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Pre-Pregnancy Diabetes Rates Have Doubled
MONDAY, April 28 (HealthDay News) -- The number of women starting their pregnancies with type 1 or type 2 diabetes has doubled since 1999, but rates of gestational diabetes have stayed the same, new research finds.
In some age groups, the results were even worse. Researchers from Kaiser Permanente found that the number of teenagers who had diabetes before birth jumped fivefold.
"It's important to recognize with the increase in overweight and obesity, more women than ever will be entering their reproductive years with diabetes," said study author Jean Lawrence, a research scientist at Kaiser Permanente Bellflower Medical Center, in Bellflower, Calif.
And, she added, "having diabetes during pregnancy increases the risk of miscarriage early in pregnancy and the risk of stillbirth later in pregnancy. It also increases the chances of having a baby with birth defects, and it may result in larger babies and more difficult deliveries."
Results of the study are published in the May issue of Diabetes Care.
Past research has focused on the number of women who develop diabetes during pregnancy, which is called gestational diabetes, and generally disappears after the baby is born.
The new study, which included 175,249 women who gave birth from 1999 to 2005, also included women with type 1 and type 2 diabetes. All of the women in the study were treated at one of 11 Kaiser Permanente hospitals in southern California. Fifty-two percent of the women were Hispanic, 26 percent were white, 11 percent were Asian/Pacific Islanders, and 10 percent were black, according to the study.
Preexisting diabetes -- type 1 or type 2 -- was found in 1.3 percent of all pregnancies. In 1999, the rate of preexisting diabetes was 0.81 per 100 births; by 2005, that number had jumped to 1.82 per 100 births.
But, during that six-year period, gestational diabetes rates remained nearly unchanged. In 1999, 7.5 women per 100 births had gestational diabetes; in 2005, it was 7.4 women per 100 births.
What did change during the study period was the proportion of preexisting diabetes compared to gestational diabetes. In 1999, of all pregnancies affected by diabetes, 10 percent were due to preexisting diabetes, while 90 percent were due to gestational diabetes. In 2005, 21 percent of women had preexisting diabetes, compared to 79 percent with gestational diabetes, according to the study.
The researchers also noted some differences in race and age. Black, Hispanic and Asian/Pacific women were more likely to have diabetes before birth, and teens and women over 40 experienced dramatic jumps in their pre-pregnancy diabetes rates. Teen mothers saw a fivefold increase in preexisting diabetes, while mothers over 40 saw a 40 increase in the rate of pre-pregnancy diabetes.
Experts blame much of the increase on the rising trend of overweight and obesity.
"We saw an increase in type 2 diabetes. That's due to the increase in overweight and obesity. Also, type 2 is being diagnosed at younger ages," said Lawrence, who suggested that women do whatever they can to reduce their risk of type 2 diabetes by eating a healthful diet, maintaining a proper weight and being active. She said there's no known way to prevent type 1 diabetes.
Dr. Stuart Weiss, an endocrinologist at the New York University Langone Medical Center, said he "was surprised that the incidence of gestational diabetes wasn't up."
For women who know they have diabetes before pregnancy, Weiss advised: "Control your blood glucose levels as aggressively as possible. Control isn't easy to do, because you have to have adequate nutrition and still control your blood sugar."
But, he added, it's crucial to try, because it may help prevent some of the serious complications associated with diabetes.
More information
To learn more about diabetes and pregnancy, visit the U.S. Centers for Disease Control and Prevention.
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Diabetes Drug Slows Clogging of Arteries
 MONDAY, March 31 (HealthDay News) -- The diabetes drug Actos is better than another diabetes drug, Amaryl, at slowing clogging of the arteries in patients with both type 2 diabetes and cardiovascular disease.
The Cleveland Clinic researchers behind the new findings say this is the first time that a diabetes medication has been shown to slow atherosclerosis, giving doctors new insight into which drugs may be most effective and safest for this group of patients.
"As we go forward, the study tells us that we must do comparative effectiveness trials looking at different diabetes strategies," study author Steve Nissen, chairman of the department of cardiovascular medicine at Cleveland Clinic, said Monday. "We can't just focus on pricking your finger, getting blood sugar down. The goal in diabetes therapy is to prevent complications, and the most feared complication is heart disease, which will kill 75 percent of all diabetics. I'm thrilled with results."
Another expert hailed the results.
"The biggest news here is that pioglitazone [Actos] appears safe, does not increase cardiovascular risk, and may even reduce it," said Dr. Robert Scott III, an assistant professor of internal medicine at the Texas A&M Health Science Center College of Medicine and senior staff cardiologist with Scott&White in Temple, Texas. "It looks safe to use in people with coronary artery disease, and it is well-tolerated. We may need another trial to see how it helps, but at least it doesn't hurt, and that was our biggest concern."
The findings are published in the April 2 issue of the Journal of the American Medical Association and were released Monday to coincide with a presentation at the American College of Cardiology annual meeting, in Chicago. The research was funded by Takeda Pharmaceuticals North America Inc., which makes Actos.
Individuals with type 2 diabetes are particularly susceptible to atherosclerosis, as evidenced by the fact that 75 percent of this group eventually die of cardiovascular disease.
Amaryl (glimepiride) belongs to a class of drugs known as sulfulonylureas, which have been prescribed for decades. Actos, along with its cousin Avandia, is a thiazolidinedione, a relatively new class of diabetes drugs.
Both Actos and Avandia appear to increase the risk of heart failure (the entire class now carries a black-box warning to that effect), but Avandia has been associated with an increased risk of heart attack, while Actos has been linked with a reduced risk of negative cardiovascular outcomes.
"Both are associated with heart failure, but there were increased deaths [with Avandia]," said Dr. Stanley Mirsky, an endocrinologist with Lenox Hill Hospital in New York City and co-author of the Diabetes Survival Guide.
For this study, 543 patients with both coronary disease and type 2 diabetes were randomized to receive either Amaryl or Actos for 18 months. Actos works by making the body more sensitive to insulin, while Amaryl works by spurring the body to produce more insulin. All participants were also taking medications for heart disease.
Progression of atherosclerosis was measured by intravascular ultrasonography in the 360 patients who actually completed the study.
One measure found a 0.73 increase in plaque in the Amaryl group versus a 0.16 decrease in the Actos group. A second measure found a 0.64 increase for Amaryl and a 0.06 decrease for Actos.
The study was not designed to measure actual clinical endpoints, meaning cardiovascular events or death.
The authors stated that the exact mechanisms for the decreases associated with Actos were unclear, although several biomarkers linked to atherosclerosis progression were impacted by the drug, including a 16 percent increase in HDL or "good" cholesterol, a 15 percent reduction in triglyceride levels, and a 45 percent drop in C-reactive protein (CRP) levels.
It's also not clear if the benefits associated with Actos extend to other medications in that class of drugs.
An accompanying editorial found the results "reassuring."
"You've got to take into consideration the benefit of preventing heart attacks may be greater than the few people who get heart failure," Mirsky said.
More information
Visit the American Heart Association  for more on atherosclerosis.
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Minorities, Poor Have Tougher Time Monitoring Diabetes
 FRIDAY, March 14 (HealthDay News) -- Minority and low-income Americans with insulin-treated diabetes are less likely to monitor their blood glucose than other diabetics, a new study shows.
The researchers examined data on 16,630 Hispanic, black and white adults aged 19 and older with insulin-treated diabetes to come to this conclusion.
At every income level, fewer Hispanics and blacks reported daily self-monitoring of blood glucose than whites. The study was to be presented Friday at the American Heart Association's Annual Conference on Cardiovascular Disease Epidemiology and Prevention, in Colorado Springs, Colo.
"Minority and financially vulnerable adults with insulin-treated diabetes appear to have lower reported rates of self-monitoring of blood glucose [SMBG] -- a vital disease management component," study author Dr. Deborah A. Levine, an assistant professor in general internal medicine at the Ohio State University College of Medicine, said in a prepared statement.
"Efforts to improve diabetes control, including the collection and use of SMBG data in Hispanic and black populations with diabetes [particularly those on insulin], are warranted given that Hispanics and blacks have a higher frequency of diabetes-related complications compared to whites. We need to better understand income's role in racial and ethnic disparities in SMBG to offer effective programs and policies to improve SMBG by minorities," Levine said.
The study found that among those with annual household incomes of $20,000 and higher, SMBG rates were 85 percent for whites, 78 percent for Hispanics, and 77 percent for blacks. Among those with household incomes of less than $20,000, SMBG rates were 85 percent for whites, 79 percent for blacks, and 65 percent for Hispanics.
The researchers also found that among those with household incomes of less than $20,000, 49 percent of Hispanics received diabetes education, compared with 62 percent of whites and 64 percent of blacks.
"Receipt of diabetes education varied significantly by race-ethnicity only in the less-than-$20,000 income group," Levine said. "At incomes of $20,000 or more, both Hispanics and blacks had 40 percent lower odds of daily SMBG compared to whites. At incomes of less than $20,000, however, the odds of daily SMBG decreased by 70 percent for Hispanics compared to whites, but did not change for blacks."
These racial and ethnic disparities in self-monitoring of blood glucose were not fully explained by demographic characteristics such as health insurance, health status, or diabetes-related measures such as diabetes education, disease duration or end-organ damage, Levine said.
The findings suggest that poverty significantly worsens self-monitoring of blood glucose and receipt of diabetes education among Hispanics. This means that income must be "explicitly considered when assessing SMBG performance and designing SMBG interventions for Hispanics with insulin-treated diabetes," Levine said.
In 2005, 15.1 million U.S. adults (7.3 percent of the adult population) had diagnosed diabetes, according to the American Heart Association. Of those, 13.2 percent were non-Hispanic black females and 10.7 percent were non-Hispanic black males; 11 percent were Mexican-American males and 10.9 percent were Mexican-American females; and 6.7 percent were white males and 5.6 percent were white females.
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about diabetes control.
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