Metformin during pregnancy

door | dec 3, 2023 | diabetes, gezondheidszorg

 

 

During the last decades, gestational diabetes mellitus (GDM) prevalence has been on the rise. While insulin remains the gold standard treatment for GDM, metformin use during pregnancy is controversial. This review aimed to comprehensively assess the available data on the efficacy and safety of metformin during pregnancy, both for the mother and the offspring. Metformin has been validated for maternal efficacy and safety, achieving comparable glycemic control with insulin. Additionally, it reduces maternal weight gain and possibly the occurrence of hypertensive disorders. During the early neonatal period, metformin administration does not increase the risk of congenital anomalies or other major adverse effects, including lower APGAR score at 5 min, neonatal intensive care unit admissions, and respiratory distress syndrome. Several studies have demonstrated a reduction in neonatal hypoglycemia. Metformin has been associated with an increase in preterm births and lower birth weight, although this effect is controversial and depends on the indication for which it was administered. Evidence indicates possible altered fetal programming and predisposition to childhood obesity and metabolic syndrome during adulthood after use of metformin in pregnancy. With critical questions still requiring a final verdict, ongoing research on the field must be conducted.

 

You may find the full (Open Access) article HERE.

 

 

 

Schildklier en kwaliteit van leven

door | nov 2, 2023 | gezondheidszorg, schildklier

 

Hypothyroidism is associated with a decreased health-related quality of life (HRQoL). Wehypothesized that individuals with hypothyroidism (defined as use of thyroid hormone (TH)) and especially those having an impaired HRQoL are characterized by a high prevalence of comorbid disorders, and that the impact of hypothyroidism and comorbidity on HRQoL is synergistic. Presence of comorbidity was based on data obtained using structured questionnaires, physical examination, biochemical measurements and verified medication use. Single morbidities were clustered into 14 different disease domains. HRQoL was measured using the RAND-36. Logistic regression analyses were used to determine the effect of TH-use on the odds of having an affected disease domain and a lower score than an age-and sex-specific reference value for HRQoL. TH was used by 4537/147201 participants of the population-based Lifelines cohort with a mean(±SD) age of 51.0±12.8 years (88% females). 85% of the TH-users had ≥1 affected disease domain, in contrast to 71% of non-users. TH-use was associated with a higher odds of 13/14 affected disease domains, independent of age and sex. In a multivariable model, TH-use was associated with a decreased HRQoL across 6/8 dimensions. No significant interactions between TH-use and affected disease domains were observed. TH-users with an impaired HRQoL had significantly more comorbidity than those not having an impaired HRQoL. In this large, population-based study, we demonstrated that TH-users had more comorbidity than individuals not using TH. The co-existence of other chronic medical conditions in subjects with TH-use led to further lowering of HRQoL in an additive manner.

Find the current accepted version of this article at: https://ec.bioscientifica.com/view/journals/ec/aop/ec-23-0266/ec-23-0266.xml

 

door | okt 31, 2023 | diabetes, gezondheidszorg

 

Objectives: Cardiovascular disease (CVD) is a precarious complication of type 1 diabetes (T1D). Alongside glycaemic control, lipid and blood pressure (BP) management are essential for the prevention of CVD. However, age-specific differences in lipid and BP between individuals with T1D and the general population are relatively unknown.

Design: Cross-sectional study.

Setting: Six diabetes outpatient clinics and individuals from the Lifelines cohort, a multigenerational cohort from the Northern Netherlands.

Participants: 2178 adults with T1D and 146 22 individuals without diabetes from the general population.

Primary and secondary outcome measures: Total cholesterol, low-density lipoprotein cholesterol (LDL-cholesterol), systolic BP (SBP) and diastolic BP (DBP), stratified by age group, glycated haemoglobin category, medication use and sex.

Results: In total, 2178 individuals with T1D and 146 822 without diabetes were included in this study. Total cholesterol and LDL-cholesterol were lower and SBP and DBP were higher in individuals with T1D in comparison to the background population. When stratified by age and medication use, total cholesterol and LDL-cholesterol were lower and SBP and DBP were higher in the T1D population. Men with T1D achieved lower LDL-cholesterol levels both with and without medication in older age groups in comparison to women. Women with T1D had up to 8 mm Hg higher SBP compared with the background population, this difference was not present in men.

Conclusions: Lipid and BP measurements are not comparable between individuals with T1D and the general population and are particularly unfavourable for BP in the T1D group. There are potential sex differences in the management of LDL-cholesterol and BP.

 

Read the full article at: https://bmjopen.bmj.com/content/13/10/e073690.long

 

 

 

Subtyperen van type 2 diabetes

door | mei 10, 2023 | diabetes, gezondheidszorg

Al jaren wordt getracht om de heterogeniteit van type 2 diabetes beter in kaart te brengen. Recentelijk zijn verschillende manieren van subtypering van type 2 diabetes gepubliceerd. De meeste aandacht gaat naar een onderverdeling in 5 subtypen, vlak na het stellen van de diagnose. Twee van deze subtypen worden gekenmerkt door insulinedeficiëntie; circa de helft van deze patiënten moet relatief vroeg beginnen met insuline. Eén subtype wordt gekenmerkt door ernstige insulineresistentie en een verhoogd risico op nierschade en niet-alcoholische leverziekte.

Subtypering kan leiden tot beter inzicht in de pathofysiologische achtergronden bij een specifiek individu, tot een beter onderbouwde aanpassing van de leefstijl, een betere inschatting van het risico op late complicaties en persoonsgerichte medicamenteuze behandeling. Er is ook meer aandacht voor specifieke factoren die de individuele respons op medicatie beïnvloeden, zoals geslacht, leeftijd en relatief lichaamsgewicht.

Het is te hopen dat deze ontwikkelingen in de nabije toekomst leiden tot een beter op het individu gerichte begeleiding en behandeling van type 2 diabetes.

 

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