versus Type II Diabetes Mellitus in pregnancy and adverse pregnancy outcome
This intention of this dissertation is to firstly provide an overview of the most recent research into the issue of Type 1 and Type 2 diabetes, with the aim of examining in detail specific aspects and differences between the two types and the impact of diabetes mellitus on pregnancy and pregnancy outcomes. A further focus of this study is the emphasis on Type II diabetes and on the non-physical causative and prognostic factors in pregnancy. Issues such as naturalistic therapies and environmental and hereditary issues will form part of the overall discussion. The study also attempts to provide a balanced and comprehensive view of both types of the disease from various perspectives.
Overview: The essential difference between Type I and Type II diabetes
There are two forms of diabetes mellitus. Type I is insulin dependent while Type II is non-insulin-dependent. In Type II sufficient insulin is formed in the pancreas, but the body has difficulty in processing and using the insulin. Type II is more common and is often found in older adults. This type of diabetes will form one of the central points of focus in this study due to the problematics and research controversy in certain areas that it has engendered and its prevalence in pregnant women. For example, research has found that "some women develop diabetes during pregnancy. Although this type of diabetes goes away after pregnancy, women who have had it may develop Type II diabetes later in life." (Diabetes: What You Need to Know)
This relationship between the onset of diabetes during pregnancy and the possible connection to the later development of Type II diabetes will form a central locus of this dissertation. It should however be pointed out that this will not be the exclusive focus of the study, as the dissertation will of necessity also cover a wide range of research in order to approach the central problematics of Type II diabetes.
In general diabetes can create a wide range of health problems for both mother and child. These include damage to eyes, blood vessels, nerves and kidneys through high sugar levels. This can also result in increasing the risk of heart attack and stroke. Short-term effects can include episodes of hypoglycemia, hyperglycemia and ketoacidosis. Research also indicates that women are particularly susceptible to developing diabetes. "Approximately 8.1 million or 8.2% of all women in the United States have diabetes; however, about a third of these do not know it. Women with diabetes have an increased risk of vaginal infections and complications during pregnancy. (Women Face an Added Risk of Developing Diabetes.) This is further bolstered by research that strongly relates diabetes during pregnancy to the onset of both Type I and Type II. " ... diabetes discovered during pregnancy accounts for 88% of cases, preexisting Type II Diabetes for 8%, and preexisting Type I Diabetes for 4% "(D. Rouiller, 2003). This results in various complications for the pregnancy, including the fact that mothers who are affected by hyperglycemia are at risk for intrauterine death or neonatal mortality. (ibid) There are also further effects and outcomes in that "offspring of patients with gestational diabetes are at significant risk for fetal macrosomia and other neonatal morbidities, including hypoglycemia, hypocalcemia, polycythemia, and hyperbilirubinemia. (ibid)
2. Research possibilities and focus
There is a vast array of research material on the differences between the two types of diabetes and there are many controversial areas surrounding the differences in diagnosis and treatment of the types of diabetes in pregnant women. In the first instance this study will present and overview of the present state of research in order to establish a foundation from which to assess and analyze the central issue -- which is the essential difference between Types I and Type II Diabetes Mellitus. Secondly, the dissertation will focus on Type II in that it provides areas for research into "alternative" or more flexible treatment and new possibilities. This aspect will be established on the grounds of a rigorous overview and assessment of the literature to date. The following are some of the central areas that will form the kernel of the research trajectory in this dissertation.
2.1. Research Overview of the difference between types I and II
This area will provide a comprehensive literary overview and will aim to isolate various aspects of the two types in relation to the central focus of the study. One of the focal points that will be used to filter the array of research data is the effect of natural remedies on both types, particularly Type II. A second focus will be on the control and outcomes for the mother and child though an analysis of research on fetal care. Special attention will also be paid to areas of controversy -- such as in diabetic scanning and diagnostic procedures. In the focus on Type II the research will be attuned to literature on extraneous factors such as hereditary and environment in the causation of Type II diabetes. Non-conventional means of treatment and control will also be studied.
2.2 Gestational diabetes and Type II
Research indicates that there is a close correlation ion between gestational diabetes and Type II Diabetes.
Many women who have gestational diabetes go on to develop Type II Diabetes years later. There seems to be a link between the tendency to have gestational diabetes and Type II Diabetes. Gestational diabetes and Type II Diabetes both involve insulin resistance. Certain basic lifestyle changes may help prevent diabetes after gestational diabetes." (Gestational Diabetes)
This is an important aspect which will form one of the research trajectories that are intended to coalesce with the coverall issue and relationship of Type I and Type II diabetes. A useful overview of gestational diabetes can be found in the Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. (Metzger BE, 1998) Another aspect that is contentious is the scanning and treatment of GDM.
(Harris MI. 1988; pp. 402-411) Studies have also shown that selective screening can result in missed diagnoses. (Gestational Diabetes Mellitus)
2.3 Other important areas of research include the following:
2.3.1. Lifestyle interventions. This relates to the core focus of this study on Type II Diabetes and deals with aspects such as nutrition therapy and exercise as aspects that can affect treatment and prognosis.
2.3.1. Pharmacologic interventions
2.3.2. Long-term risks and outcomes
This is an important area that will form part of the general discussion and deals with the paucity of research on the long-term effects of diabetes during pregnancy. "Many animal studies suggest long-term consequences of in utero hyperglycemia for the offspring, but human studies, by nature of the length of follow-up required, are few." (Gestational Diabetes Mellitus)
2.3.3. There is a vast array of factors that are seen as causative in Type II Diabetes. One of these, which will be studied in depth, is the genetically increased predisposition towards the disease. (ibid)
2.3.4. Pregnancy and outcomes risk with diabetes one
Research proves that pregnant women with Type I Diabetes have a substantially increased risk of vascular complications. In a study published in Diabetes Care the following results were obtained.
Pregnancy enhances microvascular function, but in women with diabetes, such improvements are insufficient to attain responses seen in healthy non-pregnant women. This suggests a persistent vascular defect in young women with Type I Diabetes that may contribute to adverse pregnancy outcome. Our data suggests a role for the chronic effects of hyperglycemia in the impaired vascular responsiveness in such women. (Sattar, Naveed, 2003)
2.3.5. Pregnancy raises risk of Type II Diabetes
This will be a special area of focus as "each successive pregnancy may slightly elevate a woman's risk of developing Type II Diabetes later in life, according to a new epidemiologic study. " (Fackelmann, K.A.)
2.3.6. An area related to complications and prognosis of both Types will also be included. For example, the issue of Type II diabetes is a major risk factor for cardiovascular disease will be decussated. (PRODIGY Guidance - Diabetes Type II - lipid management)
This study will attempt to achieve not only an overall perspective on the two Types of the disease but will also focus on specific areas of concern. This focus will largely be determined by the central issues suggested above and by the emphasis on research dealing with Type II.
Auslander, Wendy F., et al. "Family Stress and Resources: Potential Areas of Intervention in Children Recently Diagnosed with Diabetes." Health and Social Work 18.2 (1993): 101+. Questia. 6 Jan. 2005 http://www.questia.com / .
Binder, Markus, et al. "A Pilot Study Examining the Effect of Distant Healing on Type II Diabetes Patients." The Journal of Parapsychology 63.3 (1999): 1998.
Decoster, Vaughn A. "CHALLENGES OF TYPE 2 DIABETES AND ROLE OF HEALTH CARE SOCIAL WORK: A Neglected Area of Practice." Health and Social Work 26.1 (2001): 26. Questia. 6 Jan. 2005 http://www.questia.com / .
Diabetes: What You Need to Know. American Family Physician, August 1, 1999.…