Early type 2 diabetes risk skyrockets with low birthweight and overweight at age 20

From news-medical.net

New research being presented at this year's European Congress on Obesity (ECO) in Venice, Italy (12-15 May), and published in Diabetologia (the journal of the European Association for The Study of Diabetes [EASD]) suggests that having a low birthweight together with being overweight in young adulthood (but not childhood) contributes to the development of type 2 diabetes at an early age (59 years or younger) in men.

Notably, the study involving over 34,000 Swedish men, found that those born with a low birthweight (<2.5 kg/5 lbs 8oz) who were also overweight at aged 20 years (BMI >25kg/m²) were 10 times more likely to develop early type 2 diabetes than those with a birthweight in the normal range (2.5-4.5 kg) who were normal weight as young adults (BMI <25 kg/m²).

Importantly, the researchers from the University of Gothenburg and Sahlgrenska University Hospital also found that babies with a low birthweight who were overweight at age 20 years had a 27% absolute risk of developing early type 2 diabetes, compared with an absolute risk of 6% for those with a birthweight in the normal range who were also normal weight at aged 20 years. This suggests that preventing excess weight gain during young adulthood in boys born with low birthweight could reduce the absolute risk of early type 2 diabetes by 21%.

Type 2 diabetes is being diagnosed at progressively younger ages, suggesting that significant risk may begin to accumulate during the developmental period. The association between low birthweight and overweight in childhood and/or young adulthood and type 2 diabetes in adults is already known, but it has been unclear how much influence the combination of these two factors exerts.

To find out more, researchers analysed data from 34,231 men born between 1945 and 1961 involved in the BMI Epidemiology Study (BEST) Gothenburg-;a population-based cohort examining the associations between growth and BMI development in early life and the risk of disease in later life.

The researchers analysed birthweight and BMI of participants from school health care records (at the age of 8 years) and from medical examinations on enrolment in the military (at age 20), which was mandatory until 2010.

Participants were followed from 30 years of age until type 2 diabetes diagnosis, death, or emigration, or until 31st December 2019. Information on type 2 diabetes diagnoses was retrieved from Swedish national registers to estimate the risk of early (<59.4 years) and late (>59.4 years) type 2 diabetes. They also examined whether these associations were independent of, or modified by, socioeconomic factors such as level of education.

During an average 34 years follow up (after 30 years of age), a total of 2,733 cases of type 2 diabetes were diagnosed (1,367 cases of early diabetes and 1,366 cases of late diabetes). The analyses found that birthweight below the average (median; <3.6 kg/7lbs 9oz) and overweight at age 20 years (BMI >25 kg/m²), but not overweight at age 8 years (BMI >17.9 kg/m²), were associated with an increased risk of both early and late type 2 diabetes.

Furthermore, low birthweight and overweight in young adulthood were found to have an additive effect on the risk of type 2 diabetes. For example, having a below average birthweight (<3.6 kg/7lbs 9oz), followed by overweight at 20 years of age was associated with a six times greater risk of developing early type 2 diabetes. Whereas a lower birthweight (<2.5 kg/5 lbs 8oz) combined with later overweight at 20 years was linked with a 10 fold greater risk of developing early type 2 diabetes.

Adjusting for education, a known risk factor for type 2 diabetes, did little to change the results.

Our findings establish low birthweight and overweight in young adulthood as the main developmental determinants, whereas overweight in childhood is of lesser importance for type 2 diabetes in adult men. The combination of low birthweight followed by overweight at age 20 years is associated with a massive excess risk for early type 2 diabetes, which is substantially higher than the risk associated with low birthweight or being overweight as a young adult separately."

Dr Jimmy Celind, lead author, researcher at Sahlgrenska Academy's Institute of Medicine, University of Gothenburg

Co-author Dr Jenny Kindblom from Sahlgrenska University Hospital adds, "It's possible that the metabolic consequences of foetal growth restriction, which promotes resilience against starvation through fat storage and insulin resistance, when combined with a detrimental BMI trajectory during puberty when the insulin resistance is at a lifetime peak due to the surge of growth and sex hormones, result in an additive excess risk for later type 2 diabetes. Public health initiatives should target boys born with low birthweight to work on prevention of overweight as young adults, to reduce this huge excess risk for early type 2 diabetes."

The authors acknowledge that the findings are associations only and that the study wasn't designed to measure direct cause and effect, and point to several limitations, including that the participants were mainly white men which may limit the generalisability of the findings to other ethnicities and women. In addition, the analyses were unable to account for the influence of other known risk factors for type 2 diabetes such as smoking, dietary habits, and physical activity which could have influenced the results.

https://www.news-medical.net/news/20240304/Early-type-2-diabetes-risk-skyrockets-with-low-birthweight-and-overweight-at-age-20.aspx

Here's What You Should Know About Diabetes and Breastfeeding

From healthline.com

If you’re pregnant and have diabetes, you might be wondering whether or not you can breastfeed your baby. 

The short answer: Yes.

You can and possibly should try breastfeeding, as it has a number of benefits for your health and your baby’s health.

For birthing parents who live with diabetes, breastfeeding — also known as chestfeeding — may help keep glucose levels in check. For babies, breast milk may help lowerTrusted Source the potential risk of type 1 diabetes (T1D) later in the child’s life.

Keep reading to learn more about breastfeeding with diabetes, what the benefits are, and what questions you might want to talk with your healthcare team about. 

Should you breastfeed if you have diabetes?

The American Diabetes Association shares that not only can birthing parents with diabetes breastfeed, but they also should try breastfeeding to help manage their diabetes. They recommend breastfeeding for at least the first 6 months of a baby’s life to reap the most benefits for both parent and child.

Breastfeeding benefits

Benefits for baby:

• lower risk of developing T1D
• reduced risk of developing overweight or obesity when they’re older, which may help prevent type 2 diabetes (T2D)
• lower risk of developing other health issues, like ear infections, eczema, asthma, and respiratory disease

Benefits for birthing parents:

• faster recovery from giving birth, including more rapid weight loss after pregnancy
• lower risk of developing certain health conditions, including arthritis, osteoporosis, breast and ovarian cancers, and high blood pressure
• reduced risk of developing T2D

Is it safe to use insulin and diabetes medications when breastfeeding?

Medications like metformin and insulin are safe to take while breastfeeding.

La Leche League International further explains that insulin molecules are “too large” to pass through breast milk to the baby. That said, you may need to work with your care team to adjust your dose after pregnancy and during breastfeeding.

Researchers point out that some newer medications for T2D may not be safe or do not have enough study concerning breastfeeding.

• SGLT-2 inhibitors: Sodium-glucose cotransporter 2 inhibitors increase glucose excretion in the urine. This class of drugs includes canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. These drugs have no human lactation information and are not FDA-recommended in their respective package inserts because of the theoretical risk of injury to the developing kidney.
• GLP-1 agonists: The glucagon-like peptide-1 receptor antagonists are a class of medications that include dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide. Taken by injection each day or week, the current FDA-approved labelling recommends against nursing with all of these drugs, although there are no reports of their use in breastfed infants.
• DPP-4 inhibitors: Known as dipeptidyl peptidase-4 inhibitors, these are a class of prescription medications used along with diet and exercise to manage blood sugar in adults with type 2 diabetes. The meds in this class include alogliptin, linagliptin, saxagliptin, and sitagliptin. There’s no information available on their excretion into milk or use in lactation, but this research notes that saxagliptin and linagliptin may be “better choices among drugs in this class for nursing mothers.”

Some of the lesser-used drugs for diabetes that prescribers can also suggest include colesevelam, meglitinides, pramlintide, and thiazolidinediones.

Regardless, some people may find that breastfeeding makes their blood sugar more difficult to predict, so speak with your doctor about drugs as well as closer monitoring or even continuous glucose monitoring, if necessary.

How does breastfeeding impact gestational diabetes?

Up to 9 percentTrusted Source of women develop high blood sugar during pregnancy. Also known as gestational diabetes (GD), this condition usually goes away on its own after a baby is born. But having GD may put a woman at higher risk of developing T2D later on.

Trusted SourceResearch shows that breastfeeding may lower this risk by increasing both a mother’s insulin sensitivity and glucose metabolism. Duration of breastfeeding also matters.

• 2 months. Women who breastfeed for at least 2 monthsTrusted Source may see a reduction in risk by around half.
• 5 months. Women who breastfeed for at least 5 monthsTrusted Source see more than half a reduction in risk.

Is there a recommended blood sugar level for breastfeeding?

Experts recommend keeping your glucose levels somewhere between 90 and 180 mg/dL while breastfeeding. Any lower glucose levels may lead to dangerous hypoglycaemia, or low blood sugar.

Some people may discover that their blood sugars drop between 54 and 90 mg/dL during a breastfeeding session. That’s because the body uses the glucose in the blood to make breast milk.

Be sure to keep hypoglycaemia treatments close by, if needed. Whatever the case, you may need help from your diabetes care team to adjust your insulin and medication doses or to eat differently in order to manage your blood sugars while breastfeeding.

How is diabetes linked to low milk supply?

A 2016 case studyTrusted Source indicates that having gestational, T1D, or T2D may impact milk supply.

The researchers uncovered that women with low milk supply were likely to have a diagnosis of one of these types of diabetes rather than latch issues, nipple issues, or other breastfeeding issues. 

Beyond that, the researchers share that higherTrusted Source body mass indexes (BMIs) are associated with low milk supply and that insulin resistance may be to blame. More research is needed to establish the specific link.

Does breast milk impact diabetes risk in babies?

While the exact causes of T1D are not known, the number of cases in young children have increased in the last 50 years.Trusted Source This has led researchers to believe environmental factors — like smoking during pregnancy, type of birth, or infant diet — may be at play.

While various studies on breastfeeding have not yielded clear evidence that breastfeeding prevents T1D, others do show promise.

For example, one Scandinavian studyTrusted Source revealed that babies who’d never been breastfed had a two-fold increase in the risk of developing T1D compared to those who did breastfeed.

Interestingly, there wasn’t much difference in data between babies breastfed for different durations of time. The same goes with those who were fully breastfed and those who had breast milk combined with other feeding methods, like formula.

Other diabetes risks during breastfeeding

Breastfeeding may increase the chance of developing hypoglycaemia in the overnight hours. This can be addressed by working with your diabetes care team to adjust sleeping schedules for breastfeeding, and also adjusting insulin doses and medications during these times.

You may want to make sure that you eat before breastfeeding sessions or have a snack on hand if you’re breastfeeding while you’re out and less able to keep your glucose levels stable.

You’ll need to eat extra calories each day to support milk production. The American College of Obstetricians and Gynecologists suggests speaking with your doctor about exactly how many extra calories you should eat and what type of calories are best to manage your blood sugar.

Women with diabetes who breastfeed are also at a higher risk of developing yeast infections. One type of yeast infection that may occur is called breast and nipple thrush, which can affect breastfeeding. Symptoms include:

• nipple pain or itching
• discharge
• change in nipple colour

If you notice these symptoms, talk with your diabetes care team or lactation consultant about treatment options and modified feeding practices.

Takeaway

You can and likely should try breastfeeding if you have diabetes. Fortunately, you may be able to take your usual medications safely. Breastfeeding may even help regulate your blood sugar — all while providing a host of other benefits to both you and your baby.

Your doctor can answer questions you may have about other issues, like adjusting your medication dosages, avoiding hypoglycaemia, or managing yeast infections.

If you deal with low milk supply, reach out to a lactation consultant for support or try searching for one via the United States Lactation Consultant Association’s online directory.

https://www.healthline.com/health/diabetes/diabetes-and-breastfeeding#breastfeeding-with-diabetes

Breastfeeding helps prevent mothers from developing diabetes after childbirth

From myvetcandy.com

A team of South Korean researchers found that lactation can lower the incidence and reduce the risk of maternal postpartum diabetes. The researchers identified that lactation increases the mass and function of pancreatic beta cells through serotonin production. The team suggested that sustained improvements in pancreatic beta cells, which can last for years even after the cessation of lactation, improve mothers' metabolic health in addition to providing health benefits for infants. 

Pregnancy imposes a substantial metabolic burden on women through weight gain and increased insulin resistance. Various other factors, including a history of gestational diabetes, maternal age, and obesity, further affect women's risk of progressing to diabetes after delivery, and the risk of postpartum diabetes increases more in women who have had gestational diabetes and/or repeated deliveries. 

Diabetes-related complications include damage to blood vessels, which can lead to cardiovascular and cerebrovascular diseases such as heart attack and stroke, and problems with the nerves, eyes, kidneys, and many more. Since diabetes can pose a serious threat to mothers' metabolic health, the management of maternal metabolic risk factors is important, especially in the peripartum period. Previous epidemiological studies have reported that lactation reduces the risk of postpartum diabetes, but the mechanisms underlying this benefit have remained elusive.

The study, published in Science Translational Medicine on April 29, explains the biology underpinning this observation on the beneficial effects of lactation. Professor Hail Kim from the Graduate School of Medical Science and Engineering at KAIST led and jointly conducted the study in conjunction with researchers from the Seoul National University Bundang Hospital (SNUBH) and Chungnam National University (CNU) in Korea, and the University of California, San Francisco (UCSF) in the US.

In their study, the team observed that the milk-secreting hormone 'prolactin' in lactating mothers not only promotes milk production, but also plays a major role in stimulating insulin-secreting pancreatic beta cells that regulate blood glucose in the body.

The researchers also found that 'serotonin', known as a chemical that contributes to wellbeing and happiness, is produced in pancreatic beta cells during lactation. Serotonin in pancreatic beta cells act as an antioxidant and reduce oxidative stress, making mothers' beta cells healthier. Serotonin also induces the proliferation of beta cells, thereby increasing the beta cell mass and helping maintain proper glucose levels.

The research team conducted follow-up examinations on a total of 174 postpartum women, 85 lactated and 99 non-lactated, at two months postpartum and annually thereafter for at least three years. The results demonstrated that mothers who had undergone lactation improved pancreatic beta cell mass and function, and showed improved glucose homeostasis with approximately 20mg/dL lower glucose levels, thereby reducing the risk of postpartum diabetes in women. Surprisingly, this beneficial effect was maintained after the cessation of lactation, for more than three years after delivery.

Professor Kim said, "We are happy to prove that lactation benefits female metabolic health by improving beta cell mass and function as well as glycaemic control.

"Our future studies on the modulation of the molecular serotonergic pathway in accordance with the management of maternal metabolic risk factors may lead to new therapeutics to help prevent mothers from developing metabolic disorders," he added.

https://www.myvetcandy.com/livingblog/2020/5/2/breastfeeding-helps-prevent-mothers-from-developing-diabetes-after-childbirth