Pre-conception diabetes care in insulin-dependent diabetes mellitus.

Prospective studies of pre-conception diabetes care have confirmed its positive impact on the incidence of malformations by improving glycaemic control. Less information is available on the impact of pre-conception care on maternal and neonatal morbidity. This audit addresses its impact on timing and mode of delivery, incidence of macrosomia and rate of admission to neonatal unit care in addition to sociodemographic factors which may influence attendance at such a service. Attenders were more likely to be in a stable relationship and be non-smokers. They were more likely to book for antenatal care earlier and with a lower glycated haemoglobin. There were no early deliveries (i.e. < 30 weeks) or small for gestational age (SGA) babies in those who attended for pre-conception care and no neonatal deaths. Admission to NNU care was reduced by 50% in those who attended for pre-conception care. Although the rate of macrosomia was reduced, there was no impact on the Caesarian section rate. A pre-conception diabetes clinic may have a positive impact on neonatal morbidity.     

Olympic diabetes

Winning an Olympic gold medal represents the pinnacle of achievement in any sporting event, to do so with diabetes is almost miraculous. This report outlines the history and management of Steven Redgrave's diabetes, and describes the physiology associated with the extremes of human endurance and the difficulties that this presents.     

Childhood diabetes

The child with diabetes mellitus has special problems that require skilled attention best achieved by a team of professionals. The goals of managing a child with diabetes are summarized in Table 7. The features that distinguish the child from an adult with diabetes are inability to communicate or verbalize symptoms, unpredictable eating and exercise patterns, special nutritional requirements of growth, and the emotional and psychological upheavals experienced during adolescence.     

Gestational diabetes

The perinatal morbidity and mortality associated with gestational diabetes can be significantly reduced when cases are recognized and closely monitored. There is much controversy about the diagnosis of gestational diabetes and the practicality of universal screening.     

Secondary diabetes

Secondary diabetes can be defined as a diabetic condition that develops after the destruction of the beta-cells in the pancreatic islets and/or the induction of insulin resistance by an acquired disease (e.g. endocrinopathies) or others. Recently, diabetes mellitus has divided into four distinct types (type 1 diabetes, type 2 diabetes, other specific types of diabetes and gestational diabetes) in the Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus in USA. The categories between secondary diabetes and the other specific types of diabetes might be different a little, some of the latter being described here. The details of the genetic defects in insulin action has been presented elsewhere (see Chapter V-3).