Abatacept may decelerate progression of atherosclerosis in RA patients with CVD: Study

Researchers have found that abatacept treatment may benefit patients with rheumatoid arthritis (RA) who have a high risk of cardiovascular disease, according to a study published in Arthritis Research & Therapy. The study evaluated the effects of abatacept on the progression of atherosclerosis in patients with RA, showing potential advantages in terms of cardiovascular outcomes. This study was conducted by Yamada Z. and colleagues.

The use of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has significantly improved the prognosis and quality of life for patients with RA. However, older patients (aged ≥ 65 years) face a higher risk of developing infections and other complications due to the use of these drugs. Understanding the potential benefits and risks of different medications is crucial for providing optimal care.

This open-label, prospective observational study evaluated the 3-year efficacy and safety of abatacept in a cohort of younger (aged 20-64 years) and older (aged ≥ 65 years) RA patients. Eligible patients were refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), bDMARD-naïve, and provided written consent.

The study stratified patients into four groups: younger patients receiving abatacept (AY), older patients receiving abatacept (AO), younger patients treated with csDMARDs (CY), and older patients treated with csDMARDs (CO).

The key findings of the study were:

  • A total of 216 patients were included in the study, with 52 in the AY cohort, 73 in the AO cohort, 41 in the CY cohort, and 50 in the CO cohort.

  • Patients in the abatacept groups experienced smaller increases in mean intima-media thickness (IMT), max IMT, and plaque score compared to the csDMARD groups. Although the differences were not statistically significant, abatacept showed potential benefits in slowing the progression of atherosclerosis.

  • Significantly lower increases in plaque score were observed in the abatacept cohort compared to the csDMARD cohort, taking into account disease activity at 156 weeks (P = .0303).

  • Patients receiving abatacept showed a higher proportion of good or good/moderate European League Against Rheumatism (EULAR) response, indicating better disease control.

  • While serious adverse effects, specifically infection, were more frequent in the abatacept cohort, there were no significant differences between the older and younger patients receiving abatacept.

Investigators noted several limitations, including the study’s observational design, relatively small sample size, and limited number of cases. Additionally, the study’s generalizability may be constrained by the exclusively Japanese population.

In conclusion, abatacept treatment may offer potential benefits for RA patients at high risk of cardiovascular disease, particularly among older patients. Although further research with larger and more diverse populations is needed, abatacept appears to be a promising option for managing RA while also potentially decelerating atherosclerosis progression.

Reference:

Yamada Z, Muraoka S, Kawazoe M, et al. Long-term effects of abatacept on atherosclerosis and arthritis in older vs. younger patients with rheumatoid arthritis: 3-year results of a prospective, multicenter, observational study. Arthritis Res Ther. 2024;26(1):87. Published 2024 Apr 17. doi:10.1186/s13075-024-03323-8

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What are Perioperative adverse cardiac events in maxillofacial surgery?

Recently published meta-analysis focused on the incidence and presentation of perioperative adverse cardiac events (ACEs) during maxillofacial surgery in adults. The review included 12 studies with a total of 34,227 patients and categorized ACEs into four types. The main findings include an overall incidence of ACEs of 2.58%, with heart rate and rhythm disturbances resulting in the greatest incidence among the four categories. Most commonly, ACEs resulted in intensive care unit (ICU) admission, impacting surgical outcomes. The review also revealed that ACEs, particularly heart rate and rhythm disturbances, can disproportionately impact surgical outcomes. Additionally, the analysis identified a potential publication bias, the impact of anaesthetic agents on the development of ACEs, and the occurrence of trigeminocardiac reflex (TCR) during maxillofacial surgeries.

Impact of Perioperative Adverse Cardiac Events (ACEs) on Surgical Outcomes

The findings suggest that perioperative ACEs, while relatively rare, can have a significant impact on surgical outcomes, necessitating ICU admission in a substantial proportion of cases. The review also highlighted the potential role of anaesthetic agents in contributing to ACEs and the importance of understanding the TCR in intraoperative bradycardia. The analysis had limitations, including potential publication bias, variations in the reporting and categorization of ACEs across studies, and geographic bias. The conclusions of this review emphasize the need for large-scale prospective studies to better understand the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery. This study serves as valuable groundwork for future research in this area, providing insights into potential areas of interest, such as contributory factors and long-term implications, for future researchers.

Key Points

– A systematic review and meta-analysis of 12 studies with 34,227 patients focused on the incidence and presentation of perioperative adverse cardiac events (ACEs) during maxillofacial surgery in adults. The overall incidence of ACEs was found to be 2.58%, with heart rate and rhythm disturbances having the greatest incidence among the four categories of ACEs.

– Perioperative ACEs were found to have a significant impact on surgical outcomes, often resulting in the need for intensive care unit (ICU) admission. The review emphasized the potential role of anaesthetic agents in contributing to ACEs and the importance of understanding the trigeminocardiac reflex (TCR) in intraoperative bradycardia.

– The study identified limitations such as potential publication bias, variations in the reporting and categorization of ACEs across studies, and geographic bias. The conclusion highlighted the need for large-scale prospective studies to better understand the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery, underscoring the study’s valuable groundwork for future research.

Reference –

Chohan, Mehak*; Liu, Winnie1,*; Chowdhury, Tumul2. Perioperative adverse cardiac events in maxillofacial surgery: A systematic review and meta-analysis. Indian Journal of Anaesthesia 68(5):p 426-438, May 2024. | DOI: 10.4103/ija.ija_1206_23

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Blood test predicts psychosis risk and most effective treatments, claims study

A team of researchers led by Indiana University School of Medicine faculty have developed a breakthrough new blood test for schizophrenia, a psychiatric disorder that includes hallucinations and delusions.

Schizophrenia and related psychotic disorders affect over 3 million people in the United States. The new test identifies biomarkers in a person’s blood that can objectively measure their current severity and future risk for schizophrenia and match them to treatments that will be most effective for their individual biology.

“Schizophrenia is hard to diagnose, especially early on, and matching people to the right treatment from the beginning is very important,” said Alexander Niculescu, MD, PhD, Professor of Psychiatry and Medical Neuroscience at the IU School of Medicine, staff psychiatrist and investigator at the Richard L. Roudebush Veterans Administration Medical Center in Indianapolis and senior author on the study. “Psychosis usually manifests in young adulthood — a prime period of life. Stress and drugs, including marijuana, are precipitating factors on a background of genetic vulnerability. If left unchecked, psychosis leads to accumulating biological damage, social damage and psychological damage.”

In a study published in the high impact Nature Publishing Group journal Molecular Psychiatry, researchers tested psychiatric patients that they followed for over a decade. They identified biomarkers that were predictive of high hallucinations and high delusions states, as well as future psychiatric hospitalizations related to hallucinations and delusions. They also studied which biomarkers are targets of existing drugs, which enables matching of patients to the right treatments.

The work builds on previous research over the last two decades by Niculescu and his colleagues on blood biomarkers for other psychiatric disorders (mood disorders, anxiety, post-traumatic stress disorder, suicidality risk, pain and memory disorders).Niculescu said in general, the best biomarkers were more predictive than the standard scales used to evaluate someone with hallucinations or delusions, which means the use of this biomarker test can help reduce subjectivity and uncertainty from psychiatric assessments.

“Fortunately, biologically some of the existing medications work quite well if initiated early in the right patients,” Niculescu said. “Social support is also paramount, and once that and medications are in place, psychological support and therapy can help as well. There is still plenty left to understand and apply about cognition and its abnormalities, but there is reason for optimism in this era of emerging precision psychiatry.”

Reference:

Hill, M.D., Gill, S.S., Le-Niculescu, H. et al. Precision medicine for psychotic disorders: objective assessment, risk prediction, and pharmacogenomics. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-024-02433-8.

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Combo of Epley maneuver and dizzy-fix training device yield remarkable treatment outcomes for BPPV management: Study

India: Benign paroxysmal positional vertigo (BPPV) affects millions worldwide, causing episodes of dizziness and imbalance triggered by changes in head position. While the Epley maneuver has been a cornerstone in BPPV treatment, a recent study delved into its efficacy when paired with the Dizzy-Fix training device. Published in the Indian Journal of Otolaryngology and Head & Neck Surgery, the study offers insights into optimizing BPPV management for better patient outcomes.

The study revealed a staggering 90% symptom resolution by day 7, surpassing the traditional approach’s 60% success rate with a combination of Epley Maneuver and the Dizzy-Fix Training Device in treating benign paroxysmal positional vertigo.

“Patients reported reductions in Dizziness Handicap Inventory scores (from 30 to 5), higher satisfaction ratings (4.5/5 versus 3.8/5), & lower recurrence rates (10% versus 40%),” the researchers wrote.

The Dizzy-Fix device is a portable tool designed for at-home use that provides visual and auditory cues to guide patients through head movement exercises to reposition displaced inner ear crystals, a common cause of BPPV symptoms.

Led by Sanjay Kumar, Dept of ENT-HNS, Command Hospital Air Force, Bangalore, India, the study aimed to evaluate the effectiveness of combining the epley maneuver with the dizzy-fix training device in BPPV treatment, aiming to enhance treatment outcomes and patient satisfaction.

The randomized controlled trial enrolled 50 patients diagnosed with posterior canal BPPV. They were allocated into two groups: one receiving the traditional Epley Maneuver and the other undergoing the Epley Maneuver supplemented with the Dizzy-Fix Training Device.

Key measures included the changes in the Visual Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI) scores, the proportion of symptom-free patients at one month, the recurrence rate within one month, and patient satisfaction.

Following were the study’s key findings:

  • The Dizzy-Fix group achieved a significantly higher symptom resolution rate by day 7 (90% versus 60%) and reported greater patient satisfaction (4.5/5 versus 3.8/5) versus the Epley Maneuver alone group.
  • The group also exhibited a more substantial decrease in DHI scores (from an average of 30 to 5) and a lower recurrence rate (10% versus 40%) within the first-month post-treatment.

In conclusion, the researchers found significant improvement in BPP management, evidenced by reduced symptom recurrence, enhanced patient satisfaction, and faster symptom resolution by incorporating the Dizzy-Fix Training Device with the Epley Maneuver.

“These findings underscore the value of real-time visual feedback technologies integration in vestibular rehabilitation, promising better patient outcomes, and advancing the quality of care in BPPV treatment,” the researchers wrote.

Reference:

Kumar, S., Singh, R., Dutta, A. et al. Enhancing BPPV Treatment Outcomes: A Comparative Study of the Epley Maneuver with and without the Dizzy-Fix Training Device. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04710-y

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Gastric bypass improves long-term diabetes remission, even after weight regain, reveals study

Adults who have obesity and Type 2 diabetes are much more likely to see their diabetes stay in remission if they undergo gastric bypass surgery rather than sleeve gastrectomy, even after regaining weight, according to a study published in the Journal of the American College of Surgeons (JACS).

Some people who undergo weight loss surgery regain a significant amount of weight within a few years after the procedure. Specific types of bariatric surgery include gastric bypass, which bypasses a part of the small intestine, called the duodenum, and a more popular, minimally invasive procedure called sleeve gastrectomy, which works by making the stomach smaller, restricting the amount of food that can be consumed.1

“We showed that in patients who had bariatric surgery, bypassing the duodenum has a greater benefit for patients with diabetes. We saw that patients who had sleeve gastrectomy and weight recurrence had a much greater chance of having their diabetes return when compared to their gastric bypass counterparts, even after adjusting for all diabetes patient factors,” said lead study author Omar M. Ghanem, MD, FACS, DABS, a bariatric and metabolic surgeon at Mayo Clinic in Rochester, Minnesota.

“We know that the first portion of the intestine, the duodenum, plays a very important part of digestion, and helps regulate what we call the ‘gut metabolic pathway.’ Bypassing that axis contributes to many physiologic actions or changes in metabolism and one of them is the regulation of glycemia and eventually diabetes,” Dr. Ghanem said.

For the study, researchers investigated whether diabetes returned when patients regained their weight after bariatric surgery. The review was based on data from 224 patients who underwent gastric bypass surgery and 46 control subjects who underwent sleeve gastrectomy at Mayo Clinic between 2008 and 2017. All patients involved in the analysis had obesity and had been diagnosed with Type 2 diabetes before they underwent weight loss surgery. Each patient was followed for at least five years after the operation. Diabetes remission rates were then grouped into four weight relapse categories and compared. The aim was to see if weight gain led to diabetes recurrence.

Among key findings of the study

• Overall, 75% of gastric bypass patients saw their diabetes stay in remission, compared with only 34.8% of patients in the sleeve gastrectomy group.

• After adjusting for patient and weight-related factors, the odds of diabetes returning over the 5-year follow-up period were 5.5 times greater in the sleeve gastrectomy group compared to the gastric bypass group.

• In a subgroup analysis of gastric bypass patients, diabetes remission rates were stratified into four weight regain categories. Over half of the patients in all four categories (patients who lost weight after surgery and regained 25%, 25% to 50%, 50% to 75%, and more than 75% of the weight they initially lost from having surgery) kept their diabetes in remission.

• Among patients who regained 100% or more of their weight after gastric bypass surgery, about 60% kept their diabetes in remission five years after the operation, compared to zero in the gastric sleeve group.

• Insulin use, higher preoperative A1c (which measures average blood sugar levels), and longer preoperative duration of diabetes were associated with diabetes recurrence, whereas weight regain was not.

Obesity is a leading risk factor contributing to death in the U.S. Most of the mortality risk linked to obesity is due to the development of diabetes and cardiovascular diseases.2 The researchers noted they intend to conduct more in-depth studies to understand this connection on a cellular level, which will better explain these findings.

“These findings help us understand how the bypass works and how to keep diabetes in remission. Looking forward, we need to understand the mechanism behind this association so we can counsel patients on the best procedure for them when presenting to us with diabetes,” Dr. Ghanem said.

“A major determining fact when choosing the most appropriate surgery is if the patient wants to eliminate diabetes or wants to have the least chance of having diabetes come back in the long term. While both procedures are great, we know that gastric bypass is a better procedure for patients with diabetes at this point.”

“Diabetes remission is more durable after gastric bypass than after sleeve gastrectomy. The magnitude of the difference in this study is important,” said Anthony T. Petrick, MD, FACS, director, division of bariatric and foregut surgery, Geisinger Health System, who was not involved with the study. “Although there was a small number of sleeve gastrectomy patients in this study, the long-term follow-up is a strength of these findings.”

A potential limitation of the study is that it is a retrospective, single-center study. Therefore, the results may not apply to other bariatric programs across the country.

Reference:

Ghanem, Omar M MD, FACSa; Abi Mosleh, Kamal MDa; Kerbage, Anthony MDb; Lu, Lauren BSc; Hage, Karl MDa; Abu Dayyeh, Barham K MDb. Continued Diabetes Remission Despite Weight Recurrence: Gastric Bypass Long-Term Metabolic Benefit. Journal of the American College of Surgeons ():10.1097/XCS.0000000000000934, February 13, 2024. | DOI: 10.1097/XCS.0000000000000934.

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Use of acid reflux drugs linked to higher risk of migraine, claims study

People who take acid-reducing drugs may have a higher risk of migraine and other severe headache than people who do not take these medications, according to a study published in the April 24, 2024, online issue of Neurology Clinical Practice, an official journal of the American Academy of Neurology. The acid-reducing drugs include proton pump inhibitors such as omeprazole and esomeprazole, histamine H2-receptor antagonists, or H2 blockers, such as cimetidine and famotidine, and antacid supplements.

The study does not prove that acid-reducing drugs cause migraine; it only shows an association.

Acid reflux is when stomach acid flows into the esophagus, usually after a meal or when lying down. People with acid reflux may experience heartburn and ulcers. People with frequent acid reflux may develop gastroesophageal reflux disease, or GERD, which can lead to cancer of the esophagus.

“Given the wide usage of acid-reducing drugs and these potential implications with migraine, these results warrant further investigation,” said study author Margaret Slavin, PhD, RDN, of the University of Maryland in College Park. “These drugs are often considered to be overprescribed, and new research has shown other risks tied to long-term use of proton pump inhibitors, such as an increased risk of dementia.”

For the study, researchers looked at data on 11,818 people who provided information on use of acid-reducing drugs and whether they had migraine or severe headache in the past three months.

A total of 25% of participants taking proton pump inhibitors had migraine or severe headache, compared to 19% of those who were not taking the drugs. A total of 25% of those taking H2 blockers had severe headache, compared to 20% of those who were not taking those drugs. And 22% of those taking antacid supplements had severe headache, compared to 20% of those not taking antacids.

When researchers adjusted for other factors that could affect the risk of migraine, such as age, sex and use of caffeine and alcohol, they found that people taking proton pump inhibitors were 70% more likely to have migraine than people not taking proton pump inhibitors. Those taking H2 blockers were 40% more likely and those taking antacid supplements were 30% more likely.

“It’s important to note that many people do need acid-reducing medications to manage acid reflux or other conditions, and people with migraine or severe headache who are taking these drugs or supplements should talk with their doctors about whether they should continue,” Slavin said.

Slavin noted that the study looked only at prescription drugs. Some of the drugs became available for over-the-counter use at non-prescription strength during the study period, but use of these over-the-counter drugs was not included in this study.

Other studies have shown that people with gastrointestinal conditions may be more likely to have migraine, but Slavin said that relationship is not likely to fully explain the tie between acid-reducing drugs and migraine found in the study.

A limitation of the study is that a small number of people were taking the drugs, especially the H2 blockers.

Reference:

Slavin, M., et al. (2024) Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey. Neurology® Clinical Practice. doi.org/10.1212/CPJ.0000000000200302.

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Stairs climbing may increase longevity, claims study

Climbing stairs is associated with a longer life, according to research presented today at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC).

“If you have the choice of taking the stairs or the lift, go for the stairs as it will help your heart,” said study author Dr. Sophie Paddock of the University of East Anglia and Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK. “Even brief bursts of physical activity have beneficial health impacts, and short bouts of stair climbing should be an achievable target to integrate into daily routines.”

Cardiovascular disease is largely preventable through actions like exercise. However, more than one in four adults worldwide do not meet recommended levels of physical activity. Stair climbing is a practical and easily accessible form of physical activity which is often overlooked. This study investigated whether climbing stairs, as a form of physical activity, could play a role in reducing the risks of cardiovascular disease and premature death.

The authors collected the best available evidence on the topic and conducted a meta-analysis. Studies were included regardless of the number of flights of stairs and the speed of climbing. There were nine studies with 480,479 participants in the final analysis. The study population included both healthy participants and those with a previous history of heart attack or peripheral arterial disease. Ages ranged from 35 to 84 years old and 53% of participants were women.

Compared with not climbing stairs, stair climbing was associated with a 24% reduced risk of dying from any cause and a 39% lower likelihood of dying from cardiovascular disease. Stair climbing was also linked with a reduced risk of cardiovascular disease including heart attack, heart failure and stroke.

Dr. Paddock said: “Based on these results, we would encourage people to incorporate stair climbing into their day-to-day lives. Our study suggested that the more stairs climbed, the greater the benefits-but this needs to be confirmed. So, whether at work, home, or elsewhere, take the stairs.”

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Ultrasound Emerges as Reliable Alternative to MRI for Assessing Hip Joint Capsule Thickness, claims study

The hip joint capsule plays a crucial role in hip function and stability, with its thickness being a significant factor in various medical conditions, surgical outcomes, and rehabilitation strategies. While magnetic resonance imaging (MRI) has been the primary tool for measuring hip joint capsule thickness, a recent study explores the viability of ultrasound as an alternative method. This study was published in BMC Musculoskeletal Disorders by Gao G. and colleagues.

This research aims to evaluate the consistency between ultrasound and MRI measurements, shedding light on the potential clinical utility of ultrasound in assessing hip joint capsule thickness. A retrospective analysis included 307 patients who underwent both hip joint MRI and ultrasound imaging within a three-month timeframe. The study examined the consistency of measurements between the two methods and explored correlations between hip joint capsule thickness and other hip parameters, such as the alpha angle, lateral center-edge angle, acetabular anteversion angle, and femoral anteversion angle.

Key Findings:

  • Consistency of Measurements: Both MRI and ultrasound measurements of hip joint capsule thickness showed good agreement, with respective averages of 5.0 ± 1.2 mm and 5.0 ± 1.5 mm. Bland-Altman analysis revealed strong consistency (p-value = 0.708).

  • Statistical Comparison: The paired t-test indicated no significant statistical difference between ultrasound and MRI measurements, affirming the reliability of ultrasound in assessing hip joint capsule thickness.

  • Correlation with Acetabular Anteversion Angle: A noteworthy correlation was found between acetabular anteversion angle and hip joint capsule thickness measured by ultrasound, suggesting a potential link between these factors.

The study’s findings propose that ultrasound can be a dependable alternative to MRI for measuring hip joint capsule thickness in clinical practice. The strong consistency observed between the two methods emphasizes the potential of incorporating ultrasound as a routine assessment tool. Additionally, the correlation between acetabular anteversion angle and hip joint capsule thickness opens avenues for further research in understanding the intricate relationships within the hip joint.

Reference:

Gao, G., Fang, H., Zhou, K., Mo, Z., Liu, J., Meng, L., Wang, J., & Xu, Y. (2024). Ultrasound had high accuracy in measuring hip joint capsule thickness. BMC Musculoskeletal Disorders,2024;25(1):101. https://doi.org/10.1186/s12891-024-07228-0

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Increased Uveitis Recurrence Risk Observed After COVID-19 Vaccination: JAMA

A recent population-based cohort study published in the Journal of American Medical Association in South Korea found significant insights regarding the recurrence of uveitis following COVID-19 vaccination. The study targeted individuals with a history of uveitis who received one of the major COVID-19 vaccines and highlighted an increased risk of inflammation recurrence post-vaccination which could influence future vaccination guidelines and patient monitoring practices.

The research utilized data from the Korean National Health Insurance Service and the Korea Disease Control and Prevention Agency which included a total of 4,73,934 participants who had a prior diagnosis of uveitis and vaccination against COVID-19 with either mRNA vaccines (Pfizer-BioNTech and Moderna) or adenovirus vector-based vaccines (AstraZeneca and Janssen). The analysis spanned from February 26, 2021 to December 31, 2022 to assess the incidence and risk associated with uveitis after COVID-19 vaccination.

The findings revealed a cumulative incidence of uveitis of 8.6% at three months, 12.5% at six months and 16.8% at one year post-vaccination that predominantly affected the anterior segment of the eye. The study also observed variations in the risk linked to different types of vaccines and specific periods before and after vaccination. Also, the incidence of uveitis was elevated in the early post-vaccination phase between the first and second doses of the vaccine.

The  detailed results indicated that the highest risk was observed with the Ad26.COV2.S (Janssen) vaccine which showed a hazard ratio (HR) of 2.07, indicating more than double the risk when compared to non-vaccinated individuals. The other vaccines also showed increased risk with Pfizer-BioNTech at a HR of 1.68, Moderna at 1.51 and AstraZeneca at 1.60.

These findings suggest that COVID-19 vaccination can trigger the recurrence of uveitis in individuals with a history of this condition. While the exact mechanism behind this increased risk remains unclear, the outcomes underlines the importance of careful clinical monitoring and perhaps tailored vaccination strategies for patients known to have uveitis.

These findings necessitate a careful approach to observe and manage patients with a history of uveitis who are scheduled to receive COVID-19 vaccination. The elevated risk calls for heightened awareness and potentially pre-emptive measures to manage inflammation and prevent severe outcomes in this sensitive population. These adds a crucial layer of understanding to the complex relationships between vaccination and immune-mediated inflammatory diseases by highlighting the need for individualized patient care strategies.

Source:

Kim, J., Kwon, H. Y., & Ahn, S. J. (2024). COVID-19 Vaccine–Associated Uveitis in Patients With a History of Uveitis. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2024.0973

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Use of insulin pumps tied to preterm delivery, fetal overgrowth in pregnant women with type 1 diabetes: Study

Denmark: A recent analysis of EVOLVE Study Cohort has shown a higher risk of large for gestational age (LGA) offspring and preterm delivery with the insulin pump treatment (versus multiple daily injections) in pregnant women with type 1 diabetes before the widespread use of automated insulin delivery.

The study, published in Diabetes Care, stated, “This association did not appear to be mediated by differences in glycemic control as represented by gestational weight gain or by HbA1c.”

“Proportions of LGA offspring and preterm delivery were higher among pump users compared with MDI users (OR, 1.36 for LGA and OR, 1.46 for preterm delivery),” the study researchers reported.

Previous studies have shown that fetal overgrowth is associated with higher maternal glycemic levels during pregnancy. Ida Holte Thorius, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark, and colleagues aimed to compare the risk of preterm delivery and fetal overgrowth in pregnant women with type 1 diabetes (T1D) treated with insulin pumps versus multiple daily injections (MDI). They also examined whether possible differences were mediated through improved glycemic control or gestational weight gain during pregnancy.

For this purpose, the research team evaluated the risk of pregnancy and perinatal outcomes in a cohort of 2,003 pregnant women with T1D enrolled from 17 countries in a real-world setting during 2013–2018. 723 women were treated with pumps and 1,280 with MDI.

The study led to the following findings:

  • At inclusion (median gestational weeks 8.6 [interquartile range 7–10]), pump users had lower mean HbA1c (mean 50.6 mmol/mol vs. 53.6 ± 13.8 mmol/mol), longer diabetes duration (18.4 versus 14.4 years), and higher prevalence of retinopathy (35.3% versus 24.4%).
  • Proportions of large for gestational age offspring and preterm delivery were 59.0% vs. 52.2% (adjusted odds ratio [OR] 1.36) and 39.6% vs. 32.1% (adjusted OR 1.46), respectively.
  • The results did not change after adjustment for HbA1c or gestational weight gain.

In conclusion, insulin pump treatment in pregnant women with type 1 diabetes, before the widespread use of continuous glucose monitoring or automated insulin delivery, was linked with a higher risk of LGA offspring and preterm delivery compared with MDI in crude and adjusted analyses.

This association was not attenuated after adjustment for gestational weight gain or HbA1c.

Reference:

Ida Holte Thorius, Lise Lotte N. Husemoen, Rikke Baastrup Nordsborg, Amra C. Alibegovic, Mari-Anne Gall, Janne Petersen, Peter Damm, Elisabeth R. Mathiesen; Fetal Overgrowth and Preterm Delivery in Women With Type 1 Diabetes Using Insulin Pumps or Multiple Daily Injections: A Post Hoc Analysis of the EVOLVE Study Cohort. Diabetes Care 23 February 2024; 47 (3): 384–392. https://doi.org/10.2337/dc23-1281

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