Katherine L. Baldock

Long-term follow-up of women with gestational diabetes mellitus: The South Australian Gestational Diabetes Mellitus Recall Register

Background:  Women who have had gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes. Early detection and management of type 2 diabetes are important for reducing associated complications and costs.

Achievement of management targets associated with incident and long-term diagnosed diabetes among a representative population sample.

AIM To assess achievement of management targets among participants with diagnosed diabetes. METHODS Participants in the North West Adelaide Health Study (n=4060), a representative cohort aged 18+ years, were assessed at baseline in 2000-03 and follow-up in 2004-06. Diagnosed and undiagnosed diabetes were determined from fasting plasma glucose (> or =7.0 mmol/L) and self-reported data. RESULTS Baseline prevalences were 5.6% (95% CI 4.9-6.3) diagnosed and 1.0% (95% CI 0.7-1.4) undiagnosed diabetes. Annual incidences were 5.1 per 1000 diagnosed and 1.7 per 1000 undiagnosed diabetes. Among those with long-term diagnosed diabetes, 45.8% had HbA1c< or =7.0%, 26.8% had blood pressure<130/85 mmHg, 14.1% had body mass index< or =25, 88.5% were non- or ex-smokers, 19.2% had total cholesterol<4 mmol/L, 61.9% had triglycerides<2.0 mmol/L, 83.0% had HDL> or =1.0 mmol/L, and 45.6% had LDL<2.5 mmol/L. Participants with incident diagnosed diabetes were more likely to achieve HbA1c and less likely to achieve LDL targets than those with long-term diagnosed diabetes. Few people treated with hypoglycaemics, antihypertensives or statins were achieving targets. CONCLUSIONS Many people with diabetes are at risk of developing or worsening complications because they are not meeting recommended targets. Treatment with medication is also suboptimal, indicating a continued role for public health programs to reduce risk factors.

Are Perceived and Objective Distances to Fresh Food and Physical Activity Resources Associated with Cardiometabolic Risk

Perceived and objective measures of neighbourhood features have shown limited correspondence. Few studies have examined whether discordance between objective measures and individual perceptions of neighbourhood environments relates to individual health. Individuals with mismatched perceptions may benefit from initiatives to improve understandings of resource availability. This study utilised data from n = 1491 adult participants in a biomedical cohort to evaluate cross-sectional associations between measures of access (perceived, objective, and perceived-objective mismatch) to fruit and vegetable retailers (FVR) and public open space (POS), and clinically-measured metabolic syndrome and its component risk factors: central obesity, dyslipidaemia, hypertension and pre-diabetes/diabetes. Access measures included perceived distances from home to the nearest FVR and POS, corresponding objectively-assessed road network distances, and the discordance between perceived and objective distances (overestimated (i.e., mismatched) distances versus matched perceived-objective distances). Individual and neighbourhood measures were spatially joined using a geographic information system. Associations were evaluated using multilevel logistic regression, accounting for individual and area-level covariates. Hypertension was positively associated with perceived distances to FVR (odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.02, 1.28) and POS (OR = 1.19, 95% CI = 1.05, 1.34), after accounting for covariates and objective distances. Hypertension was positively associated with overestimating distances to FVR (OR = 1.36, 95% CI = 1.02, 1.80). Overestimating distances to POS was positively associated with both hypertension (OR = 1.42, 95% CI = 1.11, 1.83) and dyslipidaemia (OR = 1.25, 95% CI = 1.00, 1.57). Results provide new evidence for specific associations between perceived and overestimated distances from home to nearby resources and cardiometabolic risk factors.