 of 223 (8.0%).(ABSTRACT TRUNCATED AT 250 WORDS)
According to the WHO and the UN definitions, diabetes mellitus is a non-infectious disease that has an epidemic spread rate, this has led to the UN 2006 resolution against diabetes mellitus. A special diabetologic service has been established in Russia which includes Federal and regional diabetes centres, endocrinologic clinics, equipped with modem diagnostic and treatment equipment for diabetes and its vascular complications handling. Planning of diabetologic service functioning is based on State diabetes mellitus register data, according to which nowadays in Russia 3 268 871 patients have been registered. This article contains data from control-and-epidemiological studies from various regions of Russia which have shown real spread of the disease. This article also contains information about innovative technologies of treatment of diabetes mellitus and its complications, international and national foreground studies, as well as discussion of diabetologic service development perspectives.