Clinical Care

Diabetes provokes a range of reproductive and sexual health problems: menstrual changes, fertility disorders, urinary and vaginal infections, urinary incontinence and sexual dysfunction. Early diagnosis and treatment of these problems, with well-planned pre-conception care, can protect maternal and infant health. In this report, Seyda Ozcan and Nevin Sahin call for reproductive and sexual healthcare to be included in women’s diabetes management plan.

The diagnosis of gestational diabetes has for decades been based either on criteria that predict a mother’s risk for developing type 2 diabetes in the future, or those used for non-pregnant women. But gestational diabetes also carries a risk for the baby. Moreover, the level at which maternal blood glucose provokes risk for the foetus remains unclear.

The risk to a woman of having diabetes during her reproductive years varies worldwide and compares with the regional risks for the condition in general – on average between 5% and 8%. In all pregnant women, the risk for gestational diabetes should be assessed and screened early if a number of risk factors are present. Indeed, any form of diabetes during gestation, whether it develops during pregnancy or is present before conception, requires excellent multi-facetted management before and during pregnancy, and around the time of delivery.

The period after a woman gives birth provides a window of opportunity to impact on her short- and long-term future health. The end of a pregnancy heralds a transition both physically and mentally, and in terms of self-care. After delivery, most of the hormones that make a woman with gestational diabetes insensitive to the action of insulin are no longer present. In women with pre-existing diabetes, insulin needs drop dramatically; some women requiring insulin therapy to live may not need insulin for up to 72 hours.

Obesity has become a pandemic, affecting adults and children around the world.  Considerable medical, scientific and lifestyle-related knowledge and resources are being channelled into the identification of strategies to combat this major public health problem. Despite these multidisciplinary efforts, however, little attention has been paid to the damaging social and psychological consequences of obesity.

Recently, two clinical trials addressed the role of tight blood glucose control on cardiovascular risk in people with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the Action in Diabetes and Vascular Disease (ADVANCE) trial. The ACCORD study included 10,251 people with type 2 diabetes and was designed to determine whether intensive blood glucose control (HbA1c below 6%) as compared to a conventional approach (HbA1c between 7% and 7.9%) would result in favourable cardiovascular outcomes in people with type 2 diabetes at high vascular risk.

Haemoglobin A1c (HbA1c) is widely used to determine levels of long-term blood glucose, judge the adequacy of diabetes management, and adjust therapies. HbA1c results are expressed as the percentage of haemoglobin that is exposed to glucose (glycated). People’s day-to-day diabetes management is guided by self-monitoring of  capillary glucose concentrations, which are measured  in mmol/l or mg/dl.

The burden of erectile dysfunction has not been well documented across age and ethnicity. A number of studies have reported a prevalence of around 35% in middle-aged men, rising to over 75% in elderly men. Some ethnic groups appear to be at increased risk. Much higher rates have been reported in men with diabetes – up to 90%. In this article, Ronald Ma and Peter Tong describe the mechanisms linking erectile dysfunction and diabetes, its association with atherosclerosis, and look at the cardiovascular implications for men with diabetes and erectile dysfunction.

Recent years have seen an expansion in the number of conditions that are recognized as having a link with diabetes. In people with sleep apnoea breathing stops briefly but repeatedly during sleep. It is commonly associated with obesity, and therefore frequently occurs in people with type 2 diabetes. However, recent research demonstrates the likelihood of a relationship between obstructive sleep apnoea and diabetes that is independent of obesity. The links between the conditions are particularly important as both increase the risk of cardiovascular disease.

Type 2 diabetes significantly increases a person’s risk of developing multiple health complications, but the risk of these complications can be significantly reduced with modern, comprehensive diabetes care. This care is inherently complex because of its use of multiple medications in conjunction with lifestyle changes in diet, exercise, and blood glucose self-monitoring.