5 Diabetes in Pregnancy

Suggested citation:  Endocrine Society. Endocrine Facts and Figures: Diabetes. First Edition. 2015.

Diabetes in pregnancy includes two categories of patients: those who have type 1 or type 2 diabetes prior to pregnancy and those who develop gestational diabetes during a pregnancy. Gestational diabetes may progress to type 2 diabetes after pregnancy in some females.

5.1         PREVALENCE AND INCIDENCE

The prevalence of gestational diabetes can vary depending on the data source, diagnostic criteria, and the demographics of the population studied. The most recent data, taken from a retrospective insurance claims analysis, has estimated the prevalence at 6.29%. The range of data available is provided in Table 22.

Table 22. Prevalence of gestational diabetes: summary of selected studies published since 2008.
Data Source Population Prevalence Reference
MarketScan database, 2004-2011 Pregnant females, age 18-45 years 6.29% Jovanovic et al. 20155
Pregnancy Risk Assessment Monitoring System, 2009-2010 and birth certificate records (2010) Pregnant females, all ages 4.6%-9.2% DeSisto et al. 201463
Kaiser Permanente Southern California hospital records, 1999-2005 Pregnant females, age 13-58 years 7.6% Lawrence et al. 200864
National Hospital Discharge Survey, 2003-2004 Pregnant females, age 14-45 years 4.2% Getahun et al. 200865

As with other types of diabetes, an increase in the prevalence of gestational diabetes has been observed over time. Using data from the National Hospital Discharge Survey, Getahun et al. noted a relative increase of 122% between the 1989-1990 survey to the 2003-2004 survey.65

Analysis of records from all Kaiser Permanente hospitals in Southern California showed that the prevalence of pre-existing diabetes among pregnant females rose from 0.81% in 1999 to 1.82% in 2005.64 An additional retrospective study of insurance claims data in the MarketScan database (for years 2004-2011) provided additional insights on the prevalence of pre-existing type 1 diabetes versus type 2 diabetes among pregnant females (Table 23). Further, this study noted that the rate of gestational diabetes progressing to type 2 diabetes in their cohort was 0.23%.5

Table 23. Pre-existing type 1 or type 2 diabetes among pregnant females aged 18-45 years, 2004-2011.
Data Source Condition Prevalence
Truven Health MarketScan database (2004-2011), retrospective claims analysis Pre-existing type 1 diabetes 0.13%
Pre-existing type 2 diabetes 1.21%

Source: Jovanovic et al. 20155

Data from PRAMS collected between 2004 and 2006, indicated that prevalence increased with maternal age66,67, as shown in Table 24. 66

Table 24. Gestational diabetes: prevalence by age.
Age Prevalence
Under 20 years 1.0%
20-34 3.6%
35+ 8.4%

Source: Kim et al. 201066

Several studies have shown an increase in gestational diabetes prevalence from the late 1980s until the early 2000s (Table 25), but prevalence levels have remained fairly stable since then. In addition, new diagnostic criteria may result in a 2- to 3-fold increase in the diagnosed prevalence of gestational diabetes.67

Table 25. Trends in gestational diabetes.
Data Source Population Change Over Time Reference
1989-1990 and 2003-2004 NHDS Pregnant females with gestational diabetes Relative increase of 122%(1.9% in 1989-90 to 4.2% in 2003-04) Getahun et al. 200865
1991, 1997 and 2000 KPNC Pregnant females with gestational diabetes Increased 68% from 1991-1997 (3.7% to 6.6%) then leveled off at 6.2% through 2000 Ferrara et al. 200768
1999 and 2005 KPSC Pregnant females with gestational diabetes Remained constant from 1999 (7.5%) to 2005 (7.4%) Lawrence et al. 200864
1999 and 2005 KPSC Pregnant females with existing diabetes Increased from 0.81% in 1999 to 1.82% in 2005 Lawrence et al. 200864

Abbreviations: KPNC, Kaiser Permanente Northern California; KPSC, Kaiser Permanent Southern California; NHDS, National Hospital Discharge Survey

5.2         DEMOGRAPHIC DIFFERENCES

Gestational diabetes in 1995–2008 was more prevalent among Hispanics and Asian/Pacific Islanders than among whites or blacks, as indicated in an analysis of hospital records from Kaiser Permanente Southern California69 (Table 26).

Table 26. Gestational diabetes: prevalence by ethnicity.
Ethnicity Prevalence
Asian/Pacific Islander 17.1%
Hispanic 11.1%
White 7.4%
Black 6.9%
Other 7.7%

Source: Xiang et al. 201169

NHDS data showed that between 1989–1990 and 2003–2004, among females under 25 years old, the frequency of gestational diabetes increased by 13% among whites and 260% among blacks.65

5.3         LIFE EXPECTANCY AND MORTALITY

Pregnancy-related mortality ratios increase with maternal age for all females and within all age groups, and non-Hispanic black females have the highest risk of dying from pregnancy complications (Table 27).

Table 27. Pregnancy-related mortality ratios by race/ethnicity, 2006-2010.
Race/ethnicity Deaths per 100,000 live births
Non-Hispanic white 12.0
Non-Hispanic black 38.9
Hispanic 11.7
Other race/ethnicity 14.2

Source: Creanga et al. 201570

Over time, the contribution to pregnancy-related deaths of hemorrhage, hypertensive disorders of pregnancy, embolism, and anesthesia complications continued to decline, whereas the contribution of cardiovascular conditions and infection increased (Table 28).

Table 28. Causes of pregnancy-related deaths, 2006-2010.
Cause of death Percent of pregnancy-related deaths
Hemorrhage 11.4%
Embolism 14.9%
Hypertensive disorders 9.4%
Infection 13.6%
Anesthesia complications 0.7%
Cardiomyopathy 11.8%
Cerebrovascular accident 6.2%
Cardiovascular conditions 14.6%
Noncardiovascular conditions 12.8%
Unknown etiology 4.7%

Source: Creanga et al. 201570

Among the causes, cardiovascular conditions ranked first, with 14.4% of 490 maternal deaths occurring after a live birth, 11.4% after a stillbirth, 7.8% after an abortion, 20.2% with the fetus undelivered, and 12.7% unknown.70

5.4         KEY TRENDS AND HEALTH OUTCOMES

A retrospective analysis of insurance claims in the MarketScan Commercial Claims and Encounters database showed that between the years 2000-2011, the use of glyburide (an oral sulfonylurea medication, also known as glibenclamide) to treat gestational diabetes increased from 7.4 to 64.5%.71 The data indicated that since 2007, glyburide surpassed insulin as the most common treatment for gestational diabetes. Its use is somewhat controversial because glyburide is not approved by the US Food and Drug Administration for treatment of gestational diabetes, though it has been recommended by the Endocrine Society72 and the American College of Obstetrics and Gynecology73 as a suitable alternative to insulin if necessary. A systematic review and meta-analysis of the literature found that glyburide is inferior to both insulin and metformin to treat gestational diabetes, though treatment failure was higher with metformin than with glyburide; this report recommended against using glyburide to treat gestational diabetes if insulin or metformin was available as an option.74

 

Among the 10% of all pregnancies in the US complicated by diabetes, 0.2% to 0.5% involve type 1 diabetes; both fetus and mother are at increased risk for adverse effects. A 2011 literature review advised a rigorous protocol of pre-conception counseling, carbohydrate counting, use of insulin analogues, continuous subcutaneous insulin infusion (insulin pump) therapy, and real-time continuous glucose monitoring with alarms for low glucose values to obtain near-normoglycemia without episodes of severe hypoglycemia.75

Beyond drug treatment, increasing physical activity has the effect of reducing the risk of type 2 diabetes among pregnant females. Compared with females who maintained their total physical activity levels, females who increased their total physical activity levels by 7.5 metabolic equivalent hours/week or more (equivalent to 150 minutes per week of moderate-intensity physical activity) had a 47% lower risk of type 2 diabetes. This association remained significant after additional adjustment for BMI.76

Immediately subsequent to pregnancy, about 5%–10% of females with gestational diabetes are diagnosed with type 2 diabetes, and females who have had gestational diabetes have a 35%–60% risk of developing type 2 diabetes in the next 10 to 20 years.27 The risk of subsequent overt type 2 diabetes accumulates over time and the same is likely for cardiovascular disease.77 Females with previous gestational diabetes are at the risk of developing it again in subsequent pregnancies78. The risk of gestational diabetes in a second pregnancy among females with a history of the disease was 41.3%, compared to 4.2% in females without a prior diagnosis.78

Although having gestational diabetes is known to increase the risk of developing type 2 diabetes later in life, the most recent findings indicate that lifestyle interventions – specifically, increased exercise – can decrease that risk.76

Patients with pre-existing diabetes who become pregnant are at greater risk for maternal and fetal complications than their nondiabetic counterparts. In a study of 213 pairs of type 2 diabetes patients and control patients from 2000 to 2008, patients with diabetes had higher rates of preeclampsia, poly- and oligohydramnios, cesarean delivery, shoulder dystocia, postpartum hemorrhage, preterm delivery, large-for-gestational age infant, fetal anomaly, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, sepsis, intubation, and neonatal intensive care unit admission.79

The role of intrauterine hyperglycemia and future risk of type 2 diabetes in human offspring appears to be involved in the pathogenesis of type 2 diabetes/pre-diabetes in adult offspring of primarily Caucasian females with either diet-treated GDM or type 1 diabetes during pregnancy. In a study of glucose tolerance among adult offspring of females with either gestational diabetes mellitus (GDM) or type 1 diabetes, taking the impact of both intrauterine hyperglycemia and genetic predisposition to type 2 diabetes into account, the risk for type 2 diabetes or pre-diabetes was increased by 4.02 to 7.76% in offspring of mothers with type 1 diabetes and was significantly related to the mother’s having elevated blood glucose in late pregnancy.80

References

  1. Dabelea D, Mayer-Davis EJ, Saydah S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. The Journal of the American Medical Association. 2014;311(17):1778-1786.
  2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2014;37 Suppl 1:S81-90.
  3. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US. Department of Health and Human Services; 2014.
  4. Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Annals of internal medicine. 2014;160(8):517-525.
  5. Jovanovic L, Liang Y, Weng W, Hamilton M, Chen L, Wintfeld N. Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes/metabolism Research and Reviews. 2015.
  6. Irgens HU, Molnes J, Johansson BB, Ringdal M, Skrivarhaug T, Undlien DE, Sovik O, Joner G, Molven A, Njolstad PR. Prevalence of monogenic diabetes in the population-based Norwegian Childhood Diabetes Registry. Diabetologia. 2013;56(7):1512-1519.
  7. Shields BM, Hicks S, Shepherd MH, Colclough K, Hattersley AT, Ellard S. Maturity-onset diabetes of the young (MODY): how many cases are we missing? Diabetologia. 2010;53(12):2504-2508.
  8. Cheng YJ, Gregg EW, Kahn HS, Williams DE, De Rekeneire N, Narayan KMV. Peripheral insensate neuropathy–a tall problem for US adults? American Journal of Epidemiology. 2006;164(9):873-880.
  9. Koopman RJ, Mainous AG 3rd, Liszka HA, Colwell JA, Slate EH, Carnemolla MA, Everett CJ. Evidence of nephropathy and peripheral neuropathy in US adults with undiagnosed diabetes. The Annals of Family Medicine. 2006;4(5):427-432.
  10. Zhang X, Saaddine JB, Chou C-F, Cotch MF, Cheng YJ, Geiss LS, Gregg EW, Albright AL, Klein BEK, Klein R. Prevalence of diabetic retinopathy in the United States, 2005-2008. The Journal of the American Medical Association. 2010;304(6):649-656.
  11. Wong TY, Klein R, Islam FM, et al. Diabetic retinopathy in a multi-ethnic cohort in the United States. American Journal of Ophthalmology. 2006;141(3):446-455.
  12. de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. The Journal of the American Medical Association. 2011;305(24):2532-2539.
  13. Plantinga LC, Crews DC, Coresh J, Miller ER 3rd, Saran R, Yee J, Hedgeman E, Pavkov M, Eberhardt MS, Williams DE, Powe NR, Cdc Ckd Surveillance Team. Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clinical Journal of the American Society of Nephrology. 2010;5(4):673-682.
  14. Gregg EW, Li Y, Wang J, Burrows NR, Ali MK, Rolka D, Williams DE, Geiss L. Changes in diabetes-related complications in the United States, 1990-2010. The New England journal of medicine. 2014;370(16):1514-1523.
  15. American Diabetes Association. Economic Costs of Diabetes in the US in 2012. Diabetes Care. 2013;36(4):1033-1046.
  16. Vojta D, De Sa J, Prospect T, Stevens S. Effective interventions for stemming the growing crisis of diabetes and prediabetes: a national payer’s perspective. Health Affairs (Project Hope). 2012;31(1):20-26.
  17. Shrestha SS, Zhang P, Albright A, Imperatore G. Medical expenditures associated with diabetes among privately insured U.S. youth in 2007. Diabetes Care. 2011;34(5):1097-1101.
  18. Dall TM, Zhang Y, Chen YJ, Quick WW, Yang WG, Fogli J. The economic burden of diabetes. Health Affairs (Project Hope). 2010;29(2):297-303.
  19. Gordois A, Scuffham P, Shearer A, Oglesby A. The health care costs of diabetic nephropathy in the United States and the United Kingdom. Journal of Diabetes and its Complications. 2004;18(1):18-26.
  20. Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the US. Diabetes care. 2003;26(6):1790-1795.
  21. CfDCa, Frieden TR, Jaffe HW, Stephens JW, Thacker SB, Zaza S. Self-reported visual impairment among persons with diagnosed diabetes — United States, 1997–2010. MMWR Morb Mortal Wkly Rep. 2011;60(45):1549-1553.
  22. Ward A, Alvarez P, Vo L, Martin S. Direct medical costs of complications of diabetes in the United States: estimates for event-year and annual state costs (USD 2012). Journal of Medical Economics. 2014;17(3):176-183.
  23. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine. 2002;346(6):393-403.
  24. Nichols GA, Hillier TA, Brown JB. Progression from newly acquired impaired fasting glusose to type 2 diabetes. Diabetes Care. 2007;30(2):228-233.
  25. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation, 2013 Accessed 1 June 2015; http://www.idf.org/diabetesatlas.
  26. Centers for Disease Control and Prevention. Prediabetes. 2014 Accessed 1 June 2015; http://www.cdc.gov/diabetes/basics/prediabetes.html.
  27. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
  28. Go AS, Mozaffarian D, Roger VL, Benjamin EJB, Jarett D, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. 2014;129(3):e28-e292.
  29. Huang Y, Cai X, Chen P, Mai W, Tang H, Huanf Y, Hu Y. Associations of prediabetes with all-cause and cardiovascular mortality: a meta-analysis. Annals of medicine. 2014;46(8):684-692.
  30. McAuley PA, Artero EG, Sui X, Lavie CJ, Almeida MJ, Blair SN. Fitness, fatness, and survival in adults with prediabetes. Diabetes Care. 2014;37(2):529-536.
  31. Centers for Disease Control and Prevention. Self-reported prediabetes and risk-reduction activities–United States, 2006. Morbidity and Mortality Weekly Report. 2008;57(44):1203-1205.
  32. National Diabetes Information Clearinghouse. Diabetes Prevention Program (DPP). NIH Publication No. 09-5099. Accessed 10 June 2014; http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/.
  33. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England Journal of Medicine. 2001;344(18):1343-1350.
  34. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HBm Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537-544.
  35. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M, Stop-Niddm Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359(9323):2072-2077.
  36. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic females. Diabetes. 2002;51(9):2796-2803.
  37. Mayer-Davis EJ, Bell RA, Dabelea D, D’Agostino R Jr, Imperatore G, Lawrence JM, Liu L, Marcovina S, Search for Diabetes in Youth Study Group. The many faces of diabetes in American youth: type 1 and type 2 diabetes in five race and ethnic populations: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S99-101.
  38. Menke A, Orchard TJ, Imperatore G, Bullard KM, Mayer-Davis E, Cowie CC. The prevalence of type 1 diabetes in the United States. Epidemiology (Cambridge, Mass.). 2013;24(5):773-774.
  39. Imperatore G, Boyle JP, Thompson TJ, Case D, Dabelea D, Hamman RF, Lawrence JM, Liese AD, Liu LL, Mayer-Davis, EJ, Rodriguez BL, Standiford D, Search for Diabetes in Youth Study Group. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: dynamic modeling of incidence, mortality, and population growth. Diabetes care. 2012;35(12):2515-2520.
  40. Lipman TH, Ratcliffe SJ, Cooper R, Levitt Katz LE. Population-based survey of the prevalence of type 1 and type 2 diabetes in school children in Philadelphia. Journal of Diabetes. 2013;5(4):456-461.
  41. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes. 2012;61(11):2987-2992.
  42. Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, Joss N, Lees G, Leslie P, McCrimmon RJ, Metcalfe W, McKnight JA, Morris AD, Pearson DW, Petrie JR, Philip S, Sattar NA, Traynor JP, Colhoun HM. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. The Journal of the American Medical Association. 2015;313(1):37-44.
  43. Orchard TJ, Nathan DM, Zinman B, Cleary P, Brillon D, Backlund JY, Lachin JM. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. The Journal of the American Medical Association. 2015;313(1):45-53.
  44. Campbell MS, Schatz DA, Chen V, Wong JC, Steck A, Tamborlane WV, Smith J, Beck RW, Cengiz E, Laffel LM, Miller KM, Haller MJ, TD Exchange Clinic Network. A contrast between children and adolescents with excellent and poor control: the T1D Exchange clinic registry experience. Pediatric Diabetes. 2014;15(2):110-117.
  45. Simmons JH, Chen V, Miller KM, McGill JB, Bergenstal RM, Goland RS, Harlan DM, Largay JF, Massaro EM, Beck EW, TD Exhange Clinic Network. Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D Exchange Clinic Registry. Diabetes Care. 2013;36(11):3573-3577.
  46. Shankar A, Klein R, Klein BEK, Moss SE. Association between glycosylated hemoglobin level and cardiovascular and all-cause mortality in type 1 diabetes. Americal Journal of Epidemiology. 2007;166(4):393-402.
  47. Fullerton B, Jeitler K, Seitz Ms, Horvath K, Berghold A, Siebenhofer A. Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. The Cochrane database of systematic reviews. 2014;2:Cd009122.
  48. Cheng YJ, Imperatore G, Geiss LS, Wang J, Saydah SH, Cowie CC, Gregg EW. Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010. Diabetes Care. 2013;36(9):2690-2696.
  49. Rhodes ET, Prosser LA, Hoerger TJ, Lieu T, Ludwig DS, Laffel LM. Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus. Diabetic Medicine : a journal of the British Diabetic Association. 2012;29(4):453-463.
  50. Logue J, Walker JJ, Leese G, Lindsay R, McKnight J, Morris A, Philip S, Wild S, Sattar N. Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality. Diabetes Care. 2013;36(4):887-893.
  51. Tobias DK, Pan A, Jackson CL, O’Reilly EJ, Ding EL, Willett WC, Manson JE, Hu FB. Body-mass index and mortality among adults with incident type 2 diabetes. The New England Journal of Medicine. 2014;370(3):233-244.
  52. Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care. 2013;36(8):2271-2279.
  53. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218-1224.
  54. Tran L, Zielinski A, Roach AH, Jense JA, Householder AM, Cole EE, Atway SA, Amornyard M, Accursi ML, Shieh SW, Thompson EE. Pharmacologic treatment of type 2 diabetes: injectable medications. The Annals of Pharmacotherapy. 2015;49(6):700-714.
  55. Tran L, Zielinski A, Roach AH, Jense JA, Householder AM, Cole EE, Atway SA, Amornyard M, Accursi ML, Shieh SW, Thompson EE. Pharmacologic treatment of type 2 diabetes: oral medications. The Annals of Pharmacotherapy. 2015;49(5):540-556.
  56. Hampp C, Borders-Hemphill V, Moeny DG, Wysowski DK. Use of antidiabetic drugs in the U.S., 2003-2012. Diabetes Care. 2014;37(5):1367-1374.
  57. Aponte J. Prevalence of normoglycemic, prediabetic and diabetic A1c levels. World Journal of Diabetes. 2013;4(6):349-357.
  58. Chiu CJ, Wray LA. Factors predicting glycemic control in middle-aged and older adults with type 2 diabetes. Preventing Chronic Disease. 2010;7(1):A08.
  59. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. The New England journal of medicine. 2013;368(17):1613-1624.
  60. Berkowitz SA, Meigs JB, Wexler DJ. Age at type 2 diabetes onset and glycaemic control: results from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Diabetologia. 2013;56(12):2593-2600.
  61. Luk AO, Ma RC, Lau ES, Yang X, Lau WW, Yu LW, Chow FC, Chan JC, So WY. Risk association of HbA1c variability with chronic kidney disease and cardiovascular disease in type 2 diabetes: prospective analysis of the Hong Kong Diabetes Registry. Diabetes/metabolism Research and Reviews. 2013;29(5):384-390.
  62. Joseph JJ, Donner TW. Long-term insulin glargine therapy in type 2 diabetes mellitus: a focus on cardiovascular outcomes. Vascular Health and Risk Management. 2015;11:107-116.
  63. DeSisto CL, Kim SY, Sharma AJ. Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Preventing Chronic Disease. 2014;11.
  64. Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant females, 1999-2005. Diabetes Care. 2008;31(5):899-904.
  65. Getahun D, Nath C, Ananth CV, Chavez MR, Smulian JC. Gestational diabetes in the United States: temporal trends 1989 through 2004. American Journal of Obstetrics and Gynecology. 2008;198(5):525.e521-525.
  66. Kim SY, England L, Wilson HG, Bish C, Satten GA, Dietz P. Percentage of gestational diabetes mellitus attributable to overweight and obesity. American Journal of Public Health. 2010;100(6):1047-1052.
  67. Cundy T, Ackermann E, Ryan EA. Gestational diabetes: new criteria may triple the prevalence but effect on outcomes is unclear. British Medical Journal (Clinical Research Ed). 2014;348:g1567.
  68. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30 Suppl 2:S141-146.
  69. Xiang AH, Li BH, Black MH,Sacks DA, Buchanan TA, Jacobsen SJ, Lawrence JM. Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Diabetologia. 2011;54(12):3016-3021.
  70. Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstetrics and Gynecology. 2015;125(1):5-12.
  71. Camelo Castillo W, Boggess K, Sturmer T, Brookhart MA, Benjamin DK, Jr., Jonsson Funk M. Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011. Obstetrics and Gynecology. 2014;123(6):1177-1184.
  72. Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH, Yogev Y. Diabetes and pregnancy: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2013;98(11):4227-4249.
  73. Committee on Practice, Bulletins-Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstetrics and Gynecology. 2013;122(2 Pt 1):406-416.
  74. Balsells M, Garcia-Patterson A, Sola I, Roque M, Gich I, Corcoy R. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. British Medical Journal. 2015;350:h102.
  75. Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, Damm P, Mathiesen ER. Hypoglycaemia during pregnancy in females with Type 1 diabetes. Diabetic Medicine : a journal of the British Diabetic Association. 2012;29(5):558-566.
  76. Bao W, Tobias DK, Bowers K, Chavarro J, Vaag A, Grunnet LG, Strom M, Mills J, Liu A, Kiely M, Zhang C. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Internal Medicine. 2014;174(7):1047-1055.
  77. Carr DB, Utzschneider KM, Hull RL, Tong J, Wallace TM, Kodama K, Shofer JB, Heckbert SR, Boyko EJ, Fujimoto WY, Kahn SE. Gestational diabetes mellitus increases the risk of cardiovascular disease in females with a family history of type 2 diabetes. Diabetes Care. 2006;29(9):2078-2083.
  78. Getahun D, Fassett MJ, Jacobsen SJ. Gestational diabetes: risk of recurrence in subsequent pregnancies. American Journal of Obstetrics and Gynecology. 2010;203(5):467 e461-466.
  79. Knight KM, Pressman EK, Hackney DN, Thornburg LL. Perinatal outcomes in type 2 diabetic patients compared with non-diabetic patients matched by body mass index. The Journal of Maternal-Fetal and Neonatal Medicine. 2012;25(6):611-615.
  80. Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, Damm P. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of females with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340-346.
  81. Rubio-Cabezas O, Ellard S. Diabetes mellitus in neonates and infants: genetic heterogeneity, clinical approach to diagnosis, and therapeutic options. Hormone Research in Paediatrics. 2013;80(3):137-146.
  82. Fendler W, Borowiec M, Baranowska-Jazwiecka A, Szadkowska A, Skala-Zamorowska E, Deja G, Jarosz-Chobot P, Techmanska I, Bautembach-Minkowska J, Mysliwiec M, Zmyslowska A, Pietrzal I, Malecki MT, Mlynarski W. Prevalence of monogenic diabetes amongst Polish children after a nationwide genetic screening campaign. Diabetologia. 2012;55(10):2631-2635.
  83. Thomas CC, Philipson LH. Update on diabetes classification. The Medical Clinics of North America. 2015;99(1):1-16.
  84. Patterson C, Guariguata L, Dahlquist G, Soltesz G, Ogle G, Silink M. Diabetes in the young – a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Research and Clinical Practice. 2014;103(2):161-175.
  85. Wheeler BJ, Patterson N, Love DR, Prosser D, Tomlinson P, Taylor BJ, Manning P. Frequency and genetic spectrum of maturity-onset diabetes of the young (MODY) in southern New Zealand. Journal of Diabetes and Metabolic Disorders. 2013;12(1):46.
  86. Steele AM, Shields BM, Shepherd M, Ellard S, Hattersley AT, Pearson ER. Increased all-cause and cardiovascular mortality in monogenic diabetes as a result of mutations in the HNF1A gene. Diabetic Medicine : a journal of the British Diabetic Association. 2010;27(2):157-161.
  87. Thanabalasingham G, Pal A, Selwood MP, Dudley C, Fisher K, Bingley PJ, Ellard S, Farmer AJ, McCarthy MI, Owen KR. Systematic assessment of etiology in adults with a clinical diagnosis of young-onset type 2 diabetes is a successful strategy for identifying maturity-onset diabetes of the young. Diabetes Care. 2012;35(6):1206-1212.
  88. Carmody D, Bell CD, Hwang JL, Dickens JT, Sima DI, Felipe DL, Zimmer CA, Davis AO, Kotlyarevska K, Naylor RN, Philipson LH, Greeley SA. Sulfonylurea treatment before genetic testing in neonatal diabetes: pros and cons. The Journal of Clinical Endocrinology and Metabolism. 2014;99(12):E2709-2714.
  89. Thurber BW, Carmody D, Tadie EC, Pastore AN, Dickens JT, Wroblewski KE, Naylor RN, Philipson LH, Greeley SA, United States National Diabetes Working Group. Age at the time of sulfonylurea initiation influences treatment outcomes in KCNJ11-related neonatal diabetes. Diabetologia. 2015;58(7):1430-1435.
  90. Shah B, Breidbart E, Pawelczak M, Lam L, Kessler M, Franklin B. Improved long-term glucose control in neonatal diabetes mellitus after early sulfonylurea allergy. Journal of Pediatric Endocrinology & Metabolism. 2012;25(3-4):353-356.
  91. Riveline JP, Rousseau E, Reznik Y, Fetira S, Philippe J, Dechaume A, Hartemann A, Polak M, Petit C, Charpentier G, Gautier JF, Froguel P, Vaxillaire M. Clinical and metabolic features of adult-onset diabetes caused by ABCC8 mutations. Diabetes Care. 2012;35(2):248-251.
  92. Mountford WK, Soule JB, Lackland DT, Lipsitz SR, Colwell JA. Diabetes-related lower extremity amputation rates fall significantly in South Carolina. Southern Medical Journal. 2007;100(8):787-790.
  93. National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Information Clearinghouse (NDIC). Diabetic Neuropathies: The Nerve Damage of Diabetes. NIH Publication No. 09–3185, February 2009. Accessed 6 June 2014; http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/index.aspx. Accessed June 5, 2014.
  94. Greig M, Tesfaye S, Selvarajah D, Wilkinson ID. Insights into the pathogenesis and treatment of painful diabetic neuropathy. Handbook of Clinical Neurology. 2014;126:559-578.
  95. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, Curtin L, Engelgau M, Geiss L. Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care. 2004;27(7):1591-1597.
  96. Jaiswal M, Lauer A, Martin CL, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes care. 2013;36(12):3903-3908.
  97. Chin MH, Zhang JX, Merrell K. Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization. Diabetes Care. 1998;21(7):1090-1095.
  98. Hamman RF, Franklin GA, Mayer EJ, Marshall SM, Marshall JA, Baxter J, Kahn LB. Microvascular complications of NIDDM in Hispanics and non-Hispanic whites. San Luis Valley Diabetes Study. Diabetes Care. 1991;14(7):655-664.
  99. Martin TL, Selby JV, Zhang D. Physician and patient prevention practices in NIDDM in a large urban managed-care organization. Diabetes Care. 1995;18(8):1124-1132.
  100. Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care. 2003;26(6):1895-1901.
  101. Wang W, Balamurugan A, Biddle J, Rollins KM. Diabetic neuropathy status and the concerns in underserved rural communities: challenges and opportunities for diabetes educators. The Diabetes Educator. 2011;37(4):536-548.
  102. Gore M, Brandenburg NA, Hoffman DL, Tai KS, Stacey B. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. The Journal of Pain. 2006;7(12):892-900.
  103. National Eye Institute. Facts About Diabetic Retinopathy. Adapted from Don’t Lose Sight of Diabetic Eye Disease (NIH Publication No. 04-3252) and Diabetic Retinopathy: What You Should Know (NIH Publication No. 03-2171). Last Updated June 2012, Accessed 10 June 2015; http://www.nei.nih.gov/health/diabetic/retinopathy.asp.
  104. American Optometric Association. Diabetic Retinopathy. Accessed 10 June 2015; http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/diabetic-retinopathy.
  105. Klein BE, Klein R, McBride PE, Cruickshanks KJ, Palta M, Knudtson MD, Moss SE, Reinke JO. Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy. Archives of Internal Medicine. 2004;164(17):1917-1924.
  106. Stefanini FR, Badaro E, Falabella P, Koss M, Farah ME, Maia M. Anti-VEGF for the management of diabetic macular edema. Journal of Immunology Research. 2014;2014:632307.
  107. Diabetes and kidney disease. National Library of Medicine from National Institutes of Health. Last updated 16 May 2014 , Accessed 10 June 2014; http://www.nlm.nih.gov/medlineplus/ency/article/000494.htm.
  108. American Diabetes Association. Kidney Disease (Nephropathy). Last Edited December 10, 2013, accessed 10 June 2015 http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html.
  109. Young BA, Maynard C, Boyko EJ. Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans. Diabetes Care. 2003;26(8):2392-2399.
  110. Bhalla V, Zhao B, Azar KM, Wang EJ, Choi S, Wong EC, Fortmann Sp, Palaniappan LP. Racial/ethnic differences in the prevalence of proteinuric and nonproteinuric diabetic kidney disease. Diabetes Care. 2013;36(5):1215-1221.
  111. McMullan CJ, Lambers Heerspink HJ, Parving HH, Dwyer JP, Forman JP, de Zeeuw D. Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial. American Journal of Kidney Diseases. 2014;64(5):714-722.
  112. Huang YQ, Gou R, Diao YS, Yin QH, Fan WX, Liang YP, Chen Y, Wu M, Zang L, Li L, Zang J, Cheng L, Fu P, Liu F. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. Journal of Zhejiang University Science B. 2014;15(1):58-66.
  113. National Institute of Diabetes and Digestive Kidney Diseases. United States Renal Data System. Annual Data Report 2013: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD National Institutes of Health;2013.

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