Graviditetsdiabetes - ett tilltagande obstetriskt dilemma med betydande konsekvenser för folkhälsan

Diabetes. English summary

Lääkehoidon suunnitelma osana terveys- ja hoitosuunnitelmaa

Teema : turvallinen lääkehoito. Vertaisarvioitu.Terveydenhuollon ammattilaisilla on velvollisuus laatia terveys- ja hoitosuunnitelma kaikille potilaille, joiden hoito edellyttää hoidon koordinoimista ja jotka hyötyvät tästä suunnitelmasta. Tyypillisesti nämä potilaat ovat pitkäaikais- ja monisairaita henkilöitä. Pitkäaikaissairaalla potilaalla tarkoitetaan potilasta, joka tarvitsee sairautensa tai terveydentilansa takia pitkäaikaista seurantaa, hoitoa tai kuntoutusta. Terveys- ja hoitosuunnitelma laaditaan yhdessä ja yhteisymmärryksessä potilaan kanssa.Peer reviewe

Tyypin 2 diabeteksen nykyhoito

Vertaisarvioitu. English summary• Uusissa tutkimuksissa on osoitettu, että SGLT2:n estäjillä ja GLP-1-analogeilla on tyypin 2 diabeteksen ennustetta parantavia sydän- ja munuaisvaikutuksia. Ne eivät riipu veren glukoosipitoisuuden pienenemisestä. • Metformiini on yhä hoidon ensisijainen aloituslääke. Jos potilaalla on valtimotauti, sydämen vajaatoiminta tai diabeteksen aiheuttama munuaissairaus, hoitoon on herkästi syytä liittää SGLT2:n estäjä tai GLP-1-analogi. • Kun hyperglykemian hoito vaatii huomattavaa tehostusta pistoshoitoisella valmisteella, GLP-1-analogit ovat ensisijainen valinta, jos insuliininpuutosta ei ole todettu.Peer reviewe

GLP-1-reseptoriagonistit

Vertaisarvioitu. English abstract.GLP-1-reseptoriagonistit eli inkretiinimimeetit ovat monelle tyypin 2 diabetesta sairastavalle hyvä lääkevalinta. Ne ovat tehokkaita hyperglykemian hoidossa ilman hypoglykemialle altistavaa vaikutusta. GLP-1-reseptoriagonistit vähentävät valtaosalla tyypin 2 diabetespotilaista painoa tai ovat sen osalta neutraaleja. Niiden tyypillisin haittavaikutus on hoidon aloitukseen ajoittuva pahoinvointi. Uusimmat tutkimukset ovat osoittaneet GLP-1-reseptoriagonistien olevan sydän- ja verisuonitautien kannalta turvallisia, ja osan niistä on jopa todettu suojaavan sydän- ja verisuonitaudeilta. Osan niistä on todettu vaikuttavan suotuisasti myös munuaisten toimintaan. GLP-1-reseptoriagonisteilla on havaittu useita pleiotrooppisia eli oheisvaikutuksia, esimerkiksi sydäninfarktin kokoa pienentävää vaikutusta. Uusia mielenkiintoisia lääkeryhmän antamismuotoja on tulossa markkinoille, ja ensimmäinen näistä on suun kautta otettava semaglutidi.Peer reviewe

Impact of sunshine on the risk of gestational diabetes mellitus in primiparous women

ABSTRACTThere is a lack of data about the influence of sunshine hours on the prevalence for gestational diabetes mellitus (GDM). The aim of this study was to evaluate whether the prevalence of GDM varied according to hours of daily sunshine during the first trimester. The study cohort (N = 6189) consists of all primiparous women with a Finnish background who delivered between 2009 and 2015 living in Vantaa city, Finland. Data on births and maternal characteristics were obtained from National Health Registers. Data on sunshine hours were obtained from the Finnish Meteorological Institute. Individual daily sunshine hours during the first trimester of pregnancy were calculated for each woman. Diagnosis of GDM was based on a standard 75-g 2-h glucose tolerance test (OGTT). No relationship was observed between month of conception and GDM. Daily sunshine hours during the first trimester and GDM showed a U-shaped association (adjusted p-value 0.019). In OGTT, a U-shaped association was observed between 0-h glucose value and daily sunshine hours during the first trimester (p = 0.039) as well as with the 1-h glucose value (p = 0.012), respectively. In primiparous women daily sunshine hours during the first trimester showed a U-shaped association with the prevalence of GDM independent of pre-pregnancy risk factors.Abbreviations: BMI: body mass index; GDM: gestational diabetes mellitus; OGTT: standard 75 g 2-h glucose tolerance test; SD: standard deviationPeer reviewe

Impact of gestational diabetes mellitus on the duration of breastfeeding in primiparous women : an observational cohort study

Background The impact of gestational diabetes mellitus (GDM) on the duration of breastfeeding varies between shortening and no impact. Breastfeeding seems to reduce both maternal and offspring risk for type 2 diabetes and offspring risk for overweight or obesity later in life. The aim of our study was to evaluate in primiparous women whether GDM had an influence on the duration of breastfeeding, and further, to evaluate the factors that influenced on the duration of breastfeeding. Methods The study cohort (N = 1089) consisted of all primiparous women with a Finnish background excluding women with pre-existing diabetes mellitus who lived in the city of Vantaa, Finland, gave birth to a singleton living child between 2009 and 2015, and with valid data on breastfeeding available. The diagnosis of GDM was based on a standard 75 g 2-h oral glucose tolerance test. Data were obtained from Finnish national registers and from the medical records of the city of Vantaa. Results No differences were observed in the duration of breastfeeding between women diagnosed with GDM and without GDM, 7.5 (Standard Deviation [SD] 3.7) months versus 7.9 (SD 3.5) months (p = 0.17). Women diagnosed with GDM breastfed boys for a longer duration than girls (maternal age, pre-pregnancy body mass index, marital status, educational attainment, duration of pregnancy, and smoking habits adjusted p = 0.042). Women who breastfed <6 months were younger, were more likely smokers, had shorter education, and higher pre-pregnancy body mass index than women who breastfed over 6 months (p <0.001 for linearity). Conclusions In primiparous women GDM did not influence breastfeeding duration. The positive health effects of breastfeeding should be emphasized especially in young, overweight and less educated women in order to minimize the risk of obesity and type 2 diabetes for themselves and their offspring.Peer reviewe

Relationship between number of contacts between previous dropouts with type 2 diabetes and health care professionals on glycaemic control : A cohort study in public primary health care

Aim: Previous study findings have shown that more frequent contacts with the diabetes care team predict better diabetes control. It is unknown whether this is true also for previous dropouts with type 2 diabetes (T2D). The aim of this study was to evaluate if those previous dropouts with T2D who succeeded to improve their glycaemic control had more frequent contacts with health care professionals in the public primary diabetes health care system than those dropouts who did not show improvement. Methods: In this "real life" retrospective cohort study, we identified 115 dropouts with T2D who were contacted by trained diabetes nurses and who returned to a public T2D-care system. Those previous dropouts who had baseline haemoglobin A(1c) >= 53 mmoVmol (7%) and had a reduction in HbA(1c) >= 6 mmol/mol (0.5%) during the follow-up were compared with those with unsatisfactory change in HbA(1c) (baseline HbA(1c) >= 53 mmoVmol and change Results: Previous dropouts showing improvement had more visits to the diabetes nurse (p = 0.003) and other nurses (p <0.001) than those with no improvement or those with satisfactory glycaemic control. Telephone calls not focusing on diabetes (p <0.001) were also more frequent among previous dropouts with improvement than among the others. Conclusions: Especially previous dropouts with T2D who had poor glycaemic control, may benefit from more frequent contacts including visits and telephone calls. Recalling dropouts does not seem to lead to overuse of the T2D care-system by those recalled patients whose glycaemic control does not require special care. (C) 2019 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Drug purchases prior to conception and the risk of gestational diabetes mellitus

Publisher Copyright: © The Author(s) 2022.Objective: Some drugs have adverse effects on glucose metabolism, but it is unknown whether prescription drugs used prior to conception influence the future risk of gestational diabetes mellitus (GDM). Our study evaluated whether the purchase of prescription drugs 6 months prior to conception was associated with the occurrence of GDM. Methods: This cohort study enrolled women with a Finnish background who delivered between 2009 and 2015 in the city of Vantaa, Finland (N = 10,455). Data on maternal characteristics and prescription drug purchases were obtained from national health registers. The use of a unique personal identification number enabled us to combine the register data on an individual level. Results: Six months prior to conception, women who had pregnancies complicated by GDM purchased more prescription drugs than women without GDM (1.38 ± 2.04 vs. 1.11 ± 1.80). The GDM risk was higher in women with higher numbers of prescription purchases and those with more than three deliveries. Conclusions: Multiparous women who purchase several prescription drugs should be given personalized counseling to prevent GDM.Peer reviewe

Kohti tyypin 2 diabeetikon yksilöllistä hyperglykemian hoitoa

Teema : Diabetes avoterveydenhuollossa. English summaryPeer reviewe

Beneficial Effects of GLP-1 Agonist in a Male With Compulsive Food-Related Behavior Associated With Autism

Individuals with autism spectrum disorder (ASD) frequently display intensely repetitive, restricted thoughts, and behaviors. These behaviors have similarities to compulsions and/ or obsessions in obsessive compulsive disorder (OCD) and are primarily treated with behaviourally-based interventions and serotonin uptake inhibitors (SSRIs). Due to the lack of treatment responses in many cases, however, new treatments are being sought. Here we report beneficial effects of treatment with liraglutide, a glucagon-like peptide-1 (GLP-1) analog, on severe obsessive food craving, binge eating, weight gain, and behavioral problems in an adolescent male with infantile autism and moderate intellectual impairment. Liraglutide treatment reduced weight and unwanted behavior seemingly by preventing food-related repetitive thoughts and compulsions. Our report provides clinical evidence that GLP-1 signaling pathway may represent a novel target for treating food-related behavioral problems and aggressive behavior in ASD.Peer reviewe