NIHR |July 2018 | Pregnant women invited to take part in pioneering diabetes prevention research
Pregnant women visiting maternity clinics in Berkshire, Buckinghamshire, Milton Keynes and Oxfordshire are being invited to participate in a new study, The INvestigating Genetic Risk for type 1 Diabetes (INGR1D), to identify the risk of their child developing type 1 diabetes.
Mothers of infants identified to have a higher risk of type 1 diabetes will then be offered an opportunity to take part in the Primary Oral Insulin Trial (POInT trial) to see if giving high-risk children small doses of insulin powder can prevent them from developing type 1 diabetes.
Participants on the trial are given the powder or a placebo, to compare the two. Parents are asked to give their children insulin powder daily until they are three years old. They will have visits from the research team to monitor the child’s health.
The scientists hope that this intervention can train the immune system to tolerate the body’s own insulin to prevent the onset of type 1 diabetes (Source: NIHR).
Children who eat takeaways once or more each week have more body fat and higher low-density lipoprotein (LDL) “bad” cholesterol levels than those who never or hardly ever eat them. Their diets were also higher in fat and lower in protein and calcium.
This cross-sectional study looked in depth at eating habits and risk markers for coronary heart disease, obesity and diabetes in 2,529 children in England. Though this type of study can only show an association between takeaways and risk markers, it is one of the first of its type, and the results do give cause for concern.
Increasing numbers of people are eating takeaways in the UK. Local authorities and healthcare professionals are well placed to encourage parents and children to choose healthier foods, in line with current national guidance.
Some women, especially with diabetes, are recommended to express milk while still pregnant and to save it for their newborn, yet no evidence exists for this practice.
A study published in today’s Lancet aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy.
The study found that expressing while pregnant is safe for women with diabetes in low-risk pregnancies in late pregnancy (from around 36 weeks). After studying over 600 women, the authors found no increase in early births or admissions to neonatal intensive care. However, one in four women couldn’t collect any colostrum.
Before the trial, researchers had only run three small studies of expressing colostrum while pregnant, and no randomised trials for women without diabetes.
The authors advice to women with questions about expressing while pregnant is to ask their health care professional about their individual situation.
Pyatak, E. et al. Journal of Adolescent Health. Published online: November 23 2016
Purpose: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care.
Conclusions: Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.
Eisenberg, M.H. Journal of Adolescent Health. Published online: August 2016
Purpose: Among adolescents with type 1 diabetes, disordered eating behaviors (DEBs) are more prevalent and have more serious health implications than in adolescents without diabetes, necessitating identification of modifiable correlates of DEB in this population. This study hypothesized that (1) autonomous motivation and (2) controlled motivation for healthy eating (i.e., eating healthfully because it is important to oneself vs. important to others, respectively) are associated with DEB among adolescents with type 1 diabetes. The third hypothesis was that baseline healthy eating self-efficacy moderates these associations.
Methods: Adolescents with type 1 diabetes (n = 90; 13–16 years) participating in a behavioral nutrition intervention efficacy trial reported DEB, controlled and autonomous motivation, and self-efficacy at baseline, 6, 12, and 18 months. Linear-mixed models estimated associations of controlled and autonomous motivation with DEB, adjusting for treatment group, body mass index, socioeconomic status, age, and gender. Separate models investigated the interaction of self-efficacy with each motivation type.
Results: Controlled motivation was positively associated with DEB (B = 2.18 ± .33, p < .001); the association was stronger for those with lower self-efficacy (B = 3.33 ± .55, p < .001) than those with higher self-efficacy (B = 1.36 ± .36, p < .001). Autonomous motivation was not associated with DEB (B = −.70 ± .43, p = .11).
Conclusions: Findings identify controlled motivation for healthy eating as a novel correlate of DEB among adolescents with type 1 diabetes and show that self-efficacy can modify this association. Motivation and self-efficacy for healthy eating represent potential intervention targets to reduce DEB in adolescents with type 1 diabetes.
This review highlights that this is now a complex diagnosis often requiring sophisticated investigations to accurately ascertain diabetes type. It proposes making antibody measurement routine and that genetic testing should be accessible to clinicians.