SVEN DIURLIN - Metabolic conditions with increased risk to develop type 2 diabetes

Project description

The aim of the dissertation is to shed light on the progression from prediabetes and gestational diabetes (GDM) to type 2 diabetes, and to investigate differences and similarities between individuals with impaired glucose tolerance (IGT) and elevated non-diabetic fasting sugar (IFG), and implications for primary care. The following sub-studies are planned:

1. Differences in self-rated health of individuals with IGT and IFG and its implications for primary care.
2. The effect of persistent pre-diabetic conditions, IGT and IFG on the development of chronic kidney disease.
3. Validation of the diagnosis of GDM in the pregnancy register and how it correlates with the diagnosis at the post-visit to the midwife postpartum – a sub-study in the Changing Diagnostic Criteria for Gestational Diabetes – study (CDC4G).
4. Feasibility study of a lifestyle intervention in women with GDM to prevent the development of type 2 diabetes.

Studies 1 and 2 are based on longitudinal observations in a cohort study (Vara-Skövdekohorten) that was conducted in 2002-2005 where 2816 individuals were examined extensively with follow-up data after about 10 years. The participation rate in the basic survey was 76% and the individuals were a random sample of the population aged 30-74 years, living in two municipalities in southwest Sweden. The examination protocol at the follow-up was the same as at the baseline examination. The third study is a validation study of the diagnosis of gestational diabetes within the CDC4G – study. CDC4G is investigating nationally the implementation of the new guidelines for GDM that WHO developed in 2013. The pregnancy register, the National Diabetes Register and data from participating clinics will be coordinated in this validation study. The fourth study is a pilot study where the feasibility of a randomized, controlled study in a clinically adapted intervention is tested. The purpose of the study is to prevent women with GDM from developing type 2 diabetes (Prevention of PostPartum Diabetes Study – PEPP). The intervention will be linked to the regular BVC. The PEPP pilot will start at the beginning of 2022 in Skövde and Östersund.

Disorders of glucose metabolism, impaired renal function and self-perceived ill health are conditions with a high prevalence in a primary care population. These studies starts from highly relevant questions in clinical work and should provide important knowledge for primary care’s daily work and research with individuals at high risk of impaired glucose metabolism and its complications. Identifying these individuals is pivotal for the planning of simple but effective preventive measures that are feasible in primary care.