Women who experience hypertensive pregnancy disorders have significantly increased risk for future hypertension and Type 2 diabetes, report researchers.

Hypertensive pregnancy disorders occur in 5??”7% of all pregnancies, with a higher incidence in women with no previous children, explain Jacob Lykke (Yale University School of Medicine, Connecticut, USA) and colleagues.

As data on the relationship between these disorders and subsequent cardiovascular events is minimal, Lykke and team investigated associations of gestational hypertension and pre-eclampsia with subsequent cardiometabolic complications using data from 782,287 Danish women who gave birth to their first baby (singleton) between 1978 to 2007. A second cohort of 536,419 women who gave birth to two consecutive babies (singletons) in the same time period was also included.

The two cohorts excluded women with previous cardiovascular disease or diabetes. The first cohort were followed up for an average period of 14.6 years and the second cohort for a period of 12.9 years after delivery.

Overall, 43,109 women in the first cohort and 40,450 in the second cohort experienced either hypertension or pre-eclampsia during their pregnancies.

Pooling the data from the two cohorts, the researchers found that gestational hypertension and severe pre-eclampsia increased the risk for subsequent Type 2 diabetes by 3.12- and 3.68-fold, respectively.

In addition, women who experienced these disorders had a much higher risk for subsequent hypertension than women who did not. More specifically, women who had gestational hypertension, mild pre-eclampsia, and severe pre-eclampsia had a 5.31-, 3.61-, and 6.07-fold increase in risk, respectively.

“Physicians and other health care professionals should be encouraged to include the history of a woman’s pregnancy outcomes when estimating the risk of cardiovascular disease,” conclude Lykke et al in the journal Hypertension.

“Identifying these women early will allow for prompt intervention, either primarily as modification of other classical cardiovascular risk factors or secondarily as medical prophylaxis.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Improving communication and education among patients and healthcare providers could be key to addressing some of the challenges to caring for diabetes patients, specialists in diabetes medicine highlighted at a 1-day conference held by the Royal Society of Medicine in conjunction with the Federation of European Nurses in Diabetes.

Governmental department of health figures from the UK show that the incidence of diabetes rose from 1.962 million in 2007 to 2.088 million in 2008 and worldwide prevalence continues to increase exponentially, commented UK National Clinical Director for Diabetes Rowan Hillson (The Hillingdon Hospital, London).

She emphasized that all diabetic emergencies are potentially preventable and that provision of appropriate advice and education for both patients and healthcare providers, as well as improvements in communication between patients and specialists could help to achieve this.

Indeed, Caroline Butler (Care Advisor, Diabetes UK) and Stella Valerkou (Senior Policy Advisor, Diabetes UK) reported that, of 50 patients who responded to the recent Diabetes UK survey of diabetic patients, only five highlighted a positive experience.

Problems encountered by patients included a general lack of communication among healthcare staff, as well as between patients and healthcare staff, poor dietary advice and timing of medications, and a lack of knowledge among general hospital healthcare providers about diabetes care.

The problem of poor communication among healthcare staff was addressed by general practitioner David Wingfield (Brook Green Medical Centre, London) who said that, as diabetic patients often have multiple morbidities, communication between different care providers is key for providing the best treatment and achieving the best outcomes. He added that, in his experience, social support and prescribing support for pharmacists have helped these individuals.

Anne Dornhorst (Imperial College, London), Specialist Diabetes Consultant, made the point that as much diabetes care as possible should be dealt with in the community and that “consultant diabetologists shouldn’t be possessive of their patients.”

She added: “We must start promoting and speaking up for primary care and intermediate care.”

Consultant nurse Grace Vanterpool (Hammersmith and Fulham Primary Care Trust, London) emphasized the important role diabetic specialist nurses play in providing diabetic patients with information on their disease, but pointed out that nurses are not given enough time to learn and that more staff are needed to consult, teach, and counsel existing staff.

Of great importance is the need to promote the benefits of lifestyle intervention to both diabetes patients and their doctors.

Nutritionist Gary Frost (Hammersmith Hospital, London) commented that lifestyle advice is a more difficult and longer-term solution than drug therapy, but said that it should be encouraged as it is a “major way to improve quality of life for people with diabetes.”

The overall message from the meeting was that, although some aspects of diabetes care have improved, the recent rapid increase in obesity and Type 2 diabetes has increased the strain on an already overburdened health service.

More money and resources need to be provided to give both patients and healthcare providers the education and information they need to tackle the problems of diabetes successfully in the future.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Diabetes UK position statement

Meta-analysis results published in The Lancet show that intensive glucose control in patients with Type 2 diabetes significantly reduces nonfatal myocardial infarction (MI) and other coronary heart disease (CHD) related events compared with standard glucose control, with no effect on all-cause mortality.

“Previous studies have been inconclusive, leaving diabetics and their doctors unsure as to whether maintaining lower blood sugar levels actually benefitted the patients,” said lead study author Kausik Ray (University of Cambridge, UK).

“Although additional research needs to be conducted, our findings provide insight into the importance of improving glucose levels which should include lifestyle changes as well as medication.”

The researchers selected five prospective randomized trials ??” UKPDS, PROactive, ADVANCE, VADT, and ACCORD ??” for inclusion in the meta-analysis, including a total of 33,040 participants.

All five studies compared the effects of intensive (average achieved glycated hemoglobin [HbA1c] level of 6.6%) versus standard glucose control (mean achieved HbA1c of 7.5%) on death and cardiovascular outcomes.

Overall, there were 1497 nonfatal MIs, 2318 CHD events, 1127 strokes, and 2892 deaths from any cause over an average follow-up period for the five trials of 4.95 years.

Ray and team found that compared with a standard treatment regimen, intensive glycemic control reduced the incidence of non-fatal MI by 17% and CHD events by 15%.

There were no significant effects on incidence of stroke (7% reduction) or all-cause mortality (no difference) recorded between intensive and standard treatment groups.

Theodore Mazzone (University of Illinois, Chicago, USA) pointed out in an accompanying editorial that the benefits of intensive glucose control on the incidence of CHD events “will certainly not be as great as that produced by blood pressure control or statin treatment.”

However, he added that “on the basis of current information, and the urgent need to address residual risk of CHD in a rapidly expanding population with Type 2 diabetes, it is premature to conclude that glucose control has no part to play.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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