Sihui Luo

Patient and health-care provider perspectives of pregnancy-related health-care provision in Guangdong, China: a qualitative interview-based study

Abstract Background Pregnancy-related care can reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes. But little is known about the special health-care needs related to pregnancy of these women, or about the gap between these needs and health-care provision in China. We aimed to identify the perceived needs in women with type 1 diabetes and health-care providers for pregnancy-related care. The goal is for the findings to assist in the establishment of optimised management of this population in China. Methods We did in-depth interviews, a method widely used in social science to investigate peoples attitudes and behaviours. The intended interviewees included women with type 1 diabetes (aged ≥18 years) and health-care providers of both diabetes-related and pregnancy-related disciplines living in Guangdong, China. Written informed consent was obtained from all participants. Selective sampling was used to ensure that the recruited women with type 1 diabetes covering different areas of Guangdong, and were of diverse age, disease duration, marital and child-bearing status, income, and education level; and to ensure that the included health-care providers were from different types of health-care facilities. Transcripts of the interviews were coded into themes by three investigators (SX, SL, and CW) via a thematic framework method and NVIVO (version 10) qualitative software. The recruitment ended when no new themes emerged. Rendered themes of women with type 1 diabetes and health-care providers were compared by thorough discussion within the study team. Findings The recruitment started in April, 2015, and ended in June, 2016. 30 women with type 1 diabetes (mean age 26·9, SD 5·7 years) and 35 health-care providers (17 physicians and 18 nurses; 24 from general hospitals and 11 from community health facilities) were included in the study. Pregnant women and health-care providers agreed that pregnancy-related health-care resources were scarce and knowledge of pregnancy-related health care needs of both patients and health-care providers was limited. Both groups agreed that pregnancy-related health care in various forms should be started at the age of maturity (18 years old) and done by well-trained multidisciplinary health-care providers. Both groups acknowledged the importance of peer support in pregnancy-related health care. And both groups agreed on the need for guidelines for planned pregnancy and management of blood glucose and diabetic complications during pregnancy. However, health-care providers reported that bodyweight management, fetal development monitoring, type 1 diabetes-specific screening tests, and postnatal lifestyle should also be emphasised. Health-care providers had a generally positive attitude to outcomes of pregnancy if glycaemic control was satisfactory, whereas patients tended to have a pessimistic perspective. Finally, women with type 1 diabetes expressed great unmet needs: thorough and timely communication with health-care providers, psychological consultation, and type 1 diabetes knowledge in non-diabetician health-care providers. Most health-care providers did not show awareness of these needs, although they were aware of insufficient pregnancy-related knowledge and expressed their intent for further training. Interpretation Women with type 1 diabetes had various unmet needs for pregnancy-related health care, but the health-care resources were scarce in Guangdong. Both patients and health-care providers had gaps in knowledge of the need for pregnancy-related health care, indicating that further education should be given to patients, and the role of professional and psychosocial support should be enhanced. These findings identify gaps between the needs of women with type 1 diabetes and current health care provision, and would be helpful to guide the establishment of a patient-centered pregnancy-related health care system in Guangdong. Funding National Health and Family Planning Commission Foundation for public welfare industry research project (201502011), World Diabetes Foundation (WDF14-921), and Sun Yat-Sen University clinical research 5010 program (2007030).

Liraglutide, sitagliptin and insulin glargine added to metformin: the effect on body weight and intrahepatic lipid in patients with type 2 diabetes mellitus and NAFLD

To investigate the effect of antidiabetic agents on nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM), 75 patients with T2DM and NAFLD under inadequate glycemic control by metformin were randomized (1:1:1) to receive add‐on liraglutide, sitagliptin, or insulin glargine in this 26‐week trial. The primary endpoint was the change in intrahepatic lipid (IHL) from baseline to week 26 as quantified by magnetic resonance imaging–estimated proton density fat fraction (MRI‐PDFF). Secondary endpoints included changes in abdominal adiposity (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT]), glycated hemoglobin, and body weight from baseline to week 26. We analysed data from intent‐to‐treat population. MRI‐PDFF, VAT, and weight decreased significantly with liraglutide (15.4% ± 5.6% to 12.5% ± 6.4%, P < 0.001; 171.4 ± 27.8 to 150.5 ± 30.8, P = 0.003; 86.6 ± 12.9 kg to 82.9 ± 11.1 kg, P = 0.005, respectively) and sitagliptin (15.5% ± 5.6% to 11.7% ± 5.0%, P = 0.001; 153.4 ± 31.5 to 139.8 ± 27.3, P = 0.027; 88.2 ± 13.6 kg to 86.5 ± 13.2 kg, P = 0.005, respectively). No significant change in MRI‐PDFF, VAT, or body weight was observed with insulin glargine. SAT decreased significantly in the liraglutide group (239.9 ± 69.0 to 211.3 ± 76.1; P = 0.020) but not in the sitagliptin and insulin glargine groups. Changes from baseline in MRI‐PDFF, VAT, and body weight were significantly greater with liraglutide than insulin glargine but did not differ significantly between liraglutide and sitagliptin. Conclusion: Combined with metformin, both liraglutide and sitagliptin, but not insulin glargine, reduced body weight, IHL, and VAT in addition to improving glycemic control in patients with T2DM and NAFLD.

A new model to estimate insulin resistance via clinical parameters in adults with type 1 diabetes

Insulin resistance (IR) is a risk factor to assess the development of micro‐ and macro‐vascular complications in type 1 diabetes (T1D). However, diabetes management in adults with T1D is limited by the difficulty of lacking simple and reliable methods to estimate insulin resistance. The aim of this study was to develop a new model to estimate IR via clinical parameters in adults with T1D.

Pregnancy outcomes in patients with type 1 diabetes in China: a retrospective study

Abstract Background Sparse data on pregnancy outcomes for women with type 1 diabetes exist in Chinese women. We aimed to investigate maternal, perinatal, and fetal and neonatal outcomes in women with type 1 diabetes in China. Method We did a retrospective study in 11 hospitals in Beijing, Jinan, Nanjing, Shanghai, Chengdu, Changsha, Guangzhou. We compiled data on pregnancy outcomes of women with type 1 diabetes from anonymised medical records of maternal and infant birth between Jan 1, 2004, to Dec 31, 2014. We analysed perinatal maternal mortality, perinatal neonatal mortality, and perinatal birth defect rate. These outcomes in the general population were estimated from the annual report of national health statistic and the report of birth defects in China. We used χ 2 or Fishers exact test for statistical analyses of categorical data. Ethics approval was granted by all the participating hospitals. Findings We included 289 women with type 1 diabetes with a singleton pregnancy, of whom 26 (9%) had a history of adverse pregnancy outcomes at the start of the study period. At start of pregnancy, mean age was 27·6 years (SD 4·2) and mean diabetes duration was 5·26 years (SD 5·49). Nine women were excluded because of elective terminations and 15 were excluded because no data on pregnancy outcomes were available; thus, 265 women were included in the analysis. In patients with HbA 1c records available, 41 (57%) of 72 achieved the preconception HbA 1c target (≤7·0%; ie, 53·00 mmol/mol), and 49 (38%) of 130 achieved the third trimester HbA 1c target (≤6·0 %; ie, 42 mmol/mol). Nine (3%) pregnancy losses were recorded in the first trimester, 20 (8%, including ten stillbirths) in the second trimester, and six (2%) in the third trimester. Main adverse maternal outcomes were procession of diabetic complications (30 [11%] women), pre-eclampsia or eclampsia (47 [18%]), and total pregnancy losses (35 [13%]). Of 230 livebirths, 44 (19%) preterm births, 12 (5%) cardiac congenital malformations, and 18 (8%) early neonatal deaths were recorded. Of 236 infants (230 livebirths and 6 stillbirths in the third trimester), main adverse neonatal outcomes were large for gestational age (68 [29%]) and small for gestational age (12 [5%]); 96 (41%) had to admitted to the neonatal department. Overall, perinatal maternal mortality was 423·73 (95% CI 397·18–451·12) per 100 000 person-years, perinatal neonatal mortality was 55·08% (54·14–56·04), and the incidence of birth defects was 847·45 (835·92–859·05) per 100 000 person-years. Birth defects were the leading cause of neonatal perinatal deaths (10 [29%] of 34). Compared with the general population in China, women with type 1 diabetes did not have increased perinatal maternal mortality (risk ratio 11·76, 95% CI 1·65–83·78; p=0·082), but their infants had significantly higher risks of perinatal mortality (risk ratio 7·58, 95% CI 4·33–13·26; p Interpretation Adverse pregnancy outcomes are more frequent in women with type 1 diabetes than in the general population. Management of type 1 diabetes in pregnant women needs to be improved. Funding Chinese National Health and Family Planning Commission Foundation for Public Welfare Industry Research Project (201502011), Sun Yat-Sen University Clinical Research 5010 Program (2007030), and World Diabetes Foundation (WDF14-921).

Status of basal‐supported oral therapy in Chinese type 2 diabetic patients with inadequate glycemic control on oral anti‐diabetic drugs

Timely initiation and titration of basal insulin added on to oral anti‐diabetic drugs contribute to better glycemic control. However, implementation of basal‐supported oral therapy in China is not yet clear. This nationwide, prospective, 12‐week observational study was designed to explore the current status of basal‐supported oral therapy in patients with type 2 diabetes in China.