type 2 diabetes and outcomes


According to a study from Denmark, there are higher rates of sick and dead babies, as well as worse maternal outcomes for Type 2 than Type 1 or non-diabetic women.
I have a few theories on why this is the case.
First off, Type 2 diabetes can be hard to diagnose before it has done significant damage to the person's cardiovascular system. Hence, the placental implantation and development is adversely affected.
Secondly, Type 2 diabetes is seen as a non-disease by many of those who have it. You don't have many symptoms, and untreated, it takes a long time to die from it. Conversely, type 1 diabetes makes its sufferers very sick fairly quickly and it is dramatic in its effects. Coma gets attention.
Thirdly, until quite recently, there was little effort made to encourage those with type 2 diabetes to keep their sugars under tight control. Type diabetics are encouraged to check sugars at least 4 times daily, more often if sick or stressed. Pregnant type 1 diabetics test 7 times daily (at least initially). I am lucky if I can get a (non-pregnant) type 2 diabetic to test twice a week.
Another factor is that type 2 diabetes is usually treated with oral medications, and those are usually only given if lifestyle changes are unsuccessful. There is a psychological difference between taking a pill and injecting medication - injection seems to make things seem more real, more serious somehow.
I also wonder if many of these poor outcomes are among women who thought themselves infertile, and whose fertility recovered before they got their diabetes under control. I also wonder if the docs who diagnosed their diabetes and intitiated treatment gave these women the ugly truth about the impact of diabetes on reproductive outcomes.
It is extremely important for women with diabetes who are at any risk of pregnancy to keep their diabetes under very tight control before conception and during the entire pregnancy. This can drastically reduce the risk of major malformations (heart, kidneys, spinal cord) that occur in as many as 10% of babies concieved to poorly controlled diabetic women. Continuing tight control can also reduce the risk of pre-eclampsia, macrosomia (huge babies), and other complications.
Gestational diabetes is a different topic, but anyone with a history of gestational diabetes should try to eat low-glycemic for the rest of her life and should be tested for type 2 diabetes on a regular basis. Between 40 to 60% of women with gestational diabetes will go on to develop type 2 diabetes later in life.

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This page contains a single entry by alicia published on February 10, 2005 11:17 AM.

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