BNP AND NT-PRO BNP AS INDEPENDENT DIAGNOSTIC BIOMARKERS FOR CARDIOVASCULAR DISEASE IN TYPE 2 DIABETES MELLITUS

The risk of developing heart failure (HF) with a reduced and preserved ejection fraction is known to increase with pre-diabetes and diabetic mellitus (DM). Natriuretic peptides (NPs) have been shown to be an important tool for assessing the risk of cardiovascular diseases (CVD) in people with pre-diabetes and Type 2 diabetes (T2DM), regardless of HF characteristics. Elevated levels of NPs were associated with an increased risk of readmission for HF, all-cause mortality, CVD mortality, HF progression, and readmission due to HF, according to earlier clinical investigations. In pre-diabetes and T2DM populations, the discriminative power of NPs for CVD death and HF-related clinical events has not been established beyond conventional CVD risk variables. The purpose of the review is to gather details regarding the predictive value of circulating NPs based on pre-diabetes and established T2DM presentation. Researchers have found that HFrEF or HFpEF in T2DM patients may necessitate a change in NP cutoff values to diagnose primary HF and identify HF-related risks. The relationship between clinical outcomes and the dynamic of circulating levels of NPs in diabetics treated with glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors has to be clarified in big clinical trials in the future

Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India

Abstract Background In 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services. Methods The study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis. Results There were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices. Conclusions Minimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground

Risk Factors for Hyperglycaemia in Pregnancy in Tamil Nadu, India.

IntroductionHyperglycaemia in pregnancy (HIP), i.e. gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP), increases the risk of various short- and long-term adverse outcomes. However, much remains to be understood about the role of different risk factors in development of HIP.ObjectiveThe aims of this observational study were to examine the role of potential risk factors for HIP, and to investigate whether any single or accumulated risk factor(s) could be used to predict HIP among women attending GDM screening at three centres in urban, semi-urban and rural Tamil Nadu, India.MethodologyPregnant women underwent a 75 g oral glucose tolerance test. Data on potential risk factors was collected and analysed using logistical regression analysis. Receiver operating characteristic (ROC) curves, sensitivity, specificity and predictive values were calculated for significant risk factors and a risk factor scoring variable was constructed.ResultsHIP was prevalent in 18.9% of the study population (16.3% GDM; 2.6% DIP). Increasing age and BMI as well as having a mother only or both parents with diabetes were significant independent risk factors for HIP. Among women attending the rural health centre a doubling of income corresponded to an 80% increased risk of HIP (OR 1.80, 95%CI 1.10-2.93; p = 0.019), whereas it was not significantly associated with HIP among women attending the other health centres. The performance of the individual risk factors and the constructed scoring variable differed substantially between the three health centres, but none of them were good enough to discriminate between those with and without HIP.ConclusionsThe findings highlight the importance of socio-economic circumstances and intergenerational risk transmission in the occurrence of HIP as well as the need for universal screening

A cohort study of gestational diabetes mellitus and complimentary qualitative research: background, aims and design

BACKGROUND: Women with gestational diabetes mellitus (GDM) and their offsprings are at increased risk of future type 2 diabetes and metabolic abnormalities. Early diagnosis and proper management of GDM, as well as, postpartum follow-up and preventive care is expected to reduce this risk. However, no large scale prospective studies have been done particularly from the developing world on this aspect. The objective of this study is to identify and follow a cohort of pregnant women with and without GDM and their offspring to identify determinants and risk factors for GDM, for various pregnancy outcomes, as well as, for the development of future diabetes and metabolic abnormalities. METHODS: This is a prospective cohort study involving pregnant women attending prenatal clinics from urban, semi-urban and rural areas in the greater Chennai region in South India. Around 9850 pregnant women will be screened for GDM. Socio-economic status, demographic data, obstetric history, delivery and birth outcomes, perinatal and postnatal complications, neonatal morbidity, maternal postpartum and offsprings follow-up data will be collected. Those diagnosed with GDM will initially be advised routine care. Those unable to reach glycaemic control with diet alone will be advised to take insulin. Postpartum screening for glucose abnormalities will be performed at months 3 and 6 and then every year for 10 years. The offsprings will be followed up every year for anthropometric measurements and growth velocity, as well as, plasma glucose, insulin and lipid profile. In addition, qualitative research will be carried out to identify barriers and facilitators for early GDM screening, treatment compliance and postpartum follow-up and testing, as well as, for continued adherence to lifestyle modifications. DISCUSSION: The study will demonstrate whether measures to improve diagnosis and care of GDM mothers followed by preventive postpartum care are possible in the routine care setting. It will also map out the barriers and facilitators for such initiatives and provide new evidence on the determinants and risk factors for both GDM development and occurrence of adverse pregnancy outcomes and development of future diabetes and metabolic abnormalities in the GDM mother and her offspring. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-014-0378-y) contains supplementary material, which is available to authorized users

Additional file 1: of Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India

Interview guide – pregnant women. Contains the semi-structured interview guide used for the interviews with pregnant women regarding screening and testing for GDM. (DOCX 21 kb

Sensitivity, specificity, positive predictive values and negative predictive values for individual and accumulated number of risk factors and hyperglycaemia in pregnancy (HIP) stratified according to health centre.

<p>Based on those with data for all three risk factors, n = 3377.</p

Sensitivity, specificity, positive predictive values and negative predictive values for individual and accumulated number of risk factors and hyperglycaemia in pregnancy (HIP).

<p>Based on those with data for all three risk factors, n = 3377.</p