Diabetes in pregnancy: management from preconception to the postnatal period

NICE | Diabetes in pregnancy: management from preconception to the postnatal period

A new surveillance report has been published by NICE.  This surveillance report looks at new evidence in relation to diabetes in pregnancy: management from preconception to the postnatal period.

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NICE will partially update the NICE guideline on diabetes in pregnancy (NG3). The update will focus on the role of continuous glucose monitoring for women with type 1 diabetes who are planning to become pregnant or already pregnant.

This is because there is new evidence on continuous glucose monitoring. In particular, the CONCEPTT trial has published which experts deem to be a landmark trial that provides the best available evidence for the foreseeable future. The CONCEPTT trial found improvements in a range of neonatal outcomes with continuous glucose monitoring plus standard care, compared with standard care alone, and advocates routine usage in pregnant women with type 1 diabetes. This could potentially alter recommendation 1.3.17, which currently advises do not offer continuous glucose monitoring routinely to pregnant women with diabetes.

Full details are at NICE

 

Diabetes and obesity higher among LGBQ teens

OnMedica| July 2018| Diabetes and obesity higher among LGBQ teens

A new study of American teenagers is the largest study to date to report differences in levels of physical activity (PA), sedentary behaviour and obesity by sex and sexual orientation among high-school-aged students (young people between 14 and 18 years old).
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Researchers at Northwestern University used data from  350,673 students. They found, with the exception of lesbian female students, after adjusting for age, race/ethnicity, BMI, and survey year, all non‐heterosexual youth reported significantly fewer days per week of PA compared to their sex‐matched heterosexual counterparts. Overall lesbian, gay, bisexual and questioning  (LGBQ) students took part in less physical activity (approximately one day a week less) than heterosexual students.

The number of hours of sedentary activity among this group was higher than heterosexual students (an average of 30 minutes more per school day than heterosexual counterparts), and lesbian, bisexual and questioning female students were 1.55 to 2.07 times more likely to be obese than heterosexual female students.

According to the study lesbian students were 1.85 times more likely to be overweight and lesbian, bisexual, and not sure female youth were 1.55‐2.07 times more likely to be obese than heterosexual female students. No significant differences in SB, overweight, or obesity were found among gay, bisexual, or unsure male youth compared to heterosexual male youth.

Lauren Beach, Lead author of the study, said:
“Many of these youth might be taking part in sedentary activities – like playing video games – to escape the daily stress tied to being lesbian, gay, bisexual or questioning,”

The researchers explain that LGBQ youth may be at increased risk for developing type 2 diabetes mellitus compared to heterosexual youth. They suggest future studies should characterize diabetes prevalence among non‐heterosexual youth (Source: OnMedica).

The full press release is available at OnMedica

The study has now been published in the journal Pediatric Diabetes 
Abstract

Low physical activity (PA), high sedentary behavior (SB), and overweight and obesity have been shown to associate with increased Type 2 diabetes risk among adolescents. We investigated PA, SB, and overweight and obesity among Youth Risk Behavior Survey (YRBS) respondents to determine if non‐heterosexual youth may be at increased diabetes risk compared to heterosexual youth.

Weighted city and state YRBS data were pooled across 44 jurisdictions biennially from 2009‐2015, resulting in a sample size of 350,673 students. Overall, 88.4% identified as heterosexual, 2.1% as gay or lesbian, 5.7% as bisexual, and 3.7% as unsure.

With the exception of lesbian female students, after adjusting for age, race/ethnicity, BMI, and survey year, all non‐heterosexual youth reported significantly fewer days per week of PA compared to their sex‐matched heterosexual counterparts. Similarly, compared to heterosexual female youth, bisexual and not sure female youth reported significantly more hours per day of SB. These PA and SB findings remained significant after adjustment for depressive symptoms and in‐school bullying among bisexual female youth only. In fully adjusted models, lesbian students were 1.85 times more likely to be overweight and lesbian, bisexual, and not sure female youth were 1.55‐2.07 times more likely to be obese than heterosexual female students. No significant differences in SB, overweight, or obesity were found among gay, bisexual, or unsure male youth compared to heterosexual male youth.

Non‐heterosexual youth may be at increased risk for developing type 2 diabetes mellitus compared to heterosexual youth. Future studies should characterize diabetes prevalence among non‐heterosexual youth.

Full reference: Beach, L. B., Turner, B. , Felt, D. , Marro, R. and Phillips, G. L. |2018| Risk Factors for Diabetes are Higher among Non‐Heterosexual US High School Students| Pediatr Diabetes.| Accepted Author Manuscript| doi:10.1111/pedi.12720

Rotherham NHS staff are able to request this article here 

Pregnant women invited to take part in pioneering diabetes prevention research

NIHR |July 2018 | Pregnant women invited to take part in pioneering diabetes prevention research

Pregnant women visiting maternity clinics in Berkshire, Buckinghamshire, Milton Keynes and Oxfordshire are being invited to participate in a new study, The INvestigating Genetic Risk for type 1 Diabetes (INGR1D), to identify the risk of their child developing type 1 diabetes.
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Mothers of infants identified to have a higher risk of type 1 diabetes will then be offered an opportunity to take part in the Primary Oral Insulin Trial (POInT trial) to see if giving  high-risk children small doses of insulin powder can prevent them from developing type 1 diabetes.

Participants on the trial are given the powder or a placebo, to compare the two. Parents are asked to give their children insulin powder daily until they are three years old. They will have visits from the research team to monitor the child’s health.

The scientists hope that this intervention can train the immune system to tolerate the body’s own insulin to prevent the onset of type 1 diabetes (Source: NIHR).

Full details are available from NIHR 

In the news:

BBC News Stopping type 1 diabetes from birth

How psychosocial factors can influence diabetes outcomes

This publication explores the role that psychosocial factors play in the management of diabetes and the importance of addressing these to improve diabetes outcomes | Katharine Barnard | Roche

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Diabetes doesn’t just affect someone physically. This chronic and complex condition, which requires close and frequent monitoring of blood sugar levels alongside careful  consideration of activity and nutrition, places high behavioural demands on the person living with the illness on a daily basis. This can have a significant impact on a person’s mental health, well-being and their quality of life.

A survey by Diabetes UK during 2017 found that 64% of people with diabetes “sometimes or often” feel down because of their disease. It also revealed, significantly, that there is a need for more emotional and psychological support to make living with diabetes easier.

In this publication, the author argues that “there is a growing consensus that calls for a change in how diabetes is treated and managed, with a need to focus on the concept of living with diabetes rather than just treating the disease.”

Full document: How psychosocial factors can influence diabetes outcomes