The World Health Organization has updated its 1999 classification of diabetes. The new guidance distinguishes between type 1 and type 2 diabetes, as well as recommending conventional diagnostic methods. It also recognises hybrid forms of diabetes; with latent autoimmune diabetes in adults becoming slowly evolving immune-mediated diabetes of adults; and ketosis-prone type 2 diabetes being recognised as a separate entity. Monogenic diabetes is now classified based on the mutated gene and the clinical syndrome. The guidance also draws attention to hyperglycaemia first detected during pregnancy and suggests clinicians should distinguish between type 1 or 2 diabetes first diagnosed during pregnancy and gestational diabetes.
Investigators wanted to find out whether exposure to metformin during the first trimester of pregnancy, for diabetes or other indications, increased the risk of congenital anomalies. They examined a European congenital anomaly registry (EUROmediCAT). They found 168 babies affected by a congenital anomaly (141 non-genetic and 27 genetic) who were exposed to metformin. No evidence was found for a significantly increased risk of all non-genetic congenital anomalies following exposure to metformin during the first trimester.
Gestational diabetes mellitus (GDM) can have short- and long-term complications for the mother and her infant. Investigators sought to establish the effectiveness of different insulin regimens, compared with oral antidiabetes therapies and non-pharmacological interventions. They carried out a Cochrane review of relevant randomised controlled trials and found that there are minimal harms associated with the effects of treatment with either insulin or oral antidiabetes therapies. The choice to use one or the other may be down to physician or maternal preference, availability, or the severity of GDM.
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