scholarly journals Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

2017 ◽  
Vol 21 (14) ◽  
pp. 1-130 ◽  
Author(s):  
Sarah Earle ◽  
Anisah Tariq ◽  
Carol Komaromy ◽  
Cathy E Lloyd ◽  
M Ali Karamat ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Health Professionals ◽  
Preconception Care ◽  
Qualitative Interviews ◽  
Childbearing Age ◽  
Pregnancy Planning

BackgroundDiabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low.ObjectivesTo systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC.DesignMixed methods encompassing a systematic review and qualitative interviews.SettingTwo secondary care sites and 11 primary care sites.ParticipantsWomen of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin.InterventionsNone.AnalysisA narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison.ResultsEighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals.LimitationsOwing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size.ConclusionsReconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes.Future workFurther research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding.Study registrationThis study is registered as PROSPERO CRD42014015592 and ISRCTN12983949.FundingThe National Institute for Health Research Health Technology Assessment programme.

Insights into the Role of DNA Methylation and Protein Misfolding in Diabetes Mellitus

2019 ◽  
Vol 19 (6) ◽  
pp. 744-753 ◽  
Author(s):  
Sara M. Ahmed ◽  
Dina Johar ◽  
Mohamed Medhat Ali ◽  
Nagwa El-Badri
Keyword(s):  
Diabetes Mellitus ◽  
Dna Methylation ◽  
Protein Function ◽  
Protein Misfolding ◽  
Gene Sequence ◽  
Metabolic Memory ◽  
Treatment Of Diabetes

Background: Diabetes mellitus is a metabolic disorder that is characterized by impaired glucose tolerance resulting from defects in insulin secretion, insulin action, or both. Epigenetic modifications, which are defined as inherited changes in gene expression that occur without changes in gene sequence, are involved in the etiology of diabetes. Methods: In this review, we focused on the role of DNA methylation and protein misfolding and their contribution to the development of both type 1 and type 2 diabetes mellitus. Results: Changes in DNA methylation in particular are highly associated with the development of diabetes. Protein function is dependent on their proper folding in the endoplasmic reticulum. Defective protein folding and consequently their functions have also been reported to play a role. Early treatment of diabetes has proven to be of great benefit, as even transient hyperglycemia may lead to pathological effects and complications later on. This has been explained by the theory of the development of a metabolic memory in diabetes. The basis for this metabolic memory was attributed to oxidative stress, chronic inflammation, non-enzymatic glycation of proteins and importantly, epigenetic changes. This highlights the importance of linking new therapeutics targeting epigenetic mechanisms with traditional antidiabetic drugs. Conclusion: Although new data is evolving on the relation between DNA methylation, protein misfolding, and the etiology of diabetes, more studies are required for developing new relevant diagnostics and therapeutics.

Role of vasopressin signaling in the pathogenesis of diabetic nephropathy

2021 ◽  
pp. 9-20
Author(s):  
Arus Garikovna Margaryan ◽  
Svetlana Anatolievna Lebedeva ◽  
Dariya Mikhailovna Lisitsyna ◽  
Polina Igorevna Sirotkina ◽  
Lyudmila Aleksandrovna Yakubova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Major Complication ◽  
Epidemiological Studies ◽  
Animal Models Of Diabetes

The diabetic kidney disease (also known as diabetic nephropathy) is a major complication of diabetes mellitus and also the most common cause of chronic kidney disease. Elevated plasma levels of vasopressin are consistently observed in patients with either type 1 and type 2 diabetes mellitus and in animal models of diabetes mellitus. A role of enhanced vasopressin signaling in progression of the diabetic nephropathy to chronic kidney disease has been suggested in several epidemiological studies but the underlying pathogenetic mechanisms remain largely unclear and are the subject of current scientific research.

scholarly journals The protean role of haptoglobin and haptoglobin genotypes on vascular complications in diabetes mellitus

2018 ◽  
Vol 25 (14) ◽  
pp. 1502-1519 ◽  
Author(s):  
Rinkoo Dalan ◽  
Goh Liuh Ling
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Vitamin E ◽  
Clinical Studies ◽  
Vascular Complications ◽  
Cardiovascular Complications ◽  
Diabetes Patients

Introduction and background Haptoglobin (Hp) is considered to be an antioxidant and protective against cardiovascular complications. Polymorphisms in the Hp gene interact with diabetes mellitus to affect the risk of vascular complications. Methods We review the updated literature about the protean role of Hp and Hp genotypes spanning genomics, molecular, translational and clinical studies. We searched Pubmed, SCOPUS and Google Scholar for all articles using the keywords: haptoglobin and/or haptoglobin polymorphism and diabetes. We review the diverse Hp genotypes, phenotypes and the impact on diabetes complications, including lessons from animal models and in vitro models. We describe the clinical studies on the associations of Hp genotypes with vascular complications in type 1 and type 2 diabetes comprehensively. We review the studies looking at vitamin E supplementation in a personalized manner in Hp2-2 diabetes individuals. Results and conclusion Hp genotypes have evolved as a result of deletions in the traditional Hp genes. The Hp genotypes have been associated with microvascular and macrovascular complications in type 1 diabetes mellitus but the association in type 2 diabetes is more consistent with cardiovascular complications. A preferential benefit of vitamin E and other antioxidants in the Hp2-2 genotype for cardiovascular complications in type 2 diabetes has been seen presumably secondary to interaction with high-density lipoprotein function. Hence, the Hp genotype can be used to personalize antioxidant therapeutics in diabetes patients. These results need to be corroborated in large, global, pragmatic, prospective, cardiovascular outcome trials in type 2 diabetes patients.

scholarly journals Hypertriglyceridemia in Diabetes Mellitus: Implications for Pediatric Care

2018 ◽  
Vol 2 (6) ◽  
pp. 497-512 ◽  
Author(s):  
Jacob C Hartz ◽  
Sarah de Ferranti ◽  
Samuel Gidding
Keyword(s):  
Diabetes Mellitus ◽  
Children And Adolescents ◽  
Pediatric Care ◽  
Poor Control ◽  
Atherogenic Lipid Profile ◽  
Increased Risk ◽  
Atherogenic Lipid

Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). It is estimated that the risk of CVD in diabetes mellitus (DM) is 2 to 10 times higher than in the general population. Much of this increased risk is thought to be related to the development of an atherogenic lipid profile, in which hypertriglyceridemia is an essential component. Recent studies suggest that dyslipidemia may be present in children and adolescents with DM, particularly in T2DM and in association with poor control in T1DM. However, the role of hypertriglyceridemia in the development of future CVD in youth with DM is unclear, as data are scarce. In this review, we will evaluate the pathophysiology of atherogenic hypertriglyceridemia in DM, the evidence regarding an independent role of triglycerides in the development of CVD, and the treatment of hypertriglyceridemia in patients with DM, highlighting the potential relevance to children and the need for more data in children and adolescents to guide clinical practice.

scholarly journals Hormonal Contraception and Diabetes

2012 ◽  
Vol 5 ◽  
pp. CMWH.S9934
Author(s):  
L.F. Pallardo ◽  
A Cano ◽  
I Cristobal ◽  
M.A. Blanco ◽  
M Lozano ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Preconception Care ◽  
Microvascular Complications ◽  
Hormonal Contraception ◽  
Hormonal Contraceptive ◽  
Contraceptive Methods ◽  
Type 2 Dm ◽  
Increased Risk

Women with gestational diabetes mellitus are at increased risk for developing diabetes mellitus (DM), mainly type 2 DM, as well as metabolic syndrome. The presence of subsequent pregnancies increases the risk. In addition, pregnancy in patients with type 1 and type 2 DM also elevates the risk of morbidity and mortality for both mothers and offspring. Thus, all women with pre-existing type 1 or type 2 DM should receive preconception care to optimize glycemic control (HbA1c ≤ 6%). In those cases with macrovascular or microvascular complications, family planning is even more important in order to avoid the risk of aggravation of such complications associated with a new pregnancy. The present review analyzes the metabolic and cardiovascular repercussions of hormone contraception in non-diabetic women as well as in type 1 and type 2 DM patients with and without macrovascular and microvascular complications. Finally, the recommendations pertaining to hormonal contraceptive methods for women with diabetes are summarized.

scholarly journals Functional Role of miR-155 in the Pathogenesis of Diabetes Mellitus and Its Complications

2021 ◽  
Vol 7 (3) ◽  
pp. 39
Author(s):  
Stanislovas S. Jankauskas ◽  
Jessica Gambardella ◽  
Celestino Sardu ◽  
Angela Lombardi ◽  
Gaetano Santulli
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Stress ◽  
Serum Levels ◽  
In Vitro Models ◽  
Preclinical Studies

Substantial evidence indicates that microRNA-155 (miR-155) plays a crucial role in the pathogenesis of diabetes mellitus (DM) and its complications. A number of clinical studies reported low serum levels of miR-155 in patients with type 2 diabetes (T2D). Preclinical studies revealed that miR-155 partakes in the phenotypic switch of cells within the islets of Langerhans under metabolic stress. Moreover, miR-155 was shown to regulate insulin sensitivity in liver, adipose tissue, and skeletal muscle. Dysregulation of miR-155 expression was also shown to predict the development of nephropathy, neuropathy, and retinopathy in DM. Here, we systematically describe the reports investigating the role of miR-155 in DM and its complications. We also discuss the recent results from in vivo and in vitro models of type 1 diabetes (T1D) and T2D, discussing the differences between clinical and preclinical studies and shedding light on the molecular pathways mediated by miR-155 in different tissues affected by DM.

scholarly journals O-GlcNAcylation, oxidation and CaMKII contribute to atrial fibrillation in type 1 and type 2 diabetes by distinct mechanisms

2020 ◽  
Author(s):  
Olurotimi O. Mesubi ◽  
Adam G. Rokita ◽  
Neha Abrol ◽  
Yuejin Wu ◽  
Biyi Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Calmodulin Kinase ◽  
Elevated Protein ◽  
Intracellular Ca ◽  
Genetic Mouse Models

AbstractDiabetes mellitus and atrial fibrillation (AF) are major unsolved public health problems, and diabetes is an independent risk factor for AF in patients. However, the mechanism(s) underlying this clinical association is unknown. Elevated protein O-GlcNAcylation (OGN) and reactive oxygen species (ROS) are increased in diabetic hearts, and calmodulin kinase II (CaMKII) is a proarrhythmic signal that may be activated by OGN (OGN-CaMKII) and ROS (ox-CaMKII). We induced type 1 (T1D) and type 2 diabetes (T2D) in a portfolio of genetic mouse models capable of dissecting the role of OGN and ROS at CaMKII and the type 2 ryanodine receptor (RyR2), an intracellular Ca2+ channel implicated as an important downstream mechanism of CaMKII- mediated arrhythmias. Here we show that T1D and T2D significantly increased AF, similar to observations in patients, and this increase required CaMKII. While T1D and T2D both require ox-CaMKII to increase AF, they respond differently to loss of OGN-CaMKII or OGN inhibition. Collectively, our data affirm CaMKII as a critical proarrhythmic signal in diabetic AF, and suggest ROS primarily promotes AF by ox-CaMKII, while OGN promotes AF by diverse mechanisms and targets, including CaMKII and RyR2. The proarrhythmic consequences of OGN- and ox-CaMKII differ between T1D and T2D. These results provide new and unanticipated insights into the mechanisms for increased AF in diabetes mellitus, and suggest successful future therapies will need to be different for AF in T1D and T2D.

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