Gestational diabetesis on the rise worldwide, and a new Canadian study said the reason for it may not be linked to previous speculation such as obesity, maternal age or lack of exercise.
The increase could be that screening methods for gestational diabetes — a type of diabetes that occurs during the second or third trimester of pregnancy — have improved.
The study out of British Columbia and published Monday in the Canadian Medical Association Journal (CMAJ) said in Canada, the rate of gestational diabetes rose to seven per cent in 2014 from four per cent in 2004 across all racial and ethnic groups.
“We were interested in understanding why rates of gestational diabetes were increasing in British Columbia. What we found was that rates of gestational diabetes … there was a change in the way that we screen for diabetes, which has really been taken up in British Columbia,” explained Elizabeth Nethery, lead author of the study and PhD in the School of Population and Public Health at the University of British Columbia.
“We’ve been using a much more sensitive method to screen, and we found that that change in screening practice has really led to the almost doubling of gestational diabetes cases in British Columbia.”
The jump in diabetes in pregnancy has previously been linked to maternal age (the risk of diabetes when pregnant goes up with age), less exercise and poor diet, but the authors argued this is likely not the case.
The researchers looked at data from more than 550,000 pregnancies in B.C. from 2005 to 2019 as well as screening methods. During the study period, diagnoses of gestational diabetes doubled, to 14.7 per cent from 7.2 per cent in the province, and so did the amount and type of screenings.
Change in gestational diabetes screening
In order for someone to be diagnosed with gestational diabetes, a glucose screening test needs to be completed.
“Fifteen to 20 years ago, screening was really considered more optional and that has changed. And now we recommend that everybody gets screened in pregnancy,” Nethery said.
Although it’s not mandatory, Diabetes Canada recommends that doctors screen all women between the 24th and 28th weeks of pregnancy.
There are two types of screenings that are used.
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The first type is a one-step screening method that consists of a single two-hour glucose tolerance test. The second type is a two-step screening method, which consists of a one-hour glucose challenge test, followed by a two-hour oral glucose tolerance test for patients who screen positive.
The advantage of the one-step screening is that only one laboratory visit is needed, but this single visit takes several hours and requires fasting and three blood samples, the study said.
“The difference with this kind of one-step approach is that it actually catches quite a lot more people than the previous methods that we were using,” Nethery explained, meaning the use of this method could lead to more diagnoses of gestational diabetes.
Whether it’s a one- or two-step approach, there isn’t a universal method for gestational diabetes screening in Canada. In fact, it varies not only from province to province, but also city to city.
Dr. Jennifer Yamamoto, assistant professor of internal medicine at the University of Manitoba, said because of the lack of uniformity, the glucose test is “quite controversial.”
“We see a lot of variety, whether people do the one- or two-step approach,” she said. “For example, at my centre here in Winnipeg, most people will do the two-step approach. But we still have a number of clinicians who are ordering the one-step approach. So it’s very practitioner-dependent and very regional.”
Currently, Diabetes Canada recommends the two-step gestational screening method.
Lack of screening data
Another problem of gestational diabetes screening is the method is not typically recorded in data registries or hospital discharge summaries, the authors said, and this could explain why the increase in cases of the condition remains unknown.
Although there is a lack of data, the B.C. researchers were able to examine the one- and two-step screening information using medical insurance billing. They then examined a group of pregnancies in B.C. using glucose tolerance screenings (either the one- or two-step process) between 2004 and 2019.
Between 2005 and 2018, screening for gestational diabetes in the province went up to 95.5 per cent from 87.2 per cent. And the use of the one-step screening methods went from zero in 2005 to 39.5 per cent in 2019, the study found.
The authors found the increase was largely due to changes in gestational diabetes screening practices, from a two-step screening process to a more sensitive one-step screening process.
“We found that change in screening in particular really bumped up the proportion of people that were being diagnosed (with gestational diabetes),” Nethery said.
Does screening improve outcomes?
Gestational diabetes can lead to a number of pregnancy complications if not properly managed. High blood sugar during pregnancy can lead to preeclampsia, abnormal sugar levels in the baby and possible birth injury due to the baby’s large size, according to Diabetes Canada.
Treatment for the condition can be as simple as lifestyle changes, like diet and physical activity; however, some women need to inject insulin in order to manage it.
After delivery, the condition usually goes away, but in severe cases, some women and babies can develop Type 2 diabetes later on in life.
Because gestational diabetes can require a lot of medical involvement during pregnancy (such as more tests and ultrasounds), the more people diagnosed, the more strain on the health-care system, Yamamoto said.
“While newer randomized controlled trials have demonstrated that the one-step approach diagnosis a lot more diabetes, it doesn’t actually improve outcomes at a population level,” she argued.
The one-step screening method picks up gestational diabetes at lower sugar levels, meaning health-care providers can pick up more “mild forms” of the condition.
“Andthose are the types of diabetes that maybe don’t benefit from the additional treatment, as we would see in people with more severe, higher blood sugars,” Yamamoto said.
Nethery agreed.
If a person is diagnosed with gestational diabetes, there are more tests, medical visits and ultrasounds and the person is more likely to be induced, she said.
“These not only have a cost to the system, but they also have a lot of individual implications for people,” she said. “And we are potentially kind of over-diagnosing people who especially are on the lower range of blood sugar.”
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CHARLESTON, W.Va. (AP) — A linebacker at Division II West Virginia State was fatally shot during what the university said Thursday is being investigated by police as a home invasion.
The body of Jyilek Zyiare Harrington, 21, of Charlotte, North Carolina, was found inside an apartment Wednesday night in Charleston, police Lt. Tony Hazelett said in a statement.
Hazelett said several gunshots were fired during a disturbance in a hallway and inside the apartment. The statement said Harrington had multiple gunshot wounds and was pronounced dead at the scene. Police said they had no information on a possible suspect.
West Virginia State said counselors were available to students and faculty on campus.
“Our thoughts and prayers are with Jyilek’s family as they mourn the loss of this incredible young man,” West Virginia State President Ericke S. Cage said in a letter to students and faculty.
Harrington, a senior, had eight total tackles, including a sack, in a 27-24 win at Barton College last week.
“Jyilek truly embodied what it means to be a student-athlete and was a leader not only on campus but in the community,” West Virginia State Vice President of Intercollegiate Athletics Nate Burton said. “Jyilek was a young man that, during Christmas, would create a GoFundMe to help less fortunate families.”
Burton said donations to a fund established by the athletic department in Harrington’s memory will be distributed to an organization in Charlotte to continue his charity work.
West Virginia State’s home opener against Carson-Newman, originally scheduled for Thursday night, has been rescheduled to Friday, and a private vigil involving both teams was set for Thursday night. Harrington previously attended Carson-Newman, where he made seven tackles in six games last season. He began his college career at Division II Erskine College.
“Carson-Newman joins West Virginia State in mourning the untimely passing of former student-athlete Jyilek Harrington,” Carson-Newman Vice President of Athletics Matt Pope said in a statement. “The Harrington family and the Yellow Jackets’ campus community is in our prayers. News like this is sad to hear anytime, but today it feels worse with two teams who knew him coming together to play.”
DETROIT (AP) — Joe Schmidt, the Hall of Fame linebacker who helped the Detroit Lions win NFL championships in 1953 and 1957 and later coached the team, has died. He was 92.
The Lions said family informed the team Schmidt died Wednesday. A cause of death was not provided.
One of pro football’s first great middle linebackers, Schmidt played his entire NFL career with the Lions from 1953-65. An eight-time All-Pro, he was enshrined into the Pro Football Hall of Fame in 1973 and the college football version in 2000.
“Joe likes to say that at one point in his career, he was 6-3, but he had tackled so many fullbacks that it drove his neck into his shoulders and now he is 6-foot,” said the late Lions owner William Clay Ford, Schmidt’s presenter at his Hall of Fame induction in 1973. “At any rate, he was listed at 6-feet and as I say was marginal for that position. There are, however, qualities that certainly scouts or anybody who is drafting a ballplayer cannot measure.”
Born in Pittsburgh, Schmidt played college football in his hometown at Pitt, beginning his stint there as a fullback and guard before coach Len Casanova switched him to linebacker.
“Pitt provided me with the opportunity to do what I’ve wanted to do, and further myself through my athletic abilities,” Schmidt said. “Everything I have stemmed from that opportunity.”
Schmidt dealt with injuries throughout his college career and was drafted by the Lions in the seventh round in 1953. As defenses evolved in that era, Schmidt’s speed, savvy and tackling ability made him a valuable part of some of the franchise’s greatest teams.
Schmidt was elected to the Pro Bowl 10 straight years from 1955-64, and after his arrival, the Lions won the last two of their three NFL titles in the 1950s.
In a 1957 playoff game at San Francisco, the Lions trailed 27-7 in the third quarter before rallying to win 31-27. That was the NFL’s largest comeback in postseason history until Buffalo rallied from a 32-point deficit to beat Houston in 1993.
“We just decided to go after them, blitz them almost every down,” Schmidt recalled. “We had nothing to lose. When you’re up against it, you let both barrels fly.”
Schmidt became an assistant coach after wrapping up his career as a player. He was Detroit’s head coach from 1967-72, going 43-35-7.
Schmidt was part of the NFL’s All-Time Team revealed in 2019 to celebrate the league’s centennial season. Of course, he’d gone into the Hall of Fame 46 years earlier.
Not bad for an undersized seventh-round draft pick.
“It was a dream of mine to play football,” Schmidt told the Detroit Free Press in 2017. “I had so many people tell me that I was too small. That I couldn’t play. I had so many negative people say negative things about me … that it makes you feel good inside. I said, ‘OK, I’ll prove it to you.’”
VICTORIA – British Columbia’s Environment Assessment Office has fined Coastal GasLink Pipeline Ltd. $590,000 for “deficiencies” in the construction of its pipeline crossing the province.
The office says in a statement that 10 administrative penalties have been levied against the company for non-compliance with requirements of its environmental assessment certificate.
It says the fines come after problems with erosion and sediment control measures were identified by enforcement officers along the pipeline route across northern B.C. in April and May 2023.
The office says that the latest financial penalties reflect its escalation of enforcement due to repeated non-compliance of its requirements.
Four previous penalties have been issued for failing to control erosion and sediment valued at almost $800,000, while a fifth fine of $6,000 was handed out for providing false or misleading information.
The office says it prioritized its inspections along the 670-kilometre route by air and ground as a result of the continued concerns, leading to 59 warnings and 13 stop-work orders along the pipeline that has now been completed.
This report by The Canadian Press was first published Sept. 12, 2024.
