NEWS FROM DPSG BOARD
- Pilar Ramos and Gernot Desoye attended the Study Group Forum of EASD in Berlin October 1st 2018. The aim of the meeting was to update study groups on the ongoing process to bring all study groups under one (EASD) umbrella. EASD initiated this process in 2016 in order to help relieve the legal and financial responsibility of each study group. There are many financial and organizational aspects that need to be clarified. The board will be in close dialogue with Mrs Katrin Sommer, in charge of study groups at EASD, and raise specific questions for DPSG. It will be discussed at board meetings and DPSG members will be informed and later involved in a decision, when conditions are more clear.
NEWS FROM THE DPSG MEETING 2018 IN ITALY
Summary of the annual DPSG meeting 2018
The Meeting took place in Rome, from 27th – 30th of September, 2018 with attendance of 170 registrants.
The following Key Note lectures were delivered:
- Professors Denise Feig and Helen Murphy: “Improving pregnancy outcomes for women with pregestational, type 1 and type 2 diabetes: The CONCEPTT Study”
- Professor Erica P. Gunderson: “Gestational Diabetes Mellitus: A Window into Early Cardiometabolic Risk in Mothers and Children”
- Professor David Simmons: “Public health issues in GDM including transgenerational consequences and economic burden”
- Professor Dana Dabelea: “Intrauterine determinants and assessment of neonatal adiposity”
The Joseph Hoet Research Award lecture was delivered by Tine Clausen: “Diabetes, pregnancy and mode of delivery – long-term aspects for the offspring”.
The John Stowers Poster Award was given to Dr. Mie Crusell for her poster presentation of: “Offspring of women with Gestational Diabetes have an aberrant gut microbiota”, 2 nd and 3 rd prize were won by Dr. Takashi Sugiyama (“Maternal body mass index is a better indicator of large-for-gestational-age infants compared with a 75-g oral glucose tolerance test in early pregnancy”) and Dr. Sanna Mustaniemi (“Excess gestational weight gain increases risk of large-for-gestational age especially in obese women with and without GDM”).
The Jorgen Pedersen lecture, the most prestigious award of the Group, was delivered by Professor David Hill: “In islet aptum (The adaptable islet)”.
Twenty-eight oral presentations were delivered, and 60 posters were presented. Rosa Corcoy and Bill Lowe opened the meeting debating “Early prediction of GDM by omics? Yes or No?”
Moshe Hod presented the FIGO GDM initiative: “FIGO GDM Inititive – finally towards a Global Consensus”
Eulogies for André Van Assche and Lois Jovanovic who both sadly passed away during 2018 were given by Roland Devlieger and Moshe Hod respectively.
The meeting had a very high scientific quality with many lively discussions and having the potential for a number of future international collaborations within and outside the DPSG group. The Board thanks everybody for their contributions.
The local organizing committee was headed by Professor Angela Napoli who did a tremendous job and also managed to obtain substantial meeting support from the industry. The Board wishes to express our gratitude to her for this meeting and for her service in the board during 2014-18.
The Jorgen Pedersen Lecturer 2018
David J Hill, Lawson Health Research Institute, Western University, London, Ontario, Canada. In islet aptum (The adaptable islet). Increased insulin resistance (IR) is a metabolic adaptation of pregnancy driven by hormones released from the placenta and decidua. The increased IR is compensated by an adaptive increase in pancreatic β-cell mass due to both hyperplasia and hypertrophy, leading to enhanced insulin secretion. A failure of β-cells to undergo adaptive change after first trimester has been linked with gestational diabetes mellitus (GDM). Sustaining the increase in β-cell mass and functionality that should occur in pregnancy could help prevent GDM in at-risk women. In the pregnant mouse an increase in β-cell mitogenesis contributes to a 2-3-fold increase in mass peaking in late gestation. This depends on both proliferation of existing β-cells and from differentiation of resident progenitor β-cells. Multi-lineage potential progenitors have been identified in mouse and human pancreas, within islets and in the small, extra-islet endocrine clusters. They contain some insulin but poorly express glucose transporter 2 (Ins+Glut2LO cells) rendering them glucose unresponsive. Under metabolic stress they differentiated into mature, functional β-cells. We examined the phenotype and functionality of Ins+Glut2LO cells in mouse pancreas and showed them to have substantial lineage plasticity giving rise to pancreatic (endocrine and ductal) and neural lineages. During mouse pregnancy the proliferative fraction of Ins+Glut2LO cells increased significantly, preceding the increase in β-cell mass. Whilst Ins+Glut2LO cells may represent a resident population of β-cell progenitors there is evidence that at least some may represent a transient phenotype between α-and β-cells, contributing to α -to β-cell trans-differentiation. We generated a mouse model of GDM in which pregnant females demonstrate relative glucose intolerance and an impaired adaptive increase in β-cell mass due to both lower β-cell proliferation and a failure to increase Ins+Glut2LO cell proliferation and differentiation into mature β-cells. Possible therapeutic interventions aimed at enhancing Ins+Glut2LO cell number, maturation and function include GLP-1, short chain fatty acids and GABA receptor agonists. This might shift the balance between the IR and increased β-cell mass of pregnancy to prevent or reverse GDM.
The Joseph Hoet Research Award 2018
Tine Dalsgaard Clausen, Consultant, Associate Professor, Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark. Diabetes, pregnancy and mode of delivery - longterm aspects for the offspring. My research is focused on Developmental Origin of Health and Disease, especially the long-term impact of diabetes in pregnancy and the effects of mode of delivery on future health and disease in the offspring. Research methods include: clinical follow-up studies, epidemiology, randomized-controlled studies and register based studies. In 2008 I defended my PhD thesis from the Faculty of Health Sciences, University of Copenhagen:”Diabetes in pregnancy – long-term implications for the offspring”. The study comprised a clinical follow-up of a local cohort (The Rigshospitalet Cohort) of 600 adult offspring from pregnancies in women with type 1 diabetes, diet-treated GDM and two unexposed reference groups, focussing on cardio-metabolic and cognitive outcomes. Two PhD theses, focusing on pathophysiology and epigenetic markers, have subsequently been defended based on data from the cohort, which has recently been followed up for the second time. We found an increased prevalence of cardio-metabolic risk factors in offspring exposed to intrauterine hyperglycemia, and furthermore indications, that the higher the glucose estimates during pregnancy the higher risk of adverse outcomes in the offspring. Epigenetic changes may be part of the pathogenesis. Cognitive function was negatively associated with the degree of maternal hyperglycemia, but when adjusted for socioeconomic factors offspring exposed to intrauterine hyperglycemia had a cognitive function, which was comparable to unexposed reference offspring. During my post doc, which evolved from curiosity after a key note lecture at the DPSG Cambridge meeting in 2011, I focused on factors during pregnancy and delivery potentially predisposing to later Type 1 diabetes in the offspring. In conclusion, delivery by caesarean section per se did not increase the risk of childhood Type 1 diabetes, however use of broad-spectrum antibiotics during infancy predisposed the offspring to Type 1 diabetes, but only in children delivered by caesarean section. Data indicate that the gut-microbiota, which is known to be affected by delivery mode as well as antibiotic treatment, may be involved in the pathogenesis of childhood Type 1 diabetes. Data from my research is used in the clinical setting, when informing pregnant women with diabetes on future outcome in their offspring as well as when advising women aiming for caesarean delivery on maternal request.
Best posters – John Stowers Research Award: 1. Mie Crusell, 2. Takashi Sugyama and 3. Sanna Mustaniemi
Mie Crusell. Offspring of women with gestational diabetes have an aberrant gut microbiota. The composition of microbes in the gut has been associated with different disorders and disease in both children and adults such as type 2 diabetes, metabolic disorders and obesity among many others. Children born to mothers with gestational diabetes (GDM) have increased risk of developing metabolic disorders and obesity; hence we wanted to examined whether the gastrointestinal tract of children born to mothers with GDM (n=43) was differentially colonized at birth compared to children born to mothers with normal gestational glucose regulation (n=82). We furthermore wanted to examine, to what extent potential differences in the bacterial gut microbiota composition persist during infancy, thus potentially conferring risk of developing metabolic disease later in life. Faecal samples were collected from children during the first week of life and again at 9 months of age, and subjected to 16S rRNA gene amplicon sequencing. During the first week of life neonates born to mothers with GDM had lower faecal microbiota richness. At 9 months no difference in richness was observed, however GDM were featured by an aberrant gut microbiota composition of the offspring both at birth and at 9 months of age, with similarities to the gut microbiota of overweight children and adults with type 2 diabetes. Bacteria, known to produce short-chain fatty acids, which are considered beneficial for metabolic and immune regulation, were depleted in children born to mothers with GDM. The association between maternal gestational glucose regulation and gut microbiota composition withstood adjustment for confounding by mode of delivery and perinatal antibiotics treatment. Our results demonstrated that differences in glycaemic regulation in late pregnancy was linked with differences in colonization pattern of the neonate intestinal tract and with variation in the gut microbiota composition as late as 9 months after birth, an association that was linked to maternal pre-pregnancy metabolic status.
Sanna Mustaniemi. Pre-pregnancy obesity, excess gestational weight gain and gestational diabetes as a risk for large-for-gestational age at birth. Background Gestational diabetes (GDM), pre-pregnancy obesity and excess gestational weight gain (GWG) are all independent risk factors for large-for-gestational age (LGA, birthweight ≥ +2SD) infants. The aim of our study was to assess whether excess GWG is associated with LGA infant in women with and without GDM categorized by pre-pregnancy body mass index (BMI). Methods This multicenter case-control study is a part of Finnish Gestational Diabetes Study (FinnGeDi) including 1055 women with singleton pregnancies diagnosed with GDM and 1032 non-diabetic controls. Women were divided into 12 subgroups by their GDM status, pre-pregnancy BMI and GWG. Control women with normal BMI and GWG were used as reference. Results The incidence of LGA infants was 5.2% for GDM women and 2.6% for controls (p=0.002). Regardless of their GDM status, obese and overweight women were found to have excess GWG more often than normal weight women. Of those with excess GWG, obese GDM women had 11.8-fold, control women with overweight/obesity 5.0- to 6.9-fold and normal weight control women 3.9-fold risk for LGA compared with reference group. Normal GWG decreased the risk for LGA in overweight/obese controls and obese GDM women. Conclusion GDM, pre-pregnancy overweight/obesity and excess GWG increased the risk of LGA infants. Excess GWG is a risk for LGA also in normoglycemic women regardless of their pre-pregnancy BMI.
NEWS FROM WEBMASTER
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If you are not a member and want to get in contact with one of the members, you can send an email to the specific member by finding the name at members site at use the email form available for each member.
NEWS FROM FIGO
At the FIGO World Congress in Rio de Janiero, October 2018, three of the DPSG members were invited to present at a session on gestational diabetes. Moshe Hod told about secreening for gestational diabetes and presented the proces resulting in the HIP Guideline, which can be found at the website: https://www.figo.org/GlobalDeclaration-HIP. David McIntyre told about how to treat gestational diabetes. And Jeannet Lauenborg told about preventing diabetes in women with a history gestational diabetes. The session was well-attended with no free seats, and was also transmitted outside the room.
Report on the signing of the Global Declaration, by Prof. Moshe Hod;Chairman , FIGO Hyperglycemia in Pregnancy ( HIP )Working Group; Chairman , FIGO Pregnancy and NCD Committee
On October 16, 2018, at the FIGO World Congress in Rio de Janiero, the FIGO Pregnancy and NCD's Committee led the signing of the FIGO Global Declaration on Hyperglycemia in Pregnancy.
FIGO represents 130 national professional organizations all over the globe and produces guidance for Pregnancy management for some 135 million annual deliveries.
This was the culmination of two years’ work bringing together representatives of governments, professional medical organizations, public health agencies, research institutions, affected communities, and civil society groups to recognize the need to focus on hyperglycemia in pregnancy - one of the most common medical conditions seen during pregnancy. The HIP Guidelines were published in the FIGO Journal, IJGO on October 2015, building momentum through regional declarations in South Asia, Europe, Latin America, and Middle East, North Africa as well as global federations as IDF.
This is the first time that the two global professional federations of Pregnancy and Diabetes reach a consensus on the management of GDM.
It ends the dispute how to diagnose and manage GDM. Out of 135 million annual deliveries HIP Consensus was reached for nations representing over 130 million deliveries. It sends a clear message for Universal diagnosis and a one step test according to the IADPSG criteria based on the HAPO study. This global declaration sends a clear message to the world that urgent attention and action are needed.
The ceremony can be viewed here: https://youtu.be/dEua1PgJZo8.
As you are aware IADPSG is the umbrella organisation that includes membership from DPSG organisations around the world. It works to promote research in the area of Diabetes in Pregnancy, to facilitate clinical practice harmonisation on GDM screening and work in conjunction with other organisations involved in this important clinical area.
In 2017/2018 IADPSG was involved in the following :
- IADPSG was represented at NIH round table discussion August 2017, regarding research priorities in GDM. This deliberation is now published. ‘Research gaps in Gestational Diabetes’, Wexler D et al Obstetrics and Gynecology 2018: 132(2): 496-505. (Paper available at website: http://dpsghome.org/index.php/publications)
- IADPSG was represented at EBCOG meeting in Paris 2018. The Paris consensus was signed. Paris Consensus on GDM screening 2018. European J of Obstetrics & Gynecology and Reproductive biology. 2018; 227: 75-76. EBCOG committing to:
- Promoting Universal screening across Europe using IADPSG criteria
- Promoting longitudinal follow-up of mother–infant pairs
- Promoting ongoing GDM research
- Preventing childhood obesity
- IADPSG committed to working with FIGO on global acceptance of GDM screening. This will culminate at the Global IDF conference in Rio de Janeiro in October 2018. IADPSG has contributed to a publication on the barriers and challenges to GDM screening with FIGO ‘Perspectives on diagnostic strategies for hyperglycaemia in pregnancy-Dealing with the batrriers and challenges: Europe. Diabetes Research and Clinical Practice 2018 Jun 11. pii: S0168-8227(17)32041-7. doi: 10.1016/j.diabres.2018.06.001.
- IADPSG hosts an International meeting every 4 years. The next meeting will be held in Kyoto Japan from November 13-15, 2020. IADPSG is very grateful to the Japanese Society of Diabetes in Pregnancy (JDPS) for hosting the IADPSG International meeting alongside their 36th Annual Congress. The Congress President is Professor Yuji Hiramatsu and Vice-President is Professor Takashi Sugiyama. The organising Secretariat will be MA Convention Consulting. Further information will be made available through the link below, and also through further DPSG Newsletters. We would encourage as many people as possible to attend and the website will be open for abstract submissions early in 2020. http://iadpsg2020.umin.jp/
Annual DPSG meetings
- The annual DPSG meeting 2019 will be held in Graz, Austria, September 5 to 8 2019. Call for abstract will be in March. For further information follow the update on the webiste: dpsghome.org.
- The annual DPSG meeting 2020 will be held in The Netherlands. The annual DPSG meeting 2021 will be held in Spain. The annual DPSG meeting 2022 will be held in Poland.
- The next IADPSG meeting will take place in Kyoto 2020. http://iadpsg2020.umin.jp/