Zusammenfassung
Ziel der vorliegenden Studie war, (i) Auswirkungen eines Migrationshintergrunds auf das Ergebnis von 200 konsekutiven Schwangerschaften bei Frauen mit manifestem Diabetes zu evaluieren und (ii) geschlechtsspezifische Unterschiede im kardiovaskulären Risiko, der Rate diabetischer Komplikationen und dem Erreichen von Therapiezielen bei Typ-2-DiabetikerInnen mit Migrationshintergrund zu erheben. Schwangere Migrantinnen zeigten ähnliche Charakteristika bei Erstvorstellung sowie ein ähnliches Schwangerschaftsergebnis wie Nicht-Migrantinnen. Nach der Entbindung waren jedoch die Serum-Triglyzerid- und non-HDL-Konzentrationen bei Migrantinnen signifikant höher. Bezüglich geschlechtsspezifischer Unterschiede von MigrantInnen mit Diabetes wiesen Frauen ein schlechteres kardiovaskuläres Risikoprofil mit höheren Blutdruck- und Cholesterinwerten auf als Männer, obwohl die Einhaltung klinischer Empfehlungen nicht signifikant unterschiedlich war.
Summary
The objective of the present study was to assess (i) the effects of immigration on the outcome of 200 consecutive singleton pregnancies in women with overt diabetes as well as (ii) gender-specific differences in cardiovascular risk factor profile and the achievement of therapeutic targets in type 2 diabetic subjects with migration background (n = 50). In pregnant subjects, baseline characteristics at admission, pregnancy outcome and the rate of obstetrical complications were similar in immigrant and non-immigrant women. Type 2 diabetes and also preconceptionally undiagnosed diabetes were significantly more frequent in women with migration background. Following delivery, immigrants presented with a worse metabolic profile, including higher triglyceride and nonHDL levels, than the indigenous population. Furthermore, within diabetic subjects with a migration background, non-pregnant women feature a more adverse cardiovascular risk factor profile than men. However, no gender-specific differences in the total adherence to clinical recommendations according to clinical recommendations have been found.
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References
Thabit H, Shah S, Nash M, et al. Globalization, immigration and diabetes self-management: an empirical study amongst immigrants with type 2 diabetes mellitus in Ireland. Q J Med, 102: 713–720, 2009
Tran AT, Diep LM, Cooper JG, et al. Quality of care for patients with type 2 diabetes in general practice accoring to patient's ethnic background: a cross-selectional study from Oslo, Norway. BMC Health Services Res, 10: 145, 2010
Gadd M, Sundquist J, Johansson SE, et al. Eur J Cardiovasc Prev Rehabil, 12: 535–541, 2005
Small R, Gagnon A, Gissler M, et al. Somali women and their pregnancy outcome postmigration: data from six receiving countries. BJOG, 115: 1630–1640, 2008
Gould JB, Madan A, Qin C, et al. Perinatal outcomes in two dissimilar immigrant populations in the United States: a dual epidemiologic paradox. Pediatrics, 111: e676–e682, 2003
Vangen S, Stoltenberg C, Holan S, et al. Outcome of pregnancy among immigrant women with diabetes. Diabetes Care, 26: 327–332, 2003
American College of Obstetricians and Gynecologists Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetricians-Gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol, 98: 525–538, 2001
European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension – European Society of Cardiology Guidelines for the Management of Arterial Hypertension. J Hypertens, 21: 1011–1053, 2003
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care, 29(Suppl 1): S43–S48, 2006
Omori Y, Jovanovic L. Proposal for the reconsideration of the definition of gestational diabetes. Diabetes Care, 28: 2592–2593, 2005
Kitzmiller JL, Block JM, Brown FM, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care, 31: 1060–1079, 2008
Handisurya A, Bancher-Todesca D, Schober E, et al. Pregnancy outcome and risk factor profile in women with type 1 and type 2 diabetes mellitus. J Womens Health, 2010 (in press)
Kautzky-Willer A, Kamyar MR, Gerhat D, et al. Gender-specific differences in metabolic control, cardiovascular risk and interventions in patients with type 2 diabetes. Gender Med, 2010 (in press)
Kamyar MR, Johnson BJ, McAnaw JJ, Lemmens-Gruber R, Hudson SA. Evaluation of the implementation of medication guidelines in the prevention of coronary heart disease for patients with type II diabetes mellitus in primary care. Pharm World Sci, 30: 120–127, 2008
Ernst A, Kinnear M, Hudson S. Quality of prescribing: a study of guideline adherence of medication in patients with diabetes mellitus. Prac Diab Int, 22: 285–290, 2005
Scottish Intercollegiate Guidelines Network. www.sign.ac.uk/guidelines/published/numlist.html. (Cited 10 Jul. 2010)
American Diabetes Association. Standards of medical care in diabetes – 2008. Diabetes Care, 31: 12–54, 2008
The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text. http://www.escardio.org/NR/rdonlyres/EFF0C049-16C2-48AB-92B2-8A9C2E78C760/0/Guidelines_Diabetes_FT_2007.pdf. (Cited 10 July 2010)
Nielsen GL, Moller M, Sorensen HT. HbA1c in early diabetic pregnancy and pregnancy outcomes. Diabetes Care, 29: 2612–2616, 2006
Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care, 27: 1047–1053, 2004
International Diabetes Federation (IDF). Diabetes atlas, 2nd edn.: The Federation, Bruessels (Belgium), 2003
Creatore MI, Moineddin R, Booth G, et al. Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada. CMAJ, 182: 781–789, 2010
Cundy T, Gamble G, Neale L, et al. Differing causes of pregnancy loss in type 1 and type 2 diabetes. Diabetes Care, 30: 2603–2607, 2007
Farrell T, Neale L, Cundy T. Congenital anomalies in the offspring of women with type 1, type 2 and gestational diabetes. Diabet Med, 19: 322–326, 2002
Bellary S, O'Hare JP, Raymond NT, et al. Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study): a cluster randomised controlled trial. Lancet, 371: 1769–1776, 2008
Pischon T, Girman CJ, Sacks FM, et al. Non-high density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men. Circulation, 112: 3375–3383, 2005
Pilote L, Dasgupta K, Guru V, et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ, 176: S1–S44, 2007
Kautzky-Willer A, Handisurya A. Metabolic diseases and associated complications: sex and gender matter! J Clin Invest, 39: 631–648, 2009
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Handisurya, A., Bancher-Todesca, D., Kamyar, M. et al. Clinical characteristics, modalities and complications of diabetic patients with migration background at a Central European University Clinic. Wien Med Wochenschr 161, 128–135 (2011). https://doi.org/10.1007/s10354-011-0870-1
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DOI: https://doi.org/10.1007/s10354-011-0870-1