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Diabetes & Women’s Health
Sarita Bajaj, Rajesh Rajput, Jubbin J Jacob
SECTION 1: GENERAL MANAGEMENT OF DIABETES IN WOMEN
CHAPTER 1:
Medical Management of Hyperglycemia in Women with Type 2 Diabetes Mellitus
INTRODUCTION
American Diabetes Association-European Association for the study of Diabetes POSITION STATEMENT1
POLYCYSTIC OVARIAN SYNDROME
PREGNANCY
MENOPAUSE
WEIGHT GAIN
CHAPTER 2:
Cardiovascular Risks in Women with Diabetes Mellitus and their Management
INTRODUCTION
SEX ASPECT IN CARDIOVASCULAR DISEASE
Sex-specific Differences in Cardiovascular Disease
Sex-specific Conditions in Women influencing Cardiovascular Disease
CARDIOVASCULAR RISK IN WOMEN WITH DIABETES
Age
INTERACTION BETWEEN CARDIOVASCULAR DISEASE RISK FACTORS AND DIABETES
Cardiovascular Risk Factors and their Impact
Obesity
Hypertension
Dyslipidemia
Hypercoagulability, Oxidative Stress, and Subclinical Inflammation
DISPARITIES IN MEDICAL TREATMENT AND MANAGEMENT
Diabetes-related Risk Factors in the Development of Cardiovascular Disease
Duration of Diabetes
Glycosylated Hemoglobin
Microvascular Disease
C-reactive Protein
MANAGEMENT
CONCLUSION
CHAPTER 3:
Transitional Care to Young Adulthood in Adolescent Girls with Diabetes Mellitus
INTRODUCTION
HORMONAL CHANGES IMPACTING GLUCOSE METABOLISM THAT ACCOMPANY PUBERTY IN YOUNG WOMEN
PSYCHOSOCIAL ISSUES IN ADOLESCENCE AND YOUNG ADULTS
Sexual and Reproductive Health Issues in Adolescents and Young Women
Alcohol, Smoking, and Drug Use among Adolescents and Young Women with Diabetes
PRACTICAL ISSUES IN MANAGING DIABETES IN WOMEN AND YOUNG ADOLESCENTS WITH DIABETES
Poor Metabolic Control
Loss to Follow-up
Increased Risk of Acute Complications During Transition
Emergence of Chronic Complications of Diabetes
Premature Mortality during the Transition Period
CURRENT MODELS OF TRANSITION CARE AND INTERVENTIONAL STUDIES IN THE TRANSITIONAL PERIOD
Dedicated Young Adult/Transition Clinics
Transition Care Coordinators
Young Adult Support Group
Grampian Model
SUMMARY OF RECOMMENDATIONS
CHAPTER 4:
Eating Disorders in Women with Type 1 Diabetes Mellitus
INTRODUCTION
DEFINITIONS
EPIDEMIOLOGY
Prevalence of Eating Disorder and Disturbed Eating Behavior
Prevalence of Insulin Omission in Type 1 Diabetes Mellitus
PREDISPOSITION FOR DEVELOPING AN EATING DISORDER
First Level—Premorbid Factors
Increased Body Weight and a Tendency to Gain Weight
Low Self-esteem and Body Dissatisfaction
Personality Factors
Family Factors
Second Level—Factors Associated with Disease Onset
Third Level—Factors Associated with Chronic Disease Management
Intensive Insulin Treatment
Dietary Restraint
Strict Dietary Regimen and Hypoglycemic Episodes
CLINICAL SIGNS OF EATING DISORDERS AMONG INDIVIDUALS WITH TYPE 1 DIABETES MELLITUS
Poor Glycemic Control
Recurrent Diabetic Ketoacidosis Episodes
Recurrent Hypoglycemic Episodes
Missed Clinical Visits
Weight Control Behaviors
Other Characteristics
Depression
DIAGNOSING EATING DISORDERS IN INDIVIDUALS WITH TYPE 1 DIABETES MELLITUS
Morbidity and Mortality
Short-term Complications
Long-term Complications
Mortality
PREVENTION
TREATMENT
DIABETES MANAGEMENT
Realistic Blood Glucose Targets
Insulin Pump Therapy
Dietary Treatment
Psychological Treatment
Individual Treatment
Family Treatment
Group Treatment
Hospitalization
CONCLUSION
CHAPTER 5:
Anxiety and Depression in Women with Diabetes Mellitus
INTRODUCTION
ANXIETY AND DEPRESSION IN DIABETIC WOMEN
CONCLUSION
CHAPTER 6:
Menopause and Diabetes with Focus on Hormone Replacement Therapy
INTRODUCTION
DIABETES AND AGE OF ONSET OF MENOPAUSE
Insulin Resistance and Menopause
Risk of Type 2 Diabetes Mellitus in Postmenopausal Women
HORMONE REPLACEMENT THERAPY IN DIABETIC WOMEN WITH MENOPAUSE
Hormonal Replacement Therapy and Risk of Type 2 Diabetes Mellitus
Hormonal Replacement Therapy and Glycemic Control
Hormonal Replacement Therapy and Lipid Profiles
Macrovascular Disease and Hormonal Replacement Therapy
Coronary Heart Disease
Stroke
Venous Thromboembolism
Osteoporosis
Cancer
MANAGING DIABETIC WOMEN AT THE MENOPAUSE
SECTION 2: MANAGEMENT OF WOMEN WITH PREGNANCY AND DIABETES
CHAPTER 7:
Preconceptional Care of Women with Diabetes Mellitus
INTRODUCTION
COMPARISON BETWEEN TYPE 1 AND TYPE 2 PREGESTATIONAL DIABETES
COMPONENTS OF PREPREGNANCY CARE IN WOMEN WITH DIABETES
General Prepregnancy Advice
Preconceptional Care (PCC)
Evidence for Benefits of Preconceptional Care in Women with Diabetes
GENERAL PREPREGNANCY ADVICE TO ALL WOMEN IN THE REPRODUCTIVE AGE
PRECONCEPTIONAL CARE
Initial Assessment
Contraception
Medical Nutrition Therapy
Exercise
Glycemic Control (Preconception Targets)
Monitoring Blood Glucose and Ketones in Preconception
Insulin Therapy
Oral Antidiabetic Medications in Women with Type 2 Diabetes Mellitus
Antihypertensive Therapy
Lipid Lowering Therapy
Managing Diabetic Retinopathy
Managing Diabetic Nephropathy
Preconceptional Folate Supplementation
Obstetric Input at the Prepregnancy Clinic
CONCLUSION
CHAPTER 8:
Pregnancy and Diabetes Mellitus
INTRODUCTION
PREGESTATIONAL DIABETES
GESTATIONAL DIABETES
Pathophysiology
Screening
Diagnostic Criteria
Which Criteria to Use
Management
Medical Nutrition Therapy
Oral Agents
Insulin
Role of Glucose Monitoring
Labor and Delivery
Postpartum Management
CHAPTER 9:
Intrapartum and Postpartum Management of Women with Diabetes Mellitus
INTRODUCTION
INTRAPARTUM CARE
Timing and Mode of Delivery
Antenatal Steroid Use
Management of Blood Glucose during Labor
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes Mellitus
EARLY POSTPARTUM CARE
Postpartum Metabolic Management
Information and Follow-up after Birth
Operative Delivery Rates and Care of the Abdominal Wound Care
Breastfeeding and Effects on Glycemic Control
Longer Term Follow-up
Follow-up Glucose Testing
MANAGEMENT OF IMPAIRED GLUCOSE TOLERANCE AFTER PREGNANCY
CONCLUSION
CHAPTER 10:
Infant of Diabetic Mother
INTRODUCTION
PERINATAL MORBIDITIES ASSOCIATED IN INFANT WITH DIABETIC MOTHER
Pathogenesis3,4
Hyperbilirubinemia
Hypocalcemia
Macrosomia
Polycythemia and Hyperviscosity
Hypoglycemia
Decreased Bone Density
Congenital Malformations
Hypoxia
Prematurity and Respiratory Distress Syndrome
Long-term Risks
Management5,6
Delivery Room Care
CHAPTER 11:
Long-term Consequences of Gestational Diabetes Mellitus
INTRODUCTION
LONG-TERM CONSEQUENCES IN MOTHERS
Recurrence of Gestational Diabetes Mellitus
Development of Type 2 Diabetes Mellitus
Prevention of Diabetes
Risk of Metabolic Syndrome and Cardiovascular Manifestations
LONG-TERM CONSEQUENCES IN THE OFFSPRING
Various long-Term Risks in Infants Born to GDM Mothers
Risk of Overweight and Obesity
Risk of Glycemic Disorders in the Offspring
Risk of Metabolic Syndrome in the Offspring
Risk of Cardiovascular Disorders
Risk of Neurological Consequences
FOLLOW-UP OF OFFSPRING BORN TO GDM MOTHERS
CONCLUSION
CHAPTER 12:
Long-term Outcomes in Infants Born to Diabetic Mothers
INTRODUCTION
IS CHILDHOOD METABOLIC COMPLICATIONS PROGRAMMED DURING IN UTERO LIFE: VARIOUS PATHOPHYSIOLOGY ASPECTS AND CONCEPT OF A METABOLIC MEMORY2–5
LONG-TERM OUTCOMES FOR OFFSPRING OF DIABETIC MOTHERS
Metabolic Syndrome
Diabetes
Obesity
Neuropsychological Deficits
HOW TO REDUCE LONG-TERM IMPACT OF MATERNAL DIABETES ON THE OFFSPRING
CONCLUSION
CHAPTER 13:
Hypertension and Pregnancy
INTRODUCTION
HOW TO MEASURE BLOOD PRESSURE
PATHOPHYSIOLOGY
INVESTIGATIONS
TREATMENT
CHAPTER 14:
Psychosocial Issues in Gestational Diabetes Mellitus
INTRODUCTION
WHAT A DIABETIC PREGNANCY ENTAILS
PSYCHOSOCIAL CONSEQUENCES OF DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS
PSYCHOSOCIAL ASSESSMENT OF A WOMAN WITH GESTATIONAL DIABETES MELLITUS
MANAGEMENT OF PSYCHOSOCIAL ISSUES IN GESTATIONAL DIABETES MELLITUS
CONCLUSION
SECTION 3: SPECIAL TOPICS
CHAPTER 15:
Infections in Women with Diabetes Mellitus
INTRODUCTION
URINARY TRACT INFECTION
MICROBIOLOGICAL PROFILE IN DIABETIC PATIENTS
ASYMPTOMATIC BACTERIURIA
VULVOVAGINAL CANDIDIASIS
BACTERIAL VAGINAL INFECTIONS
EMPHYSEMATOUS CYSTITIS
EMPHYSEMATOUS PYELONEPHRITIS
RENAL PAPILLARY NECROSIS
CHAPTER 16:
Female Sexual Dysfunction in Women with Diabetes Mellitus
INTRODUCTION
UNDERSTANDING NORMAL SEXUAL RESPONSE IN WOMEN
DEFINING FEMALE SEXUAL DYSFUNCTION
PREVALENCE OF FSD IN GENERAL POPULATION
PATHOGENESIS OF FSD IN PATIENTS WITH DIABETES
PREVALENCE OF FSD IN PATIENTS WITH DIABETES
EVALUATION OF FSD IN A DIABETIC CLINIC
TREATMENT FOR FSD
Lifestyle Changes
Review of Drug Treatment
Specific Interventions in Relation to FSD in Diabetic Women
Hypoactive Sexual Desire Disorder (HSDD)
Sexual Arousal Disorders
CONCLUSION
CHAPTER 17:
Metabolic and Reproductive Consequences of Polycystic Ovarian Syndrome
INTRODUCTION
PATHOGENESIS AND ETIOLOGY
SYMPTO MS AND SIGNS
INVESTIGATIONS (FLOW CHART 2)
Total Testosterone
Free Testosterone
Exclusion of Non-PCOS Causes of Hyperandrogenism
Ultrasonography
Endocrine Screening Panel
Ancillary Tests
METABOLIC CONSEQUENCES
Insulin Resistance and Hyperinsulinemia
Dyslipidemia
Obesity
Coronary and Other Vascular Diseases
Obstructive Sleep Apnea
REPRODUCTIVE CONSEQUENCES
RISKS INVOLVED
MANAGEMENT
Goals of Therapy
Weight Loss
Insulin Sensitizers
Endometrial Protection
Oral Contraceptives (OC)
Androgen Suppression
Infertility
CHAPTER 18:
Diabetes and Assisted Reproductive Technologies
INTRODUCTION
EFFECT OF DIABETES ON ASSISTED REPRODUCTIVE TECHNOLOGY
Diabetes and Infertility: Is There a Link?
Type 1 Diabetes Mellitus and Infertility
Type 2 Diabetes Mellitus and Infertility
Assisted Reproductive Technology: An Opportunity for Screening for Diabetes and Optimizing Control
EFFECT OF ASSISTED REPRODUCTIVE TECHNOLOGY ON DIABETES
Does ART Increase the Chances of Gestational Diabetes Mellitus in the Resulting Pregnancy?
Do Children Born After ART Have Higher Chances of Having Diabetes?
CONCLUSION
CHAPTER 19:
Malignancies in Women with Diabetes Mellitus
INTRODUCTION
EPIDEMIOLOGICAL EVIDENCE: IS THERE A RISK? HOW STRONG IS THE ASSOCIATION?
PATHOLOGICAL LINK BETWEEN DIABETES AND CANCER: WHAT IS THE MECHANISM?
Hyperinsulinemia
Hyperglycemia
Shared Risk Factors
Breast Cancer
Effect of Diabetes on Prognosis of Breast Cancer
Endometrial Cancer
Ovarian Cancer
Colonic Cancer
Pancreatic Cancer
Liver Cancers
DRUG TREATMENT OF DIABETES AND CANCER IN WOMEN
Metformin
Thiazolidinediones
Insulin
CONCLUSION
APPENDICES:
APPENDIX 1:
Management of Diabetes Mellitus in Women Receiving Antenatal Corticosteroids to Reduce Neonatal Morbidity
APPENDIX 2:
Insulin-dextrose Infusion Setup During Active Labor and Surgery
INDEX
TOC
Index
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