Diabetes Watch

Published Online: Thursday, August 19, 2010
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Gestational Diabetes Likely to Return, Study Shows
Women who develop diabetes while pregnant are likely to experience the condition again in future pregnancies, according to a large study published in the July 14 online issue of the American Journal of Obstetrics and Gynecology.

In order to determine risk factors related to the recurrence of gestational diabetes, researchers collected medical records from the Kaiser Permanente Southern California Medical Group in Pasadena, California. They examined the first 2 pregnancies of 65,132 women and the first 3 pregnancies of 13,096 women who were treated at the center between 1991 and 2008.

A total of 4.2% of participants developed gestational diabetes with their first pregnancy. In women with a history of the condition, the risk of developing it with the second pregnancy rose to 41.3% and to 57% after 2 pregnancies. Ethnicity also increased women’s risk, with Hispanics, Asians, and Pacific Islanders showing higher rates of recurrence.

The most recent case of gestational diabetes was found to be the most influential. Among women with a diagnosis in their first but not second pregnancies, only 23% developed gestational diabetes again, compared with 44% among those whose second but not first pregnancy was complicated by the condition. The results do not account for maternal weight—a factor thought to play a role.

Counseling for women at risk of developing type 2 diabetes—particularly those with a history of gestational diabetes— should include strategies to improve diet, incorporate physical exercise, and achieve a healthy weight, according to the American College of Obstetrics and Gynecology.


Diabetic Retinopathy Cases Increase by 40%
Currently on the rise, diabetes-related eye disorders are now the leading cause of legal blindness among US adults aged 20 to 74 years, announced a new study in the August issue of the Journal of the American Medical Association. Researchers attribute the results to an overall increase in diabetes prevalence.

Among adults with diabetes aged 40 years and older, an estimated 1 in 4, or 28.5%, have diabetic retinopathy, researchers found. This indicates a 40% increase in prevalence since the last study was conducted from 1988 to 1994. According to the new report, 4.4% have such severe cases of the condition that their vision is threatened.

Compared with women, men were more likely to develop diabetic retinopathy. Rates were also higher in African- American and Mexican-American patients than in non-Hispanic white patients. Other factors that increased a patient’s risk include longer duration of diabetes, insulin use, higher systolic blood pressure, and higher levels of hemoglobin A1C, a protein used to measure blood sugar.

The results suggest patients with diabetes should vigilantly monitor and control blood sugar and blood pressure to reduce their risk. For those who have already developed eye disorders, early detection and treatment can reduce complications and lower a patient’s chances of experiencing vision loss, the researchers concluded.


Obesity and Diabetes Linked to Brain Abnormalities
Known to wreak havoc on the body’s metabolic systems, the combination of type 2 diabetes and obesity may also negatively affect brain function, new research suggests. According to a study published in the journal Diabetologia, adolescents with both diseases scored lower on cognitive tests than those who were just obese. “This is the first concrete evidence that the brain suffers complications of type 2 diabetes as early as during adolescence,” said Antonio Convit, MD, the study’s lead author, a professor of psychiatry and medicine at New York University’s Langone Medical Center, and a member of the Nathan Kline Institute.

Dr. Convit compared the test results and MRI scans of 36 obese adolescents, 18 of whom also had type 2 diabetes. Participants were evaluated for intellectual functioning, verbal memory, and psychomotor efficiency. In all areas assessed, individuals with type 2 diabetes performed “consistently worse” than the obese controls, researchers found. Significant structural differences were also noted in the brains of participants with concurrent obesity and type 2 diabetes.

Although the results do not clarify a distinct relationship between type 2 diabetes and reduced cognitive ability, according to the study’s authors, the disease may cause “subtle vascular changes, glucose and lipid metabolism abnormalities, and subtle differences in adiposity” that do impact brain function. As to why this relationship may be occurring, “future efforts are needed to elucidate the underlying pathophysiological mechanisms,” the report concluded.

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