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What Is A Class B Diabetic?

Assessing White’s Classification Of Pregestational Diabetes In A Contemporary Diabetic Population

Assessing White’s Classification Of Pregestational Diabetes In A Contemporary Diabetic Population

Go to: Abstract To assess the validity of White’s classification, including the role of chronic hypertension, in a contemporary diabetic population. We performed a retrospective cohort study of all singleton pregnancies with preexisting diabetes mellitus from 2008 to 2013. Adverse outcomes were compared across classes B, C, D and vascular disease (R, F, H) and further stratified by the presence or absence of chronic hypertension. Outcomes examined were a composite perinatal outcome (stillbirth, neonatal death, shoulder dystocia, birth injury, seizures, requiring chest compressions or intubation at delivery, blood pressure support), small for gestational age (SGA), large for gestational age (LGA), macrosomia, shoulder dystocia, preterm delivery <37 weeks, preeclampsia, and cesarean delivery. Results Of the 475 patients, the 1980 White’s classification was significantly associated with SGA, LGA, macrosomia, preterm delivery, preeclampsia, and cesarean (p ≤ 0.01). Within each White’s class based on age or time since diagnosis alone, hypertension was significantly associated with a higher incidence of preeclampsia in class B (16% without hypertension versus 32% with hypertension, p < 0.01) and C (22% vs. 40%, p = 0.04), SGA in C (4.7% vs. 21%, p < 0.01), preterm delivery in B (25% vs. 46%, p < 0.01) and C (35% vs. 58%, p = 0.01), and the composite neonatal outcome in B (7.9% vs. 17%, p = 0.03). The incidence of adverse outcomes in classes B and C with hypertension resembles the incidence of adverse outcomes in those with diabetes one class higher. The 1980 White’s classification system, taking into consideration the presence of chronic hypertension, remains a useful system for counseling pregestational diabetic women regarding adverse pregnancy outcomes. Go to: IN Continue reading >>

White’s Classification And Pregnancy Outcome In Women With Type 1 Diabetes: A Population-based Cohort Study

White’s Classification And Pregnancy Outcome In Women With Type 1 Diabetes: A Population-based Cohort Study

Abstract Our aim was to examine the association of White’s classification with obstetric and perinatal risk factors and outcomes in type 1 diabetic patients. Obstetric records of a population-based cohort of 1,094 consecutive type 1 diabetic patients with a singleton childbirth during 1988–2011 were studied. The most recent childbirth of each woman was included. The prepregnancy and the first trimester HbA1c increased from White’s class B to F (p for trend <0.001). Systolic and diastolic blood pressure and pre-eclampsia frequencies increased stepwise from class B to F (p for trends <0.001). Vaginal deliveries decreased and Caesarean sections and deliveries before 37 weeks increased from class B to F (p for trends <0.001). Fetal macrosomia (p for trend = 0.003) decreased and small-for-gestational age infants (p for trend = 0.002) and neonatal intensive care unit admissions (p for trend = 0.001) increased from class B to F. In logistic regression analysis, White’s classes were associated with pre-eclampsia but, with the exception of class R (proliferative retinopathy) and F (nephropathy), not with other adverse outcomes when adjusted for first trimester HbA1c ≥7% (≥53 mmol/mol) and blood pressure ≥140/90 mmHg. First trimester HbA1c ≥7% was associated with pre-eclampsia, preterm delivery, fetal macrosomia and neonatal intensive care unit admission. White’s classification is useful in estimating the risk of pre-eclampsia in early pregnancy independently of suboptimal glycaemic control and hypertension. However, its utility in predicting adverse perinatal outcomes seems limited when information on first trimester HbA1c, blood pressure and diabetic microvascular complications is available. White B White C White D White R White F p for trend n (%) 208 (19) 28 Continue reading >>

Pregestational Diabetes Mellitus: Obstetrical Issues And Management

Pregestational Diabetes Mellitus: Obstetrical Issues And Management

INTRODUCTION The key elements in management of pregnancies complicated by diabetes are: Achieving and maintaining excellent glycemic control Screening, monitoring, and intervention for maternal medical complications (eg, retinopathy, nephropathy, hypertension, cardiovascular disease, ketoacidosis, thyroid disease) Monitoring of, and intervention for, fetal and obstetrical complications (eg, congenital anomalies, preeclampsia, macrosomia) Most issues related to the obstetrical management of a pregnant diabetic woman (type 1 or type 2) will be reviewed here. The obstetrical management of these pregnancies is largely based upon clinical experience, data from observational studies, and expert opinion [1,2]. There is virtually no evidence from randomized trials. Continue reading >>

Articles Ontype 2 Diabetes

Articles Ontype 2 Diabetes

Diabetes is a life-long disease that affects the way your body handles glucose, a kind of sugar, in your blood. Most people with the condition have type 2. There are about 27 million people in the U.S. with it. Another 86 million have prediabetes: Their blood glucose is not normal, but not high enough to be diabetes yet. Your pancreas makes a hormone called insulin. It's what lets your cells turn glucose from the food you eat into energy. People with type 2 diabetes make insulin, but their cells don't use it as well as they should. Doctors call this insulin resistance. At first, the pancreas makes more insulin to try to get glucose into the cells. But eventually it can't keep up, and the sugar builds up in your blood instead. Usually a combination of things cause type 2 diabetes, including: Genes. Scientists have found different bits of DNA that affect how your body makes insulin. Extra weight. Being overweight or obese can cause insulin resistance, especially if you carry your extra pounds around the middle. Now type 2 diabetes affects kids and teens as well as adults, mainly because of childhood obesity. Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides. Too much glucose from your liver. When your blood sugar is low, your liver makes and sends out glucose. After you eat, your blood sugar goes up, and usually the liver will slow down and store its glucose for later. But some people's livers don't. They keep cranking out sugar. Bad communication between cells. Sometimes cells send the wrong signals or don't pick up messages correctly. When these problems affect how your cells make and use insulin or glucose, a chain reac Continue reading >>

Driving & Your Rights

Driving & Your Rights

What is Diabetes Canada’s position on driving? People with diabetes have the right to be assessed for a license to drive a motor vehicle on an individual basis in accordance with Diabetes Canada guidelines for private and commercial driving. Read the Diabetes Canada's full position statement on driving and licensing, including background and rationale. What are Diabetes Canada's recommendations for private or commercial drivers? In October 2015, the Clinical and Scientific Section of the Diabetes Canada published Diabetes and Driving: 2015 Canadian Diabetes Association Updated Recommendations for Private and Commercial Drivers. I have been diagnosed with diabetes. Can I keep driving? Most likely. In consultation with your doctor, a decision will be made as to whether you are medically fit to drive. In assessing the suitability of people with diabetes to drive, medical evaluations document any complications and assess blood glucose (BG) control, including the frequency and severity of any hypoglycemic incidents. Diabetes and its complications can affect driving performance due to: Impaired sensory or motor function Diabetic eye disease (retinopathy) Nerve damage (neuropathy) Kidney disease (nephropathy) Cardiovascular disease (CVD) Peripheral vascular disease and stroke Incidents of hypoglycemia Motor vehicle licensing authorities can require licensed drivers to be examined for their medical fitness to drive. You should not have difficulty obtaining and maintaining an operator’s license if you: Properly manage your diabetes; Are able to recognize and treat the early symptoms of hypoglycemia; and Do not have complications that may interfere with your ability to drive. Do I have to report diabetes to the motor vehicle licensing authority? Yes. As a rule, anyone applyin Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Practice Essentials Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. [1] Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. Screening for diabetes mellitus during pregnancy Gestational diabetes The following 2-step screening system for gestational diabetes is currently recommended in the United States: Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [2, 3] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood or adolescence; the disease is rarely diagnosed during pregnancy Patients diagnosed during pregnancy most often present with unexpected Continue reading >>

Diabetic Mother, Infant Of

Diabetic Mother, Infant Of

What are the classifications of maternal diabetes? Why are the classifications important? What are the risks to the infant? What can be done to decrease the risk of complications to the infant? What special tests may be required for a diabetic mother during pregnancy? What special tests may be required for the infant after birth? What special treatments may be required for the infant after birth? What is the risk of the infant developing insulin-dependant diabetes? Jan E. Paisley, M.D. Fellow in Neonatal-Perinatal Medicine William W. Hay, Jr., M.D. Professor of Pediatrics, Director of the Training Program in Neonatal-Perinatal Medicine Director of the Neonatal Clinical Research Center Section of Neonatology, Department of Pediatrics University of Colorado School of Medicine Denver, Colorado What are the classifications of maternal diabetes? The classifications of maternal diabetes are outlined in Table 1. Table 1. Whites classification of maternal diabetes. Gestational diabetes (GD): Diabetes not known to be present before pregnancy GD diet Normal glucoses maintained by diet alone GD insulin Insulin required Class A: Glucose intolerence prior to pregnancy not requiring insulin Class B: Insulin-dependent; onset after 20 years of age Class C: C1: Onset at 10 to 19 years of age C2: Duration 10 to 19 years Class D: D1: Onset before 10 years of age D2: Duration 20 years D3: Calcification of vessels of the leg (macrovascular disease) D4: Benign retinopathy (microvascular disease) D5: Hypertension (not preeclampsia) Class F: Nephropathy (kidney abnormality) with >500 mg of protein per day in urine Class R: Proliferative retinopathy of the eye or vitreous hemorrhage (bleeding within the eye) Class RF: Criteria for both classes R and F coexist Class G: Many reproductive failures Continue reading >>

Commercial Truck Driving And Diabetes: Can You Become Truck Driver With Diabetes

Commercial Truck Driving And Diabetes: Can You Become Truck Driver With Diabetes

In this article we will explore what it takes to get a commercial driver’s license with diabetes, and how to get an insulin waiver for Type 1 and Type 2 persons who use insulin. We will look at requirements for Type 1 vs. Type 2 diabetes. We will look at insulin vs. non-insulin users. We will look at state vs. interstate CDL requirements. We will also look at the Federal Motor Carrier Safety Administration (FMCSA) diabetes waiver program, and how you can be evaluated to drive a commercial vehicle across state lines when you have diabetes and use insulin. Intrastate guidelines for CDL with diabetes If you want to work in the trucking industry only within your state, and you do not plan to cross any state lines, you can get approved to drive a commercial vehicle in your state. For drivers driving within state lines, you do not need to apply for the Federal Diabetes Exemption. Likewise, you would not need to apply for the Federal Diabetes Exemption if you do not use insulin. Whatever rules and regulations your state has for holding a CDL with diabetes is what you have to follow for intrastate or interstate trucking. It is important to know that most commercial driving will be considered interstate, not intrastate driving, even if you do not cross state lines. If you are carrying cargo or passengers to or from another state, this is also considered as interstate commercial driving. For information on intrastate commercial driving, check with your home state for CDL requirements and see if they are applicable to you. They vary from state to state, with each state having its own regulations. You can look up the laws governing your state by visiting this page at the American Diabetes Association website, You can type your home state in the search for laws and requirements fo Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

This article is about the effects of pre-existing diabetes upon pregnancy. For temporary diabetic symptoms as a complication of pregnancy, see Gestational diabetes. For pregnant women with diabetes mellitus some particular challenges for both mother and child. If the woman has diabetes as an intercurrent disease in pregnancy, it can cause early labor, birth defects, and very large babies. Planning in advance is emphasized if one wants to have a baby and has type 1 diabetes mellitus or type 2 diabetes mellitus. Pregnancy management for diabetics needs stringent blood glucose control even in advance of having pregnancy. Physiology[edit] During a normal pregnancy, many physiological changes occur such as increased hormonal secretions that regulate blood glucose levels, such as a glucose-'drain' to the fetus, slowed emptying of the stomach, increased excretion of glucose by the kidneys and resistance of cells to insulin. Risks for the child[edit] The risks of maternal diabetes to the developing fetus include miscarriage, growth restriction, growth acceleration, fetal obesity (macrosomia), mild neurological deficits,[1] polyhydramnios and birth defects.[citation needed] A hyperglycemic maternal environment has also been associated with neonates that are at greater risk for development of negative health outcomes such as future obesity, insulin resistance, type 2 diabetes mellitus, and metabolic syndrome.[2] Mild neurological and cognitive deficits in offspring — including increased symptoms of ADHD, impaired fine and gross motor skills, and impaired explicit memory performance — have been linked to pregestational type 1 diabetes and gestational diabetes.[3][4][5] Prenatal iron deficiency has been suggested as a possible mechanism for these problems.[6] Birth defects are Continue reading >>

Free Six-week Diabetes Self-management Class

Free Six-week Diabetes Self-management Class

The University of Tennessee Medical Center is offering Take Charge of Your Diabetes, a free six-week diabetes self-management program that will teach participants every day skills in managing diabetes. These skills include coping mechanisms to help deal with fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear and frustration; exercise for maintaining and improving strength and endurance; healthy eating; appropriate use of medication; and partnering effectively with health care providers. Classes will be held on Tuesdays, beginning September 12 through October 17 from 5:30 -7:30 p.m. at: UT Medical Center 1928 Alcoa Hwy Medical Building B, Suite #320 Knoxville, 37920 The classes are free but registration is required by calling 865-305-6970. Space is limited. Continue reading >>

Qualification Of Drivers; Exemption Applications; Diabetes Mellitus

Qualification Of Drivers; Exemption Applications; Diabetes Mellitus

Federal Motor Carrier Safety Administration (FMCSA). Notice of applications for exemptions request for comments. FMCSA announces receipt of applications from 29 individuals for exemptions from the prohibition against persons with insulin-treated diabetes mellitus (ITDM) operating commercial motor vehicles (CMVs) in interstate commerce. If granted, the exemptions would enable these individuals with ITDM to operate CMVs in interstate commerce. Comments must be received on or before November 22, 2013. You may submit comments bearing the Federal Docket Management System (FDMS) Docket No. FMCSA-2013-0188 using any of the following methods: Mail: Docket Management Facility; U.S. Department of Transportation, 1200 New Jersey Avenue SE., West Building Ground Floor, Room W12-140, Washington, DC 20590-0001. Hand Delivery: West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue SE., Washington, DC, between 9 a.m. and 5 p.m., Monday through Friday, except Federal Holidays. Instructions: Each submission must include the Agency name and the docket numbers for this notice. Note that all comments received will be posted without change to including any personal information provided. Please see the Privacy Act heading below for further information. Docket: For access to the docket to read background documents or comments, go to at any time or Room W12-140 on the ground level of the West Building, 1200 New Jersey Avenue SE., Washington, DC, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. The Federal Docket Management System (FDMS) is available 24 hours each day, 365 days each year. If you want acknowledgment that we received your comments, please include a self-addressed, stamped envelope or postcard or print the acknowledgement page that appears after Continue reading >>

Diabetes: The Differences Between Types 1 And 2

Diabetes: The Differences Between Types 1 And 2

Diabetes, or diabetes mellitus (DM), is a metabolic disorder in which the body cannot properly store and use sugar. It affects the body's ability to use glucose, a type of sugar found in the blood, as fuel. This happens because the body does not produce enough insulin, or the cells do not correctly respond to insulin to use glucose as energy. Insulin is a type of hormone produced by the pancreas to regulate how blood sugar becomes energy. An imbalance of insulin or resistance to insulin causes diabetes. Diabetes is linked to a higher risk of cardiovascular disease, kidney disease, vision loss, neurological conditions, and damage to blood vessels and organs. There is type 1, type 2, and gestational diabetes. They have different causes and risk factors, and different lines of treatment. This article will compare the similarities and differences of types 1 and 2 diabetes. Gestational diabetes occurs in pregnancy and typically resolves after childbirth. However, having gestational diabetes also increases the risk of developing type 2 diabetes after pregnancy, so patients are often screened for type 2 diabetes at a later date. According to the Centers for Disease Control and Prevention (CDC), 29.1 million people in the United States (U.S.) have diabetes. Type 2 diabetes is much more common than type 1. For every person with type 1 diabetes, 20 will have type 2. Type 2 can be hereditary, but excess weight, a lack of exercise and an unhealthy diet increase At least a third of people in the U.S. will develop type 2 diabetes in their lifetime. Both types can lead to heart attack, stroke, nerve damage, kidney damage, and possible amputation of limbs. Causes In type 1 diabetes, the immune system mistakenly attacks the insulin-producing pancreatic beta cells. These cells are destro Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Diabetes mellitus is the most common medical complication of pregnancy, affecting 2-3% of pregnancies. Ninety percent of cases represent gestational diabetes mellitus (GDM). GDM is carbohydrate intolerance with onset during the present pregnancy. Fifty percent of women who develop GDM will develop overt DM within 20 years. Women with overt DM who conceive have a 10-fold increase in the maternal mortality and a perinatal mortality rate of 4%. Most maternal deaths are caused by diabetic ketoacidosis (DKA), and most perinatal deaths are related to prematurity. Text continued below The Priscilla White classification system is based on age at onset and duration of DM as well as vascular complications. Class Characteristics Class A1 Diet-controlled GDM Class A2 GDM complicated by insulin use, hypertension, polyhydramnios, macrosomia, or a prior stillbirth Class B Overt diabetes, with an onset after age 20 and a duration of less than 10 years Class C Overt DM, with an onset at 10 to 19 years of age or a duration of 10 to 19 years Class D Juvenile onset or a duration of 20 years or more Class F Diabetes associated with nephropathy Class R Diabetes associated with retinopathy Class M Diabetes associated with cardiomyopathy Class T Diabetes in renal transplant patients Diabetes and pregnancy The incidence of major malformations is increased by fourfold in the offspring of women with overt diabetes. A major malformation may occur in 30%, and spontaneous abortions may occur in 35%. Common fetal malformations include central nervous system, cardiac, renal, and retinal anomalies. With excellent glycemic control before conception, rates of fetal malformation and spontaneous abortion are equal to those in the general population. Maternal hyperglycemia causes fetal hyperglycemia and fet Continue reading >>

Utmb Neonatology Manual

Utmb Neonatology Manual

The Infant of the Diabetic Mother However, the infant of the diabetic mother (IDM) is likely to manifest a variety of problems, all of which require anticipation, recognition, and appropriate therapy. Classification of Maternal Diabetes Knowledge of the mother's diabetes, prior medical and pregnancy history, and complications during this pregnancy permits anticipation of many of the problems likely to be present in the postnatal period. White's Classificaton permits assessment of severity of maternal diabetes. Classes B-H require medication. Class A: Chemical diabetes: positive glucose tolerance tests prior to or during pregnancy. Prediabetes: history of large babies more than 4 kg or unexplained stillbirths after 28 weeks. Any age of onset or duration. Class B: Onset after 20 years of age; duration less than 10 yrs. Class C: C1: Onset at 10-19 years of age. C2: Duration 10-19 years. Class D: D1: Onset before 10 years of age. D2: Duration 10 years. D3: Calcification of vessels of the leg (macrovascular disease). D4: Benign retinopathy (microvascular disease). D5: Hypertension Class E: Same as D, but with calcification of pelvic vessels. Class F: Nephropathy Class G: Many reproductive failures. Class H: Diabetic cardiomyopathy Class R: Malignant retinopathy Class RF: Both nephropathy and retinopathy Pedersen's prognostic signs of pregnancy permit more accurate predictions of poor outcome. These are: clinical pyelonephritis, precoma or severe acidosis, toxemia and neglectors (women who are uncooperative with the treatment plan.) Maternal-Fetal Problems Fertility Diabetic women have normal fertility. In the first trimester there is an increased rate of spontaneous abortions. The incidence of these early losses varies with the diabetic classification: Class A, 5-10% (not si Continue reading >>

Localization Of Type 1 Diabetes Susceptibility To The Mhc Class I Genes Hla-b And Hla-a

Localization Of Type 1 Diabetes Susceptibility To The Mhc Class I Genes Hla-b And Hla-a

The major histocompatibility complex (MHC) on chromosome 6 is associated with susceptibility to more common diseases than any other region of the human genome, including almost all disorders classified as autoimmune. In type 1 diabetes the major genetic susceptibility determinants have been mapped to the MHC class II genes HLA-DQB1 and HLA-DRB1 (refs 1–3), but these genes cannot completely explain the association between type 1 diabetes and the MHC region4,5,6,7,8,9,10,11. Owing to the region’s extreme gene density, the multiplicity of disease-associated alleles, strong associations between alleles, limited genotyping capability, and inadequate statistical approaches and sample sizes, which, and how many, loci within the MHC determine susceptibility remains unclear. Here, in several large type 1 diabetes data sets, we analyse a combined total of 1,729 polymorphisms, and apply statistical methods—recursive partitioning and regression—to pinpoint disease susceptibility to the MHC class I genes HLA-B and HLA-A (risk ratios >1.5; Pcombined = 2.01 × 10-19 and 2.35 × 10-13, respectively) in addition to the established associations of the MHC class II genes. Other loci with smaller and/or rarer effects might also be involved, but to find these, future searches must take into account both the HLA class II and class I genes and use even larger samples. Taken together with previous studies4,5,6,7,8,10,11,12,13,14,15,16, we conclude that MHC-class-I-mediated events, principally involving HLA-B*39, contribute to the aetiology of type 1 diabetes. Marron, M. P., Graser, R. T., Chapman, H. D. & Serreze, D. V. Functional evidence for the mediation of diabetogenic T cell responses by HLA-A2.1 MHC class I molecules through transgenic expression in NOD mice. Proc. Natl Acad. Sci Continue reading >>

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