Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring

Yu, Y., et al. |2019| Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up| BMJ367 | doi: https://doi.org/10.1136/bmj.l6398

A recent study that analysed the association between maternal diabetes in pregnancy and early onset of cardiovascular disease (CVD) in the offspring, found that children of mums with diabetes, particularly those who mothers have CVD or diabetic complications, have higher rates of early onset CVD from childhood to early adulthood. 

The full paper is available to read in the BMJ 

Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up

BMJ: Losing weight following diagnosis of type 2 diabetes boosts chance of remission

BMJ | February 2020 | Losing weight following diagnosis of type 2 diabetes boosts chance of remission

Previous studies have shown that remission of type 2 diabetes, without medication or surgery, is achievable through intensive low calorie diets and behaviour change in those who have lived with diabetes for some years. Many of these studies have also been relatively short. A new feature in the BMJ highlights the findings of  recent study (published last year) that  looks at patients newly diagnosed with diabetes aged between 40–69 years from the ADDITION‐Cambridge trial.

BMJ Losing weight following diagnosis of type 2 diabetes boosts chance of remission

Why was this study needed?

 

Around one in 10 adults over 40 in the UK has been diagnosed with type 2 diabetes. This has been fuelled by the rise in rates of obesity. Diabetes UK estimates that in addition to the 3.8 million adults who have been diagnosed with type 2 diabetes, a further one million have the disease without knowing it. Diabetes and its complications, including kidney failure, loss of sight, and lower limb amputations, cost the NHS £6 billion every year.

Previous studies have shown that remission of type 2 diabetes, without medication or surgery, is achievable through intensive low calorie diets and behaviour change in those who have lived with diabetes for some years. Many of these studies have also been relatively short.

The present study looked at whether a more moderate approach could achieve remission over the longer term, and whether a window of opportunity exists following diagnosis when weight loss interventions may be both effective and acceptable.

 

What did this study do?

This was a prospective cohort study of 867 people, aged 40 to 69, who were newly diagnosed with diabetes. Participants had been enrolled in the ADDITION-Cambridge randomised controlled trial, from 49 GP practices in the east of England between 2002 and 2006. The trial randomised participants into an intervention group, who received additional support, or the control “usual care” group. This cohort study pooled data from both groups to look at who achieved remission during five years of follow-up.

Participants’ weight, physical activity, diet, and alcohol consumption at baseline and one year were assessed. At five year follow-up, 730 people (84%) had weight and HbA1c measures taken. The participants were predominantly white.

 

What did it find?

● Diabetes remission, defined as an HbA1c level of less than 48 mmol/mol (6.5%) in the absence of any diabetes medication or bariatric surgery, was achieved in 257 participants (30%) at five year follow-up.

● People who lost at least 10% of their body weight in the first year after diagnosis of diabetes were more likely to achieve remission at five years compared with those with stable or increased weight.

● Similar trends were observed in those who had more modest weight loss of 5% to 10% over the first year after diagnosis, but this was not statistically significant.

● In the subsequent four years (ie, between the end of the first year and the end of the five year study), achieving at least a 10% weight loss was associated with more than double the chance of remission at five year follow-up.

● In this period weight loss of 5% to 10% was also associated with an increased likelihood of remission.

 

 

NIHR Signal Losing weight following type 2 diabetes diagnosis boosts chance of remission

Signal available from BMJ

Full reference: Dambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122.

Abstract

Aim

To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5‐year follow‐up.

Method

We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40–69 years from the ADDITION‐Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self‐report), and alcohol consumption (self‐report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1–5 years, as well as remission at 5‐year follow‐up.

Results

Diabetes remission was achieved in 257 participants (30%) at 5‐year follow‐up. Compared with people who maintained the same weight, those who achieved more than or equal to 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission. In the subsequent 1–5 years, achieving more than or equal to 10% weight loss was also associated with remission.

Conclusion

In a population‐based sample of adults with screen‐detected Type 2 diabetes, weight loss of more than or equal to 10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

What’s new?

  • Biochemical remission of Type 2 diabetes in the absence of pharmacological or surgical intervention has been shown to be achievable.
  • This has been previously demonstrated in short‐term studies and only in selected populations through intensive weight loss programmes.
  • We found that weight loss of ≥10% in the first few years after diagnosis was strongly associated with remission of Type 2 diabetes at 5 years.
  • This was achieved without intensive lifestyle interventions or extreme calorie restrictions.
  • Our findings should inform discussions with people who have newly diagnosed Type 2 diabetes as a motivation towards remission of the disease without restrictive and sometimes unachievable calorie restrictions.

Study available from Diabetic Medicine