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Type 2 diabetes after GDM in Mexican American population

Type 2 diabetes after GDM in Mexican American population. Camelia Stefanescu, RNC, BSN CSUDH Dominguez Hills MSN-FNP. Definition. “Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.”

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Type 2 diabetes after GDM in Mexican American population

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  1. Type 2 diabetes after GDM in Mexican American population Camelia Stefanescu, RNC, BSN CSUDH Dominguez Hills MSN-FNP

  2. Definition • “Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.” • Although these women's glucose and insulin levels often return to normal after pregnancy, as many as 50 percent may develop type 2 diabetes within 20 years of the pregnancy. • Mexican American women may be at particularly high risk for developing type 2 diabetes. American Diabetes Association. (2002). Gestational diabetes mellitus. (Position statement). Diabetes Care, 25, S94-96. National Diabetes Information Clearinghouse. (2002). Diabetes in Hispanic Americans. Retrieved November 7, 2003, from http://diabetes.niddk.nih.gov/dm/pubs/hispanicamerican/index.htm

  3. Complications of diabetes in Mexican Americans • Higher rates of the diabetes complications nephropathy (kidney disease), retinopathy (eye disease), and peripheral vascular disease have been documented in studies of Mexican Americans, whereas lower rates of myocardial infarctions (heart attacks) have been found. National Diabetes Information Clearinghouse. (2002). Diabetes in Hispanic Americans. Retrieved November 7, 2003, from http://diabetes.niddk.nih.gov/dm/pubs/hispanicamerican/index.htm

  4. Exercise and diet value in preventing diabetes (DDP study) • Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5 to 7 percent of their body weight. • Of the 3,234 participants enrolled in the DPP, 45 percent were from minority groups that suffer disproportionately from type 2 diabetes, Hispanic American among them. • This was a double-blinded large randomized clinical trial, followed by a cohort study. Diabetes Prevention Program Research Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346, 393-403.

  5. Troglitazone in Prevention of Diabetes (TRIPOD) study • 235 Hispanic women with previous gestational diabetes were randomized to receive either placebo or troglitazone (thiazolidinedione class). • After a median follow-up of 30 months, the annual incidence of type 2 diabetes in the two groups was 12.3 and 5.4%, respectively. • Thus, troglitazone treatment was associated with a 56% relative reduction in progression to diabetes. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP (2002). Preservation of pancreatic-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Diabetes,51, 2796-2803.

  6. Conclusion • Being overweight or physically inactive is a major risk factor for developing diabetes. Hispanic Americans have high rates of both of these risk factors. • Healthy lifestyles are particularly important for people who are at increased risk of diabetes. Some diabetes may be prevented with weight control and regular physical activity. • Hispanic Americans with diabetes have a higher incidence of diabetes complications such as eye and kidney disease than non-Hispanic whites. However, they may have lower rates of heart disease. • If Hispanic Americans can prevent or control their diabetes, their risk of complications will decrease. • The cost-effectiveness of intervention strategies is unclear, but the huge burden resulting from the complications of diabetes and the potential ancillary benefits of some of the interventions suggest that an effort to prevent diabetes may be worthwhile. National Diabetes Information Clearinghouse. (2002). Diabetes in Hispanic Americans. Retrieved November 7, 2003, from http://diabetes.niddk.nih.gov/dm/pubs/hispanicamerican/index.htm American Diabetes Association (2003). The prevention or delay of type 2 diabetes. Diabetes Care, 26 Suppl 1, S62-9.

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