| 1. |
- Fadl, Helena, 1965-, et al.
(författare)
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Changing diagnostic criteria for gestational diabetes in Sweden-a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol
- 2019
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Ingår i: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden () is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches. Methods This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January-December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included. Discussion The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.
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| 2. |
- Akalin, S., et al.
(författare)
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Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control
- 2009
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Ingår i: International Journal of Clinical Practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 63:10, s. 1421-1425
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is compelling evidence showing that achieving good glycaemic control reduces the risk of microvascular complications in people with type 1 and type 2 diabetes. Likewise, there is clear evidence to show that achieving good glycaemic control reduces the risk of macrovascular complications in type 1 diabetes. The UKPDS 10-year follow up suggests that good glycaemic control also reduces the risk of macrovascular complications in type 2 diabetes. Despite this, recent results from ACCORD, ADVANCE and VADT present conflicting results and data from the ACCORD trial appear to suggest that very low HbA(1c) targets (< 6.0%) may, in fact, be dangerous in certain patient populations. Aim: To review recent results from ACCORD, ADVANCE and VADT and provide clear guidance on the clinical significance of the new data and their implications for the practising physician treating patients with type 2 diabetes. Methods: A Pubmed search was used to identify major randomised clinical trials examining the association between glycaemic control and diabetes-associated complications. The data was reviewed and discussed by the GTF through a consensus meeting. The recommendations for clinical practice in this statement are the conclusions of these analyses and discussions. Results: Evidence from ACCORD, ADVANCE, VADT and UKPDS suggests that certain patient populations, such as those with moderate diabetes duration and/or no pre-existing CVD, may benefit from intensive blood glucose control. These trials highlight the benefit of a multifactorial treatment approach to diabetes. However, ACCORD results indicate that aggressive HbA(1c) targets (< 6.0%) may not be beneficial in patients with existing CVD and a longer duration of diabetes. Conclusions: Glycaemic control remains a very important component of treatment for type 2 diabetes and contrasting results from the ACCORD, ADVANCE and VADT should not discourage physicians from controlling blood glucose levels.
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| 3. |
- Alvarsson, M, et al.
(författare)
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Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients
- 2003
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 26:8, s. 2231-2237
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment. RESEARCH DESIGN AND METHODS - ▀-Cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0-2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5-10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2-3 days of temporary withdrawal of treatment. RESULTS - After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 ▒ 0.08 nmol/l, whereas it was decreased by 0.12 ▒ 0.08 nmol/l in the glibenclamide group, P < 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamide-treated group (P = 0.02). HbA1c levels decreased significantly during the first year in both groups, however, at the end of the second year, HbA1c had deteriorated in the glibenclamide group (P < 0.01), but not in the insulin-treated group. The difference in evolution of HbA1c during the second year was significant between groups, P < 0.02 A questionnaire indicated no difference in well-being related to treatment. CONCLUSIONS - Early insulin versus glibenclamide treatment in type 2 diabetes temporarily prolongs endogenous insulin secretion and promotes better metabolic control.
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| 4. |
- Alvarsson, M, et al.
(författare)
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Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up
- 2008
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Ingår i: Diabetes, Obesity and Metabolism. - : Wiley. - 1462-8902 .- 1463-1326. ; 10:5, s. 421-429
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. Methods: Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. Results: Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 +/- 0.8 vs. +0.3 +/- 1.0 kg, p < 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p < 0.01) and 2 (p < 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p < 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered. Conclusions: In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial.
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| 7. |
- Berntorp, Kerstin E.
(författare)
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Gestational diabetes : what’s up?
- 2016
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 59:7, s. 1382-1384
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Tidskriftsartikel (refereegranskat)
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| 8. |
- Hjelm, Katarina, et al.
(författare)
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Beliefs about health and illness in women managed for gestational diabetes in two organisations.
- 2008
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 24:2, s. 168-192
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to explore beliefs about health, illness and health care in women with gestational diabetes mellitus (GDM) managed in two different organisations based on diabetology or obstetrics.Semi-structured interviews were made in two different clinics. clinic A: a specialist diabetes clinic with regular contact with a diabetologist and antenatal care provided by a midwifeclinic B: a specialist maternity clinic providing regular contact with a midwife, a structured programme for self-monitoring of blood glucose and insulin treatment, and a 1-day diabetes class by an obstetrician, a diabetologist, a midwife and a dietician. The clinics were located at two different university hospitals in Sweden.Participants were a consecutive sample of Swedish women diagnosed with GDM; 13 managed in clinic A and 10 managed in clinic B.The findings showed that women described their perceptions of as well-being, being healthy and freedom from disease. All respondents reported a delay in the provision of information about GMD and an information gap about GDM and the management of the condition, from diagnosis until the start of treatment at the specialist clinic. Respondents from clinic A expressed fear about future development of type 2 diabetes. Women from clinic B discussed different causes of GDM, and many claimed that health-care staff informed them that GDM was a transient condition during pregnancy. Respondents from clinic A reported a conflict in their treatment of pregnancy and GDM as two different conditions.Beliefs differed and were related to the health-care model chosen.
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| 9. |
- Kilpatrick, E. S., et al.
(författare)
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Good glycaemic control: an international perspective on bridging the gap between theory and practice in type 2 diabetes
- 2008
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Ingår i: Current Medical Research and Opinion. - : Informa Healthcare. - 1473-4877 .- 0300-7995. ; 24:9, s. 2651-2661
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Tidskriftsartikel (refereegranskat)abstract
- Background: Good glycaemic control is crucial in reducing the risk of diabetes-related complications. Despite the availability of evidence-based treatment guidelines, glycaemic control appears to remain suboptimal in most countries. Objectives: In this commentary we outline the extent to which diabetes guideline targets on HbA(1c) are being met in clinical practice and - where targets are being missed - to identify potential reasons for this shortfall. Furthermore, we discuss possible actions that may improve glycaemic control. Methods: A literature search of MEDLINE using 20 core terms was conducted to help assess the state of glycaemic control in patients with type 2 diabetes worldwide. Results: Despite clinical guidelines, evidence suggests that glycaemic control is suboptimal in most parts of the world, with average HbA(1c) values varying from 7.0% to 12.6% and thus above virtually all HbA(1c) recommendations. The potential reasons for this shortfall are numerous. However, lack of diabetes education and awareness of HbA(1c) appear to be particularly important. A number of education initiatives from around the world have been shown to improve HbA(1c) levels significantly and thus improve standards of care. Conclusions: Poor glycaemic control in patients with type 2 diabetes appears to be a worldwide problem. As the global rise in diabetes (and its complications) seems destined to affect many less affluent countries, it is essential that appropriate steps are taken to address the barriers to good glycaemic control and ultimately improve outcomes for all people with type 2 diabetes.
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| 10. |
- Scott, Eleanor M., et al.
(författare)
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Continuous Glucose Monitoring Metrics and Birth Weight : Informing Management of Type 1 Diabetes Throughout Pregnancy
- 2022
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992. ; 45:8, s. 1724-1734
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To determine gestational weekly changes in continuous glucose monitoring (CGM) metrics and 24-h glucose profiles and their relationship to infant birth weight in pregnant women with type 1 diabetes. RESEARCH DESIGN AND METHODS An analysis of >10.5 million CGM glucose measures from 386 pregnant women with type 1 diabetes from two international multicenter studies was performed. CGM glucose metrics and 24-h glucose profiles were calculated for each gestational week, and the relationship to normal (10–90th percentile) and large (>90th percentile) for gestational age (LGA) birth weight infants was determined. RESULTS Mean CGM glucose concentration fell and percentage of time spent in the pregnancy target range of 3.5–7.8 mmol/L (63–140 mg/dL) increased in the first 10 weeks of pregnancy and plateaued until 28 weeks of gestation, before further improvement in mean glucose and percentage of time in range until delivery. Maternal CGM glucose metrics diverged at 10 weeks of gestation, with significantly lower mean CGM glucose concentration (7.1 mmol/L; 95% CI 7.05–7.15 [127.8 mg/dL; 95% CI 126.9–128.7] vs. 7.5 mmol/L; 95% CI 7.45–7.55 [135 mg/dL; 95% CI 134.1–135.9]) and higher percentage of time in range (55%; 95% CI 54–56 vs. 50%; 95% CI 49–51) in women who had normal versus LGA. The 24-h glucose profiles were significantly higher across the day from 10 weeks of gestation in LGA. CONCLUSIONS Normalbirthweightisassociatedwithachievingsignificantly lower mean CGM glucose concentration across the 24-h day and higher CGM time in range from before the end of the first trimester, emphasizing the need for a shift in clinical management, with increased focus on using weekly CGM glucose targets for optimizing maternal glycemia from early pregnancy.
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| 11. |
- Weng, Jianping, et al.
(författare)
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Screening for MODY mutations, GAD antibodies, and type 1 diabetes--associated HLA genotypes in women with gestational diabetes mellitus.
- 2002
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 25:1, s. 68-71
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether genetic susceptibility to type 1 diabetes or maturity-onset diabetes of the young (MODY) increases susceptibility to gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We studied mutations in MODY1-4 genes, the presence of GAD antibodies, and HLA DQB1 risk genotypes in 66 Swedish women with GDM and a family history of diabetes. An oral glucose tolerance test was repeated in 46 women at 1 year postpartum. RESULTS: There was no increase in type 1 diabetes-associated HLA-DQB1 alleles or GAD antibodies when compared with a group of type 2 diabetic patients (n = 82) or healthy control subjects (n = 86). Mutations in known MODY genes were identified in 3 of the 66 subjects (1 MODY2, 1 MODY3, and 1 MODY4). Of the 46 GDM subjects, 2 had diabetes (4%) and 17 had impaired glucose tolerance (IGT) (37%) at 1 year postpartum. Of the two subjects who developed manifest diabetes, one carried a MODY3 mutation (A203H in the hepatocyte nuclear factor-1alpha gene). There was no increase in high-risk HLA alleles or GAD antibodies in the women who had manifest diabetes or IGT at 1 year postpartum. CONCLUSIONS: MODY mutations but not autoimmunity contribute to GDM in Swedish women with a family history of diabetes and increase the risk of subsequent diabetes.
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