Maternal diabetes tied to poor blood sugar control and complications among youth with type 2 diabetes
USA: Maternal diabetes is associated with worse blood sugar control, reduced heart rate variability, and glomerular hyperfiltration in youth with type 2 diabetes (T2D), according to findings from the TODAY trial published in the Journal of Clinical Endocrinology & Metabolism.
The association was seen in all cases of maternal diabetes, whether diagnosed during versus after pregnancy.
Prenatal exposures, such as parental diabetes, overnutrition, and undernutrition, are recognized risk factors for future cardiometabolic disease. Currently, there is no data on the effects of parental diabetes on complications or disease progression in youth-onset type 2 diabetes. Rachana D Shah, Children's Hospital of Philadelphia and a research team from the USA aimed to investigate the effects of parental diabetes history on β-cell function, glycemic outcomes, and complications in a U.S. cohort of youth-onset type 2 diabetes.
For this purpose, the researchers enrolled 699 participants aged 10-17 with T2D at 15 U.S. centres. They were followed for up to 12 years as part of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) and TODAY2 follow-up studies. For 621 participants (Before or during pregnancy = 218; Never =301; After pregnancy = 102), information about diabetes diagnosis in biological mothers was available, and in biological fathers for 519 (Paternal diabetes = 167; No diabetes = 352).
The authors reported the following findings:
- Maternal (but not paternal) diabetes was linked with loss of blood sugar control over time, defined as HbA1c of more than 8% for over six months.
- Maternal (but not paternal) diabetes after 12 years of follow-up was linked with an increased risk of low heart rate variability and glomerular hyperfiltration.
- Effects were largely independent of sex, race/ethnicity, age, and household income.
- The outcomes were similar for whether maternal diabetes was diagnosed during vs after pregnancy.
To conclude, maternal diabetes, irrespective of whether diagnosed after versus during pregnancy, is linked with glomerular hyperfiltration, worse glycemic control, and lower heart rate variability in youth with type 2 diabetes. The strong link between diabetes outcomes with maternal diabetes indicates a possible role in utero programming.
Reference:
Rachana D Shah, MD, MS, Steven D Chernausek, MD, Laure El ghormli, MS, Mitchell E Geffner, MD, Joyce Keady, RN MSN CPNP, Megan M Kelsey, MD, MS, Ryan Farrell, MD, Bereket Tesfaldet, MS, Jeanie B Tryggestad, MD, Michelle Van Name, MD, Elvira Isganaitis, MD, MPH, Maternal Diabetes in Youth-Onset Type 2 Diabetes Is Associated with Progressive Dysglycemia and Risk of Complications, The Journal of Clinical Endocrinology & Metabolism, 2022;, dgac663, https://doi.org/10.1210/clinem/dgac663
