By Robert Preidt

HealthDay Reporter

THURSDAY, Feb. 16, 2017 (HealthDay News) -- Diabetes that develops during pregnancy -- known as gestational diabetes -- carries health risks for both the mom-to-be and her baby, new research confirms.

A team of French researchers analyzed data from more than 700,000 births in France occurring after 28 weeks of pregnancy in 2012.

Compared to other pregnant women, those with gestational diabetes were 30 percent more likely to experience preterm birth, 40 percent more likely to require a C-section, and 70 percent more likely to have preeclampsia/eclampsia, a dangerous spike in blood pressure.

Risks weren't confined to the mother, however. Babies born to women with gestational diabetes were 80 percent more likely to be of significantly larger-than-average size at birth; 10 percent more likely to suffer respiratory issues; 30 percent more likely to experience a traumatic birth, and 30 percent more likely to have heart defects, the study found.

Babies born after 37 weeks to women with gestational diabetes also had an increased risk of death, compared to babies born to women without the condition, the study authors said.

The study clearly shows that gestational diabetes "is a disease related to adverse pregnancy outcomes," concluded a team led by Dr. Sophie Jacqueminet, of the Pitie-Salpetriere Hospital in Paris.

Two experts in diabetes care weren't surprised by the findings, and they noted that while a woman's weight isn't always a factor, the odds for gestational diabetes go up in the obese.

"Gestational diabetes is a dangerous entity, and the child is at risk," said Dr. Robert Courgi, an endocrinologist at Northwell Health's Southside Hospital, in Bay Shore, N.Y.

"As obesity increases, so does [the risk of] diabetes," he added. "We need to do a better job at diagnosing and treating gestational diabetes."

The study also found that the risk of death was 30 percent higher among babies born to women whose gestational diabetes was treated with a special diet. There was no increased risk of death among babies born to women whose gestational diabetes was treated with insulin, however.

This difference in death risk could be because women with diet-treated gestational diabetes tend to give birth later than those who are insulin-treated, the research team said.

Outcomes were worse for mothers with gestational diabetes "who gave birth later because the baby was exposed to higher blood sugar levels for a longer period of time," Courgi explained.

Dr. Gerald Bernstein coordinates the diabetes program at Lenox Hill Hospital in New York City. He stressed that gestational diabetes requires prompt and proper treatment.

"Once diagnosed, treatment is geared to maintain normal blood sugar but without the risk of hypoglycemia [low blood sugar]," Bernstein explained. "This may range from nutritional and other lifestyle changes to the addition of insulin. The goal is to give the baby a maximum opportunity for growth and development without an unusual early delivery, so that key organs are as mature as possible.

"Most patients are followed by an endocrinologist, a high-risk ob-gyn and diabetes educators in various disciplines," Bernstein added. "To reduce birth complications, early diagnosis along with aggressive therapy with a full health care team is essential."

The study was published Feb. 15 in the journal Diabetologia.

WebMD News from HealthDay

SOURCES: Robert Courgi, M.D., endocrinologist, Northwell Health's Southside Hospital, Bay Shore, N.Y.; Gerald Bernstein, M.D., endocrinologist and coordinator, Friedman Diabetes Program, Lenox Hill Hospital, New York City; Dibatetologia, news release, Feb. 15, 2017

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Gestational Diabetes Poses Risks for Mom, Baby - WebMD

Fat cells can regulate genes in distant organs like the liver by sending out molecular messengers.

Steve Gschmeissner/Science Source

By Emma HiolskiFeb. 16, 2017 , 6:00 PM

Theres more to those love handles than meets the eye. Fat tissue can communicate with other organs from afar, sending out tiny molecules that control gene activity in other parts of the body, according to a new study. This novel route of cell-to-cell communication could indicate fat plays a much bigger role in regulating metabolism than previously thought. It could also mean new treatment options for diseases such as obesity and diabetes.

I found this very interesting and, frankly, very exciting, says Robert Freishtat of Childrens National Health System in Washington, D.C., a pediatrician and researcher who has worked with metabolic conditions like obesity and diabetes. Scientists have long known that fat is associated with all sorts of disease processes, he says, but they dont fully understand how the much-reviled tissue affects distant organs and their functions. Scientists have identified hormones made by fat that signal the brain to regulate eating, but this new studyin which Freishtat was not involvedtakes a fresh look at another possible messenger: small snippets of genetic material called microRNAs, or miRNAs.

MiRNAs, tiny pieces of RNA made inside cells, help control the expression of genes and, consequently, protein production throughout the body. But some tumble freely through the bloodstream, bundled into tiny packets called exomes. There, high levels of some miRNAs have been associated with obesity, diabetes, cancer, and cardiovascular disease.

To understand how miRNAs function in fat, a team of researchers led by Thomas Thomou, a diabetes researcher at Joslin Diabetes Center and Harvard Medical School in Boston, studied a genetically engineered strain of mice in which fat cells lacked a critical miRNA-processing enzyme. These rodents had less fat tissue, and they couldnt process glucose as effectively as nonengineered mice. They also had low circulating miRNA levels overall, suggesting that most of the miRNAs in exosomes come from fat tissue, the researchers reported this week in Nature.

By transplanting fat from normal mice, the researchers restored the previously low miRNA levels in the modified mice. Transplants of brown fatspecialized energy-burning fat that regulates temperaturehelped restore glucose processing in the genetically modified mice, whereas white fatenergy-storing fattransplants did not.

In a previous study with the mice whose fat had impaired miRNA production, the researchers also noticed that other organsincluding the heart and liverwere affected, even though the genetic modification didnt alter those tissues directly. So they decided to investigate whether fat uses miRNAs to communicate with other tissues, Thomou says. They developed a method to measure cross-talk using a human miRNA. In one group of mice, they engineered brown fat cells to produce the human miRNA and package it in exosomes; in another, they engineered liver cells to produce a fluorescent molecular target for the miRNA. Injecting exosomes from the first group of mice into mice from the second group caused a drastic drop in liver cell fluorescence, because the miRNA bound to the fluorescent target and suppressed its production. This confirmed that fat tissue, through exosomes, can communicate with the liver and regulate gene expression. Exosomal miRNAs from brown fat were also found to regulate expression of an important metabolism gene, Fgf21, in liver cells.

This finding will provide not only insights into new pathways of tissue communication, but also pathways that can be altered in disease states, says study co-author C. Ronald Kahn, a diabetes researcher and physician at Harvard University. If researchers can figure out how to engineer exomes to target specific cell types, adds Thomou, they might one day use the vesicles to deliver drugs and other therapies. But its far from clear, he notes, whether exomes target specific cell typesusing a kind of molecular ZIP code that could help them travel from point A to point B.

Thomou and his team plan to continue identifying specific miRNA signatures from different tissues to determine what other factors, besides miRNAs, are bundled into exosomes. For Freishtat, the new work offers an exciting way to begin filling a gap between mouse models and human patient studies. This is a big deal, he says. Were just beginning to scratch the surface of exosomes and how they regulate processes in the body.

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Fat tissue can 'talk' to other organs, paving way for possible treatments for diabetes, obesity - Science Magazine

THURSDAY, Feb. 16, 2017 (HealthDay News) -- People with diabetes have to think about their condition and make treatment decisions constantly -- and all that extra work and worry can lead to psychological distress at times.

"Diabetes distress" isn't the same as depression, however, diabetes experts note. It's a condition unique to the 24/7 demands that come with diabetes, particularly for people dependent on insulin.

"The day you develop diabetes, it's like the universe just handed you a new full-time job that you have to do in addition to whatever else you're doing. It's a special job that has a big impact on the rest of your life. There's no pay and no vacation," said William Polonsky, president of the Behavioral Diabetes Institute in San Diego.

Alicia McAuliffe-Fogarty, vice president of lifestyle management at the American Diabetes Association, put it this way: "Diabetes distress is the extra burden that people with diabetes have to carry. They have to do everything that other people do -- take care of work, family, finances -- and in addition they have to make sure to check their blood sugar, remember to take their medicine and/or adjust their insulin doses, count carbohydrates when they eat.

"It's a day-to-day and minute-to-minute burden. It's doing everything 'right' and still seeing your blood sugar levels go up," she added.

Diabetes distress is a range of different emotional responses that come with dealing with the burdens of caring for diabetes, Polonsky explained.

"It's being fed up and overwhelmed with the demands and concerns of diabetes. It's feeling powerless in the face of diabetes. It's knowing that despite your best actions, sometimes those [insulin] numbers go up and down and it seems beyond your ability to influence. And it can negatively influence one's quality of life," he added.

The phenomenon hasn't been well-studied -- Polonsky said he and his colleagues are in the middle of a study on diabetes distress that will hopefully answer some questions about the condition.

He said diabetes distress probably affects about 30 percent of people with diabetes at some point in their lives.

"It's not everybody, and it's not all the time, but it's pretty darn common, and a whole lot more common than depression" among those with diabetes, Polonsky added.

Diabetes distress and other psychological conditions are common enough that the American Diabetes Association added a section to its Standards of Medical Care in Diabetes - 2017 guidelines on screening and treating people with diabetes for distress, depression and other mental health concerns.

The new guidelines, published recently in the journal Diabetes Care, suggest that providers screen all of their diabetes patients with standardized tests for these conditions.

A demanding juggling job with no breaks

There are two main types of diabetes -- type 1 and type 2.

People with type 1 diabetes don't make enough insulin -- a hormone the body needs to use the carbohydrates in food for fuel. Because of this, people with type 1 rely on insulin injections or insulin delivered through a tiny catheter inserted under the skin and then attached to an insulin pump worn outside the body. People with type 1 diabetes using shots may need five or six insulin injections daily.

In people with type 2 diabetes, the body is no longer able to use insulin properly. Most (95 percent) of diabetes cases involve the type 2 form of the disease. Sometimes, people with type 2 diabetes also need to use insulin injections.

However, using insulin is a difficult balancing act -- too much or too little can cause problems, even life-threatening ones.

When blood sugar levels drop too low from too much insulin, people can become disoriented, and if levels drop even further, they may pass out. Blood sugar levels that are too high and left untreated over time can cause complications such as kidney troubles, eye problems and heart disease.

To keep track of blood sugar levels when using insulin, most people rely on glucose meters and a lancing device that pricks the finger to draw out a drop of blood. This may be done as few as 4 times a day, or as many as a dozen or more times daily, depending on how blood sugar levels are fluctuating.

And, many factors besides insulin can influence blood sugar levels. Food, alcohol, physical activity, emotions such as stress, and illness all can cause unpredictable changes in blood sugar levels.

It helps to find strength in numbers

Both Polonsky and McAuliffe-Fogarty said it's important to recognize and treat diabetes distress because it can have a negative impact on blood sugar management.

"In some studies, diabetes distress can impact diabetes care more than depression," McAuliffe-Fogarty said.

Antidepressants aren't likely to help someone with diabetes distress, according to Polonsky.

McAuliffe-Fogarty suggests checking in with your health care provider so you can go over your current diabetes management regimen. It's possible that changes in your management might help, she said.

Or, it might help to have a visit with a diabetes educator to go over some of the basics again, she recommended. Many people with type 1 diabetes are diagnosed as children, and as adults may not realize they're missing some of the basics of diabetes education.

"Maybe pick one or two things that would make the most impact on your management and focus on those one or two small things, and you'll likely achieve those goals. Then set one or two more goals and move along like that -- not everything needs to happen at once," McAuliffe-Fogarty said.

It's also important to look for "evidence-based hope," Polonsky said. Many studies have suggested that with consistent modern management of diabetes, many people can live well with the disease.

"Most people have heard the scary messages, but with good care, the odds are pretty good you can live a long and healthy life with diabetes," he noted.

Both experts agreed that support is an important component of treating diabetes distress. "You don't want to do diabetes alone. If you have someone who's rooting for you, that really helps," Polonsky said.

He said parents or spouses can give a person with diabetes a break by taking over the management of the disease for a little while. It gives them a "diabetes vacation."

For some, distress can get more serious. Depression isn't always easy to spot in someone with diabetes. And some of the physical signs of diabetes, such as low energy, could signal that someone's blood sugar is out of whack, Polonsky explained.

McAuliffe-Fogarty said about one in every four or five people with diabetes will experience depression at some point.

She said signs that suggest you need to speak with a mental health professional include: changes in appetite and sleep patterns, having no interest in activities you once enjoyed, social isolation, feeling persistently sad or hopeless, and having a down mood on more days than not.

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Dealing With Diabetes Distress - Helena Independent Record

Chronic disease management company Livongo is collaborating with Voluntis, the Paris, France-based company that develops companion apps for medical devices, to offer an integrated program, insulin delivery system and app for people with type 2 diabetes.

Members will have access to the Livongo for Diabetes Program with Voluntis Insulia, the diabetes management app that received both FDA approval and a CE Mark late last year. The app is designed for people treated with basal insulin and is classified as a prescription-only medical device.

The Livongo for Diabetes program consists of a cellular-enabled smart blood glucose meter, access to a certified diabetes educator and unlimited blood glucose strips. The cloud-based meter with connection to a virtual care team offers 24/7 coaching based on the users real-time blood sugar and data, and the device recently upgraded to include over-the-air update capabilities, just like a smartphone.

With the added connectivity to the Voluntis Insulia app, users will also receive automated basal insulin dose recommendations and educational messages from their coaches, who are also benefitting from a bump in patient data from the additional information collected by Insulia.

We know that the three pillars of diabetes management are nutrition, exercise and medication, Livongo Chief Medical Officer Dr. Jennifer Schneider said in a statement. But having the right information on how to manage is also critical. By integrating with Insulia, we can give members with type 2 diabetes additional insight and tips for medication optimization making managing diabetes easier.

While there are many connected blood glucose meters and diabetes management apps, those developed as prescription-only medication management aids are less common. Similar offerings in the space include the FDA-cleared wireless integration of Johnson and Johnson subsidiary LifeScans blood glucose monitoring system and BlueStar, WellDocs mobile diabetes management platform, and the all-inclusive, FDA and CE Mark-approved OneDrop monitoring system.

The Livongo for Diabetes program is available through many self-ensured employers, health plans and health systems throughout the United States, and Voluntis will launch Insulia throughout the country over the year. The French company is also working on a digital diabetes app called Diabeo, which is not yet cleared for use in the United States, and they have also developed companion apps for cancer treatments by Roche and AstraZeneca.

We are pleased to bring Insulia to Livongo members, Romain Marmot, Voluntiss chief operating officer, said in a statement. Livongos mission to empower patients through technology is in perfect accord with our own. We hope that by combining Insulia companion software with Livongos diabetes program we can further empower people living with type 2 diabetes.

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Livongo, Voluntis team up to offer integrated app for diabetes management program - MobiHealthNews

Recently, dietary guidelines for the general population have shifted towards a plant-based diet (rich in legumes, whole-grain cereals, fruits, vegetables and nuts) and low in animal-based foods (like red meat and pastries). Increasing evidence is suggesting that plant-based diets are beneficial for health and they also have less impact on the environment.

Researchers at the Unit of Human Nutrition of the Universitat Rovira i Virgili (Tarragona-Spain), in collaboration with other centers from the PREDIMED Study and Harvard University, have evaluated the associations between total and subtypes of fat intake and the risk of type 2 diabetes. In addition, they have evaluated the relationship between food sources rich in saturated fatty acids and the incidence of type 2 diabetes.

The researchs main findings showed that those participants who consumed higher amounts of saturated fatty acids and animal fat had a twofold higher risk of developing type 2 diabetes than those participants with a lower intake of saturated and animal fat. The consumption of 12 grams per day of butter was associated with a twofold higher risk of diabetes after 4.5 years of follow-up, whereas the intake of whole-fat yogurt was associated with a lower risk. The present study analyzed data from 3,349 participants in the PREDIMED Study who were free of diabetes at baseline but at high cardiovascular risk. After 4.5 years of follow-up, 266 participants developed diabetes.

This study will be published in the scientific journal The American Journal of Clinical Nutrition in February 2017 and was led by doctors Marta Guasch-Ferr;, researcher at Harvard T.H. Chan School of Public Health, Nerea Becerra-Toms, researcher at the URVs Unit of Human Nutrition, and Jordi Salas-Salvad;, who is head of the URVs Unit of Human Nutrition, Clinical Director of Nutrition at the Internal Medicine Service of the Sant Joan University Hospital in Reus, principal investigator at the CIBERObn, and member of the Pere Virgili Health Research Institute (IISPV).

According to the researchers, these findings emphasize the healthy benefits of a Mediterranean diet for preventing chronic diseases, particularly type 2 diabetes, and the importance of substituting saturated and animal fats (especially red and processed meat) for those found in vegetable sources such as olive oil and nuts.

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Consuming saturated animal fats increases the risk of type 2 ... - ScienceBlog.com (blog)

Endocrinology Advisor

Should Blood Pressure Goals Differ in Patients With and Without Diabetes? Endocrinology Advisor Results of a meta-analysis have found that lowering blood pressure (BP) significantly reduces cardiovascular (CV) risk in patients with and without diabetes; however, only patients with diabetes had a reduced incidence of end-stage renal disease (ESRD).

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Should Blood Pressure Goals Differ in Patients With and Without Diabetes? - Endocrinology Advisor