News in Brief: ADIPS benchmarking program highlights ‘major concern’ in diabetes care in pregnancy; Calls for national pancreatic surgery program; Aussie RCT of zoledronic acid in Duchenne Muscular Dystrophy shows improved BMD

Wednesday, 12 May 2021

ADIPS benchmarking program highlights ‘major concern’ in diabetes care in pregnancy

A pilot diabetes in pregnancy audit program has uncovered significant variation in the pre-pregnancy and antenatal services received by women with diabetes across the country sparking calls for an ‘urgent’ national audit to standardise care.

The pilot audit covered 10,144 patient records (GDM, n = 8696, T1D, n = 435, T2D, n = 1013) from 11 diabetes services across Australia and New Zealand.

But investigators from the Australasian Diabetes in Pregnancy Society (ADIPS), who initiated the audit, said a large number of data items recording important T1D and T2D pre-pregnancy care were missing across services suggesting an absence of agreed indicators for measuring quality of care.

Of the data that was available many women with T1D and T2D were found to have had a higher mean HbA1c of 7.7 ± 1.6% at conception, which investigators have called ‘a major concern’.

The mean recorded gestational week at first visit to the participating diabetes service was beyond the recommended eight weeks of gestation for women with both T1D and T2D (9.1 ± 5.3 and 11.1 ± 6.1 weeks respectively).

Meanwhile the rate of major pregnancy complications were high for women with both T1D and T2D:  preterm births (<37 weeks)  ranged from 3.7% to 9.4% (p < 0.05), large for gestational age 10.3–26.7% (p < 0.001), admission to special care nursery 16.7–25.0% (p < 0.001), and neonatal hypoglycaemia (<2.6mmol/L) 6.0–27.0% (p < 0.001).

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Pancreatic surgery is successful for pancreatitis – call for a national program

Preliminary findings from the total pancreatectomy with islet autotransplantation (TP‐IAT) program shows the procedure is successful in patients with chronic pancreatitis improving pain management and achieving 50% insulin independence rates.

The latest report from the Australian Islet Consortium on clinical outcomes of 16 patients who underwent the procedure between 2010 and 2020 show 50% achieved sustained insulin independence at a median two years post transplant, with a median HbA1c of 34 (30–42) mmol/mol.

The procedure also resulted in reduction of pain and reduced reliance on analgesia. Preliminary results suggest benefit from the surgery occurs when it is performed early in the disease process with investigators noting that timely identification and referral of potential candidates is ‘crucial to the success of the procedure’.

Meanwhile two deaths occurred among the cohort. One patient, aged 50 years, died three days after TP-IAT surgery from a myocardial infarction following post-operative blood loss and refused transfusion.

Another patient, aged 36 years and the first TP-IAT recipient in Australia, died seven years post transplant following multiple complications including chronic malabsorption on long-term total parenteral nutrition, opioid dependence and recurrent sepsis as a consequence of multiple laparotomies and small bowel resections.

Investigators say this patient would not have qualified for the transplant under the current selection criteria.

The group is now calling for the establishment of a coordinated national TP-IAT program with the intention to provide comprehensive assessment and TP-IAT for Australians and New Zealanders with hereditary pancreatitis.

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Aussie RCT of zoledronic acid in Duchenne Muscular Dystrophy shows improved BMD

Adding zoledronic acid to calcium and vitamin D improved bone mineral density in boys with glucocorticoid dependent Duchenne Muscular Dystrophy (DMD), a small RCT has shown.

The intervention, involving five zoledronic acid infusions (0.025mg/kg at months 0,3, 0.05mg/kg at months 6, 12 and 18), was compared to calcium and vitamin D alone among 62 boys with glucocorticoid dependent DMD between 6-16 years treated across paediatric hospitals in Australia.

At 12 and 24 month follow up, the mean difference in changes of lumbar spine BMD raw and Z-score from baseline was 1.2 SD (95% CI: 0.9-1.5), higher by 19.3% (14.6-24.0) and 1.4 SD (0.9-1.9), higher by 26.0% (17.4-34.5) in zoledronic acid recipients compared to control arms respectively.

Five control participants developed Genant 3 vertebral fractures while there were none reported in the zoledronic acid group.

Meanwhile mobility, pain and bone turnover markers were similar between arms at 12 and 24 months while trabecular BMC and vBMD pQCT at the radius and tibia were greater at 12 months in the zoledronic acid cohort compared to controls with the difference remaining at 24 months at the radius.

Whilst the small cohort meant demonstrable fracture benefit was difficult to show, investigators said improved BMD ‘might reduce incident vertebral fracture’.

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