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Type 2 Diabetes and Yeast Infections

A vaginal yeast infection, also known as candidiasis, is a condition that causes itching and irritation around the vagina, a thick white vaginal discharge that looks like cottage cheese, and burning when using the bathroom or having sex.

Although many women experience yeast infections, women with type 2 diabetes are at a greater risk, especially if their blood sugar levels are higher than normal.

Blood Sugar and Yeast Infections

Most women have yeast organisms as part of their normal flora, the tiny microorganisms that live on and inside our bodies. These microorganisms don’t cause any discomfort or symptoms because they’re limited in number. But when there’s overgrowth, their presence becomes a problem.

“No one knows exactly why yeast infections are more common [in women with type 2 diabetes], but there is a definite association with how well a person’s diabetes is controlled,” says Vincent Woo, MD, endocrinologist at the University of Manitoba Health Sciences Centre in Winnipeg, Canada. An increased level of blood sugar from diabetes affects the entire body, not just the blood. “Elevated blood sugar appears in the mucus of the vagina and vulva, so they serve as an excellent culture medium for yeast,” says Daniel Einhorn, MD, a former president of the American Association of Clinical Endocrinologists and medical director of the Scripps Whittier Diabetes Institute in San Diego. Yeast gets energy from sugar, so in an environment that is moist with sugar, yeast may overgrow.

Diabetes and the Ability to Fight Yeast Infections

The effects of diabetes on the body become more obvious as time goes on. People who don’t keep good control of their blood sugar may develop complications related to the constantly high levels. One such complication is a difficulty in fighting off infections, either bacterial or fungal.

Dr. Einhorn explains, “Some women, especially those with poorly controlled diabetes, have some compromise in their ability to fight off any infection. ” This means that once a yeast infection has begun, getting rid of it may not be that easy.

Yeast Infection Treatment

Treatment of a yeast infection is the same for people with diabetes as for those without it. “These infections are managed the [same] way as any other yeast infection. All the standard agents will work,” says Einhorn.

Over-the-counter treatments consist of antifungal vaginal creams and suppositories, which are used for one to seven days, depending on the product. Your doctor can tell you which product is best for you.

If you get yeast infections very frequently or they don’t completely go away, your doctor may treat you for longer periods of time or prescribe a yeast infection medication called Diflucan (fluconazole). This is an effective treatment for yeast infections, but it shouldn’t be used if you’re pregnant.

Although most women believe they can tell if they have a yeast infection, this isn’t always the case. According to the Centers for Disease Control and Prevention (CDC), many women often misdiagnose themselves and buy over-the-counter yeast infection treatments that are ineffective for their problem. This is dangerous because the real problem is not being properly treated. If you’re not certain that you have a yeast infection, or if your symptoms don’t go away with over-the-counter treatment, see your doctor for proper diagnosis and treatment.

Lowering Your Risk for Yeast Infections

While yeast infections can’t always be prevented, you can lower your risk of developing one, even if you have type 2 diabetes. Some tips that may help prevent yeast infections include:

  • Avoid wearing tight-fitting clothes.
  • Wear cotton underwear.
  • Eat yogurt with live cultures of Lactobacillus acidophilus.

Still, notes Einhorn, “The most important [way to prevent yeast infections] is to optimize glucose control, so that the sugar in the secretions from the vulva and vagina doesn’t promote the buildup of yeast.”

For more on diabetes complications, check out Diabetes Daily’s article “Diabetes and Infections”!

Lower genital tract infections in diabetic women

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  • Diabetes and Women | CDC

    Women with diabetes have more to manage. Stay on track by checking your blood sugar often, eating healthy food, and being active so you can be your healthiest and feel your best.

    How is diabetes different for women than it is for men? Diabetes increases the risk of heart disease (the most common diabetes complication) by about four times in women but only about two times in men, and women have worse outcomes after a heart attack. Women are also at higher risk of other diabetes-related complications such as blindness, kidney disease, and depression.

    Not only is diabetes different for women, it’s different among women—African American, Hispanic/Latina, American Indian/Alaska Native, and Asian/Pacific Islander women are more likely to have diabetes than white women.

    How you manage diabetes may need to change over time depending on what’s happening in your life. Here’s what to expect and what you can do to stay on track.

    Yeast and Urinary Tract Infections

    Many women will get a vaginal yeast infection at some point, but women with diabetes are at higher risk especially if their blood sugar levels are high.

    More than 50% of women will get a urinary tract infection (UTI) in their lifetime, and your risk may be higher if you have diabetes. Causes include high blood sugar levels and poor circulation (which reduces your body’s ability to fight infections). Also, some women have bladders that don’t empty all the way because of diabetes, creating a perfect environment for bacteria to grow.

    What You Can Do: To prevent yeast infections and UTIs, keep your blood sugar levels as close to your target range as possible. Other ways to prevent UTIs: drink lots of water, wear cotton underwear, and urinate often instead of waiting until your bladder is full.

    Menstrual Cycle

    Changes in hormone levels right before and during your period can make blood sugar levels hard to predict. You may also have longer or heavier periods, and food cravings can make managing diabetes harder. You may notice a pattern over time, or you may find that every period is different.

    What You Can Do: Check your blood sugar often and keep track of the results to see if there’s a pattern. If you use insulin, you might need to take more in the days before your period. Talk to your doctor about changing your dosage if needed. Being active on most days, eating healthy food in the right amounts, and getting enough sleep can all help too.


    Diabetes can lower your interest in sex and your ability to enjoy it. For some women, vaginal dryness can make intercourse uncomfortable or even painful. Causes can include nerve damage, reduced blood flow, medications, and hormonal changes, including those during pregnancy or menopause.

    What You Can Do: Be sure to talk to your doctor if you’re having any sexual issues. He or she can let you know your options, from using vaginal lubricants to doing exercises that can increase sexual response.

    Birth Control

    It’s important to use birth control if you don’t want to become pregnant or if you want to wait until your blood sugar levels are in your target range, since high blood sugar can cause problems during pregnancy for you and your baby. There are many types of birth control methods, including intrauterine devices (IUDs), implants, injections, pills, patches, vaginal rings, and barrier methods like condoms and diaphragms. Choosing the right option for you will depend on whether you have any other medical conditions, current medicines you take, and other factors.

    What You Can Do: Talk with your doctor about all your birth control optionsexternal icon and risks. Continue checking your blood sugar, track the results, and let your doctor know if your levels go up.

    Sometimes having high blood sugar can feel like a test you didn’t pass. But numbers are just numbers. Think of them instead as information. Did a certain food or activity make your levels go up or down? Armed with that knowledge, you can make adjustments and get closer to your target range more often.

    You can’t go wrong with the basics: check your blood sugar regularly, eat healthy food, and be active on most days.

    Getting Pregnant

    If you know you want to have a baby, planning ahead is really important. Diabetes can make it harder to get pregnant, and high blood sugar can increase your risk for:

    • Preeclampsia (high blood pressure)
    • Delivery by cesarean section (C-section)
    • Miscarriage or stillbirth

    A baby’s organs form during the first 2 months of pregnancy, and high blood sugar during that time can cause birth defects. High blood sugar during pregnancy can also increase the chance that your baby could:

    • Be born too early
    • Weigh too much (making delivery harder)
    • Have breathing problems or low blood sugar right after birth

    What You Can Do: Work with your health care team to get your blood sugar levels in your target range and establish good habits such as eating healthy and being active. Your blood sugar levels can change quickly, so check them often and adjust your food, activity, and medicine as needed with guidance from your doctor.

    During Pregnancy

    Gestational diabetes—high blood sugar during pregnancy—can develop in women who don’t already have diabetes. It affects 2% to 10% of pregnancies in the United States every year. Any woman can have gestational diabetes, but some are at higher risk, including those who are overweight or have obesity, are more than 25 years old, or have a family history of type 2 diabetes. Careful management is important to ensure a healthy pregnancy and healthy baby.

    What You Can Do: If you’re diagnosed with gestational diabetes, your doctor will work with you to create a treatment plan to help keep your blood sugar in your target range by eating healthy food in the right amounts and being active most days of the week. You may need diabetes medicine or insulin shots to keep you and your baby healthy.

    Gestational diabetes usually goes away after your baby is born. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes. It’s important to get tested for diabetes 4 to 12 weeks after delivery and continue to get tested every 1 to 3 years to make sure your blood sugar levels are in a healthy range. Ask your doctor about participating in the CDC-led National Diabetes Prevention Program, which includes a lifestyle change program scientifically proven to prevent or delay type 2 diabetes in people at risk.


    After menopauseexternal icon, your body makes less estrogen, which can cause unpredictable ups and downs in blood sugar. You may gain weight, which increases your need for insulin or other diabetes medicines. Hot flashesexternal icon and night sweats may disrupt your sleep, making managing blood sugar harder. This is also a time when sexual problems can occur, such as vaginal dryness or nerve damage.

    What You Can Do: Ask your doctor about ways you can manage menopause symptomsexternal icon. If your blood sugar levels have changed, you may need to change the dosage of any diabetes medicines you’re taking. Heart disease risk goes up after menopause, so make heart-healthy choices that also help manage your diabetes, such as eating healthy food and being active.

    Bacteria may cause Type 2 diabetes

    Bacteria and viruses have an obvious role in causing infectious diseases, but microbes have also been identified as the surprising cause of other illnesses, including cervical cancer (Human papilloma virus) and stomach ulcers (H. pylori bacteria).

    A new study by University of Iowa microbiologists now suggests that bacteria may even be a cause of one of the most prevalent diseases of our time: Type 2 diabetes.

    The research team led by Patrick Schlievert,  professor and department executive officer of microbiology at the UI Carver College of Medicine, found that prolonged exposure to a toxin produced by Staphylococcus aureus (staph) bacteria causes rabbits to develop the hallmark symptoms of Type 2 diabetes, including insulin resistance, glucose intolerance, and systemic inflammation.

    “We basically reproduced Type 2 diabetes in rabbits simply through chronic exposure to the staph superantigen,” Schlievert says.

    The UI findings suggest that therapies aimed at eliminating staph bacteria or neutralizing the superantigens might have potential for preventing or treating Type 2 diabetes.

    Obesity is a known risk factor for developing Type 2 diabetes, but obesity also alters a person’s microbiome—the ecosystem of bacteria that colonize our bodies and affect our health.

    “What we are finding is that as people gain weight, they are increasingly likely to be colonized by staph bacteria—to have large numbers of these bacteria living on the surface of their skin,” Schlievert says. “People who are colonized by staph bacteria are being chronically exposed to the superantigens the bacteria are producing.”

    Schlievert’s research has previously shown that superantigens—toxins produced by all strains of staph bacteria—disrupt the immune system and are responsible for the deadly effects of various staph infections, such as toxic shock syndrome, sepsis, and endocarditis.

    The team’s latest study, published recently in the journal mBio, shows that superantigens interact with fat cells and the immune system to cause chronic systemic inflammation, and this inflammation leads to insulin resistance and other symptoms characteristic of Type 2 diabetes. In examining the levels of staph colonization on the skin of four patients with diabetes, Schlievert’s team estimates that exposure to the bacterial superantigens for people who are heavily colonized by staph is proportional to the doses of superantigen that caused the rabbits to develop diabetes symptoms in the team’s experiments.

    “I think we have a way to intercede here and alter the course of diabetes,” Schlievert says. “We are working on a vaccine against the superantigens, and we believe that this type of vaccine could prevent the development of Type 2 diabetes.”

    The team also is investigating the use of a topical gel containing glycerol monolaurate, which kills staph bacteria on contact, as an approach to eliminate staph bacteria from human skin. They plan to test whether this approach will improve blood sugar levels in patients with prediabetes.

    In addition to Schlievert, the UI research team included Bao Vu, Christopher Stach, Katarina Kulhankova, Wilmara Salgado-Pabón, and Aloysius Klingelhutz. The study was funded in part by grants from the Carver Trust Collaborative.

    Diabetes, infections, and you – APIC

    What is diabetes?   

    Diabetes is a chronic disease in which blood glucose (a type of sugar) levels are above normal levels. In people who have diabetes, the pancreas either doesn’t make enough insulin (a hormone that helps glucose get the cells of our bodies), or it doesn’t use insulin as well as it should. This can cause sugar to build up in the blood and lead to serious health complications like blindness, heart disease, kidney failure, and lower-extremity amputations. 

    Most cases of diabetes fall into two broad categories: 

    Type 1 diabetes
    In type 1 diabetes, the body does not produce insulin. The body breaks down the sugars and starches you eat into a simple sugar called glucose, which it uses for energy. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells of the body.

    Type 2 diabetes
    Type 2 diabetes is the most common form of diabetes. If you have type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it isn’t able to keep up and can’t make enough insulin to keep your blood glucose at normal levels. 

    Why are people with diabetes more prone to infections?

    High blood sugar levels can weaken a person’s immune system defenses. People who have had diabetes for a long time may have peripheral nerve damage and reduced blood flow to their extremities, which increases the chance for infection. The high sugar levels in your blood and tissues allow bacteria to grow and allow infections to develop more quickly.

    What are common infections for people with diabetes? 

    The most common infections in people with diabetes include:

    • Ear, nose, and throat infections: Fungal infections of the nose and throat are seen almost exclusively in patients with diabetes. Symptoms include severe ear pain and ear discharge.
    • Urinary tract infections (UTIs): Uncontrolled diabetes is one of the major causes for UTIs. These UTIs are commonly caused by germs such as Escherichia coli, Klebsiella, Enterococcus, and Candida. Kidney infections and inflammation of the bladder are also common.
    • Skin and soft tissue infections:  People with diabetes are at risk for infections and wounds in the leg (also called diabetic foot). Repeated trauma and poor footwear can lead to these infections. If these infections aren’t treated promptly and properly, it can result in the need to amputate.
    How can people with diabetes prevent infection? 
    1. Make sure your blood sugar levels are well controlled. This can be achieved by exercising regularly, making healthy food choices, and following your healthcare provider’s recommendations for routine blood glucose testing.
    2. Take medicines exactly as prescribed by your healthcare provider.
    3. Maintain good personal hygiene. Wash your hands frequently, especially after using the bathroom; after sneezing, blowing your nose, or coughing; before eating; when visiting someone who is sick; or whenever your hands are dirty. 
    4. Never share your insulin pen. These are meant for only one person. Before your healthcare provider uses an insulin pen on you, ask if you are the first patient to use that particular pen. 
    5. Get your flu vaccine each year and stay up to date on all vaccinations. 
    6. Wear good, soft, and covered footwear. Wear clean socks daily. People who have diabetes should examine their feet on a daily basis. 
    7. Seek early medical care if you are injured or ill.

    Risk of Vaginal Infections at Early Gestation in Patients with Diabetic Conditions during Pregnancy: A Retrospective Cohort Study


    Pregnant women with gestational diabetes mellitus (GDM) are reported to be at increased risk for infections of the genital tract. This study aimed to compare the prevalence of asymptomatic bacterial vaginosis (BV) and Candida colonization at early gestation between pregnant women with and without diabetic conditions during pregnancy. We included data from 8, 486 singleton pregnancies that underwent an antenatal infection screen-and-treat programme at our department. All women with GDM or pre-existing diabetes were retrospectively assigned to the diabetic group (DIAB), whereas non-diabetic women served as controls (CON). Prevalence for BV and Candida colonization was 9% and 14% in the DIAB group, and 9% and 13% in the CON group, respectively (n.s.). No significant difference regarding stillbirth and preterm delivery (PTD), defined as a delivery earlier than 37 + 0 (37 weeks plus 0 days) weeks of gestation was found. We could not find an increased risk of colonization with vaginal pathogens at early gestation in pregnant women with diabetes, compared to non-diabetic women. Large prospective studies are needed to evaluate the long-term risk of colonization with vaginal pathogens during the course of pregnancy in these women.

    Citation: Marschalek J, Farr A, Kiss H, Hagmann M, Göbl CS, Trofaier M-L, et al. (2016) Risk of Vaginal Infections at Early Gestation in Patients with Diabetic Conditions during Pregnancy: A Retrospective Cohort Study. PLoS ONE 11(5):


    Editor: David N. Fredricks, Fred Hutchinson Cancer Center, UNITED STATES

    Received: February 28, 2016; Accepted: April 4, 2016; Published: May 11, 2016

    Copyright: © 2016 Marschalek et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Data Availability: All relevant data are within the paper and its Supporting Information files.

    Funding: The authors have no support or funding to report.

    Competing interests: The authors have declared that no competing interests exist.


    Bacterial vaginosis (BV) is known to be a crucial factor for preterm delivery (PTD), causing up to 40 percent of premature births [1–3]. In addition, there is increasing evidence supporting a causal role of Candida colonization in the multifactorial pathway of PTD, since a benefit of treating women with asymptomatic candidiasis has previously been demonstrated [4, 5]. In view of the available literature on the potentially hazardous pathogens of the vaginal microflora, we introduced an antenatal screen-and-treat program at our department in 2004. This simple public health intervention led to a significant reduction of PTD and late miscarriage rates in the general population of pregnant women [6, 7].

    So far, Diabetes mellitus (DM) was thought to predispose women to Candida colonization. Results from a large population-based study indicate that women with DM are at an increased risk for infections of the lower genital tract and in particular, those with poorly controlled diabetes seem to be at highest risk for acquiring genital infections [8–11].

    As most women in Austria are routinely screened for gestational diabetes mellitus (GDM) at 24 to 28 weeks of gestation, obstetricians notice an increasing GDM prevalence [12, 13]. However, there is little research evaluating GDM as a risk factor for vaginal Candida colonization. Nowakowska et al. reported that the risk of vaginal Candida colonization in pregnant women is more than four times higher in women with DM compared to non-diabetic women, also postulating an elevated risk in those with GDM [14].

    Concerning bacterial vaginosis even less evidence is available for women with GDM. On the one hand, it appears logically consistent that diabetic pregnant women more likely acquire genital infections, because of poor metabolic control, higher body mass index (BMI) and potentially impaired leucocyte function [15, 16]. Moreover, pregnancy itself harbours an immunocompromised state, leading to an increased risk of vaginal Candida colonization [17]. On the other hand, there are data of a population-based study that reported no significant association between GDM and BV, which stands in contrast to the explanatory model [18].

    In the present study, we aimed to compare the prevalence of asymptomatic bacterial vaginosis and Candida colonization at early gestation in pregnant women with and without diabetic conditions during pregnancy. Secondary outcome variables included PTD, defined as a delivery earlier than 37 + 0 (37 weeks plus 0 days) weeks of gestation and infant birth weight. In view of the contradictory literature, the role of diabetes in the multi-factorial mechanism of vaginal infection and PTD should further be evaluated.

    Materials and Methods

    Patients and groups

    The study included retrospectively collected data from all women who presented with singleton pregnancies between January 1, 2005, and January 1, 2014, at the Medical University of Vienna, Department of Obstetrics and Gynaecology. Inclusion criteria were registration for a planned delivery at our department between 10 + 0 (10 weeks plus 0 days) and 16 + 0 (16 weeks plus 0 days) weeks of gestation including the antenatal infection screening that was part of our routine pregnancy care [7]. Delivery without undergoing the antenatal infection screening programme (e.g., intervention refused), as well as registration earlier than 10 + 0 or later than 16 + 0 gestational weeks and previous antibiotic treatment (up to 4 weeks prior to the screening) led to exclusion. Women with missing data, incomplete primary or secondary outcome parameters, were also excluded from the analyses.

    For the analyses, women were assigned to one of the following groups: the diabetic group (DIAB), which included those with GDM (or DM) or the control group (CON), which included non-diabetic women. Women of the DIAB group were subdivided into (i) those with pre-existing DM (type I or II), (ii) those with GDM and nutritional dietary or (iii) those with GDM and insulin treatment (IGDM). All non-diabetic women had non-pathologic oral glucose tolerance test (oGTT)-results and negative medical history for diabetic diseases.

    Obstetric management

    Pregnancy care was equal in both groups with routine consultations and examinations being performed in gynaecological outpatient clinics, following the national welfare pregnancy care programme that is obligatory for all pregnant women in Austria since the year 1973 [19]. In addition to this routine follow-up, pregnant women with diabetes routinely present at our department every two weeks, beginning in the second trimester of their pregnancy. All women with IGDM, GDM or pre-existing DM underwent a multi-disciplinary treatment approach, including supervision by a physician of the Department of Internal Medicine, Medical University of Vienna. In case of any complications (e.g., suboptimal glycaemic control or pregnancy-related problems), consultations were intensified. Most women of the DIAB group underwent induction of labour at 40 + 0 (40 weeks plus 0 days) weeks of gestation.

    Diabetes screening

    Since January 1, 2010, women who had not been previously diagnosed with diabetes, routinely undergo a 75-grams two-hour oGTT as part of routine pregnancy welfare care between 24 and 28 gestational weeks. According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG), GDM is diagnosed in case of at least one out of three (fasting, one-hour, two-hours) elevated plasma glucose values [20]. The following glucose levels lead to the diagnosis of GDM: fasting ≥92 mg/dL (5.1 mmol/L), one-hour post-prandial ≥180 mg/dL (10 mmol/L) and/or two-hour post-prandial ≥153 mg/dL (8.5 mmol/L). Only women that were highly suspicious for undiagnosed type II diabetes, as well as those with a prior history of GDM, underwent diabetes screening earlier than 24 gestational weeks. In case of a fasting plasma glucose level ≥126 mg/dL (7.0 mmol/L) and/or a glycated haemoglobin A1c level of ≥6.5% (≥48 mmol/mol), women were diagnosed with DM. A random plasma glucose level ≥200 mg/dL (11.1 mmol/L) was suggestive of overt diabetes. From January 1, 2005 to December 31, 2009, oGTT was exclusively performed in women with a positive family history for DM or clinical suspicion of GDM [21]. Using a 75-grams two-hour oGTT between 24 and 28 gestational weeks, GDM or impaired glucose tolerance in pregnancy was diagnosed in case of at least one out of three (fasting, one-hour, two-hours) elevated plasma glucose values [20]. During this time period, the following glucose levels led to the diagnosis of GDM: fasting ≥95 mg/dL (5.3 mmol/L), one-hour post-prandial ≥180 mg/dL (10 mmol/L) and/or two-hour post-prandial ≥155 mg/dL (8.6 mmol/L).

    Infection screening

    According to our routine protocol, vaginal smears were assessed by sterile swabs from the lateral vaginal wall and posterior fornix vaginae; smears were Gram-stained and microscopically analysed by trained and experienced microbiology staff at our department. The classification of the vaginal microflora followed Nugent et al.[22]. The presence of BV, Candida species (spp.) and Trichomonas vaginalis were assessed. In agreement with our study protocol, women with normal or intermediate vaginal microflora on the examined smears did not receive further treatment. Women with evidence of an asymptomatic vaginal infection underwent treatment within 3 to 5 days after diagnosis. Treatment of BV included clindamycin 2% vaginal cream for 6 days in case of a primary infection, oral clindamycin 0.3 g twice daily for 7 days in case of recurrent BV, local clotrimazole 0.1 g for 6 days in case of vaginal candidiasis, and local metronidazole 0.5 g for 7 days in case of trichomoniasis.[23] Recurrent infections with Candida spp. and/or Trichomonas vaginalis were retreated. Follow-up smears were obtained after 4 to 6 weeks. All women who were treated for BV, as defined by a Nugent score of 7 to 10, were consequently treated with vaginally applied Lactobacillus spp. for 6 days, in order to rebuild the physiological vaginal microflora after antibiotic treatment.[24, 25]

    Outcome variables

    The rate of asymptomatic vaginal infections in the vaginal smear, defined by the presence of BV, and/or Candida spp. (i.e., spors and/or hyphes), and/or Trichomonas vaginalis, served as the primary outcome variable. Secondary outcome variables included PTD and infant birth weight. Relevant data were extracted from obstetric databases, patient charts, and microbiology reports. PTD was defined as a delivery earlier than 37 + 0 (37 weeks plus 0 days) weeks of gestation, due to spontaneous preterm premature rupture of membranes (pPROM), preterm labour and/or iatrogenic PTD through early caesarean section or induction of labour. Late miscarriage was defined as the PTD of an infant with a birth weight of less than 500 g, born in the second trimester. Stillbirth was defined as the term or PTD of an infant that had died in utero and was born with an Apgar score of 0/0/0.

    Data Analysis

    The Fisher exact tests were used to compare categorical data. For comparisons of continuous data, Welch’s t-test was used. Continuous data are given as Mean (± SD, Standard deviation), unless otherwise stated. Discrete data are presented as Numbers (n) and Percentages (%). A two-sided p-value < 0.05 was considered statistically significant without adjustment for multiplicity.

    In order to check if the GDM screening regimes change had an impact on the results of our analysis, we conducted the analysis (A) for all available patients, and (B) only for patients who underwent infection screening after January 1, 2010. As the estimated statistics displayed only negligible differences, we herewith report results for all available patients. We also conducted a subgroup analysis, to assess, if the vaginal smear outcomes were associated with certain conditions. This evaluation was done by formulating binary logistic regression models for each outcome with a grouping variable coding for the disjoint groups (GDM, IGDM, IDDM and no diabetic condition) as independent variable. Finally, linear hypotheses specified by the presented contrasts were tested.

    All statistical calculations were performed using R Project for Statistical Computing, version 3.1.3 (R Development Core Team, MA, USA). The ethical review board of the Medical University of Vienna approved the study (Amendment to Protocol Number 1101/2014), which was performed in accordance with the Declaration of Helsinki and the guidelines of Good Scientific Practice, as supported by the Head of the Institute. As this study comprises retrospectively collected and analysed data, the ethical review board approved the waiver of informed consent.



    Between 2005 and 2014, a total of 20,052 women with singleton pregnancies delivered at our department. Of these, the data of 8,486 women (42.3%) met our inclusion criteria, followed by assignment to the following groups: 1,253 women (14.8%) in the diabetic group and 7,233 women (85.2%) in the control group. Out of the DIAB group, 61.2% of the women were diagnosed with IGDM and 31.7% with GDM with the need for dietary requirements. In addition, 7.1% of the DIAB group had pre-existing diabetes type I or type II.

    Mean maternal age of women at the time of delivery was 32.8 (± 5.8) years in the study group and 30.5 (± 6.0) years in the control group. No significant difference with respect to the history of PTD was observed between the groups. The sociodemographic and obstetric patients characteristics are provided in Table 1.

    Vaginal smears

    Analysis of vaginal screening smears showed no significant difference with respect to normal or abnormal vaginal microflora between the groups (Fig 1). Classification and distribution of vaginal smear results are shown in Table 2. Accordingly, no significant difference was found in the subgroup analysis evaluating the impact of maternal insulin therapy on the vaginal microflora (Table 3).

    Obstetric outcomes

    Median gestational age at delivery and median birth weight was 39.0 (IQR 38.0–40.0) weeks and 3,370 (IQR 3,030–3,704) grams in the DIAB group and 39.3 (IQR 38.3–40.4) weeks and 3,290 (IQR 2,940–3,620) grams in the CON group, respectively (All: p = 0.0001). No significant difference was found regarding stillbirth (0% versus 0%) and PTD rates (11% versus 9%) when comparing the DIAB group and CON group.


    This study aimed to assess the possible association between asymptomatic vulvo-vaginal infection in early pregnancy and hyperglycemic conditions including preexisting diabetes and subsequently diagnosed GDM as well. However, in our large retrospective cohort we were not able to identify an elevated risk for asymptomatic BV or vaginal Candida colonization in women affected by diabetes compared to normoglycaemic controls.

    Our findings are in contrast to previous observations indicating an increased risk of vaginal Candida colonization or infection for women suffering from diabetic disorders [14, 26–28]. In their prospective study Nowakowska et al. assessed the prevalence of fungi in 119 diabetic pregnancies and reported a four-fold increased risk of vaginal Candida colonization in patients with DM and a two-fold increased risk for women with GDM in comparison with healthy controls. These contradictory results might be explained by the different study designs: In contrast to our study, Nowakowska et al. obtained microbiologic specimens arbitrarily during the course of pregnancy and not at a specific point in time, so that it was not possible to determine the risk for vaginal colonization at early gestation. However, it has to be considered that due to the early assessment of the vaginal microflora in our cohort GDM diagnosis was performed after the time of the infection screening for some subjects. As insulin resistance increases along with gestational age, it might be possible that the susceptibility for vaginal Candida colonization in diabetic women rises with duration of pregnancy and poor glycaemic control [26, 27]. In contrast to this hypothesis, previous studies found no association between the mean HbA1c, fasting glucose levels, post-prandial glucose levels and infection rates, when evaluating groups in the same trimester of the pregnancy. No association between the occurrence of vaginal Candida colonization and the trimester of pregnancy in diabetic pregnant women has yet been identified as well [14, 28].

    In addition, antenatal screening-results in pregnant women with and without need of insulin treatment did not substantially differ from healthy controls in our study. Conversely, Stamler et al. retrospectively compared 65 pregnant women with insulin-dependent diabetes to 65 non-diabetic pregnant controls and supposed insulin dependency as a strong risk factor for infections during pregnancy in general, and vaginal Candida colonization in particular [26]. However, underreporting of the control group has to be mentioned as a possible limitation of their study, as they prospectively followed their diabetic cohort, and retrospectively matched their controls.

    Actually, there is only sparse data is available assessing the relation between GDM and BV. In a large Danish cohort study, evaluating whether BV was associated with subsequent PTD, low birth weight or perinatal infections, the overall prevalence of BV was 16%, showing a significant association with previous pregnancy termination [18]. Although PTD was also associated with GDM, the authors could not find an association between GDM and BV, comparable to our results. In fact, we were not able to identify any other study investigating GDM as a potential risk factor for BV.

    Interestingly, we found no significant differences in obstetric outcomes between the study groups. With the only exception, that non-diabetic women delivered infants at a lower birth weight, born 0.3 weeks later as compared to diabetic women, which could be explained by our pro-active clinical management of diabetic pregnancies with an induction of labour at 40 + 0 gestational weeks. In addition, it is well reported that infants of diabetic pregnant women are born at a higher birth weight [29]. Regarding stillbirth and PTD, we were unable to assess a significant difference with respect to their prevalence in our cohort. This could be a result of the elaborate follow-up programme put in place for women with diabetes, who are advised at obstetric examinations on a regular basis during the second and third trimester of pregnancy.

    Some limitations of our study have to be discussed: One of these limitations is caused by the retrospective study design, e.g. missing pre-pregnancy BMI and gestational weight gain. Another is caused by the fact that GDM criteria were different before and after January 2010. In order to assess this potential bias, we decided to perform a sensitivity-analysis of all cases to ascertain data-homogeneity. Conclusions from this analysis suggest that this regime change between the time periods of 2005–2009 and 2010–2014 had no significant impact on the current results of our study. Another limitation of our study is the lack of mean week glucose and glycated haemoglobin A1c levels in diabetic patients, in order to examine an association between glycaemia and prevalence of vaginal infection. A crucial strength of our study is that we analysed a large number of women and that we routinely performed an antenatal infection screening during an asymptomatic state at early gestation. To the best of our knowledge, this study comprises the largest collective of diabetic pregnant women screened for vaginal infection in the literature.


    In conclusion, we could not find an increased risk of colonization with vaginal pathogens at early gestation in pregnant women with diabetes, compared to non-diabetic women. Large prospective studies are needed to evaluate the long-term risk of colonization with vaginal pathogens during the course of pregnancy on the one hand, and the influence of glycaemic control on vaginal infections in women with diabetes on the other.

    Author Contributions

    Conceived and designed the experiments: JM HK LP. Analyzed the data: JM MH. Contributed reagents/materials/analysis tools: JM AF CSG MLT VK. Wrote the paper: JM AF HK MH CSG MLT VK LP.


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      Hoosen AA, Peer AK, Seedat MA, van den Ende J, Omar MA. Vaginal infections in diabetic women: is empiric antifungal therapy appropriate? Sexually transmitted diseases. 1993 Sep-Oct;20(5):265–8. pmid:8235923.
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      Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo MB, Block HM, et al. Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2000 May;89(5):570–6. pmid:10807713.
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      Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstetrics and gynecology. 2004 Feb;103(2):219–24. pmid:14754687.
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      Nowakowska D, Kurnatowska A, Stray-Pedersen B, Wilczynski J. Prevalence of fungi in the vagina, rectum and oral cavity in pregnant diabetic women: relation to gestational age and symptoms. Acta obstetricia et gynecologica Scandinavica. 2004 Mar;83(3):251–6. pmid:14995920.
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      Nowakowska D, Kurnatowska A, Stray-Pedersen B, Wilczynski J. Activity of hydrolytic enzymes in fungi isolated from diabetic pregnant women: is there any relationship between fungal alkaline and acid phosphatase activity and glycemic control? APMIS: acta pathologica, microbiologica, et immunologica Scandinavica. 2004 Jun;112(6):374–83. pmid:15511275.
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      Svare JA, Schmidt H, Hansen BB, Lose G. Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections. BJOG: an international journal of obstetrics and gynaecology. 2006 Dec;113(12):1419–25. pmid:17010117.
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      Parma M, Stella Vanni V, Bertini M, Candiani M. Probiotics in the prevention of recurrences of bacterial vaginosis. Alternative therapies in health and medicine. 2014 Winter;20 Suppl 1:52–7. pmid:24473986.
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      Petricevic L, Witt A. The role of Lactobacillus casei rhamnosus Lcr35 in restoring the normal vaginal flora after antibiotic treatment of bacterial vaginosis. BJOG: an international journal of obstetrics and gynaecology. 2008 Oct;115(11):1369–74. pmid:18823487.
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      Parveen N, Munir AA, Din I, Majeed R. Frequency of vaginal candidiasis in pregnant women attending routine antenatal clinic. Journal of the College of Physicians and Surgeons—Pakistan: JCPSP. 2008 Mar;18(3):154–7. pmid:18460243.
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    How Women With Diabetes Can Reduce Risk of Yeast Infections

    Diabetes poses a host of problems for women’s health, and among the most common are yeast infections. In fact, it’s such a telltale sign that doctors often will test a woman who has recurring infections for diabetes if she doesn’t already know she has the disease.

    Diabetes—particularly the occurrence of high blood glucose levels—can cause a bodily imbalance that can lead to an overgrowth of yeast, which thrive in warm, moist places, like your vagina. Diabetic women who have difficulty controlling their blood sugar are more susceptible to yeast infections, but there are steps you can take to stave off infections.

    How can you prevent yeast infections?

    It’s essential for women with diabetes to keep their blood sugar levels under control. Yeast eat sugar, and with all that extra glucose in your system, you’ll only fuel the problem. In addition to keeping your blood sugar in the normal range, adopt these habits to keep yeast infections at bay.


    • Change tampons or pads frequently.
    • Make sure your underwear has a cotton liner, which helps keep you cool and dry.
    • Dry yourself thoroughly after bathing or swimming.
    • Eat some unsweetened yogurt with live cultures—the good bacteria that help keep yeast in check. Alternatively, you can get these good bacteria, called probiotics, as a capsule in a nutrition store, but talk to your doctor before adding supplements to your diet.

    • When using the bathroom, wipe front to back, which helps prevent germs from spreading.


    • Wear tight-fitting underwear or pants, which can trap body heat. Instead, choose looser clothes made of nature fibers so you’ll stay dryer.

    • Sit around in a wet bathing suit or workout gear, which creates the moist environment yeast love.

    • Take long, hot baths. That goes for soaking in a hot tub, too.
    • Use bubble bath or scented tampons, which can irritate the vagina. Printed toilet paper is also a big no-no. Steer clear of anything with perfumes or dyes.

    • Douche, which washes away the good bacteria that prevent an overgrowth of yeast.
    • Take unneeded antibiotics, such as to treat a common cold. Antibiotics kill the good bacteria along with the bad, and it’s the good bacteria that help keep yeast under control.

    How can you treat a yeast infection?

    If you do develop a yeast infection, you can try an over-the-counter medication to treat it. Creams and suppositories are usually effective for mild to moderate symptoms, and they’re safe for pregnant women. A few things to know about these types of short-course vaginal therapies: You might feel some burning as a side effect, and the treatment might reduce the effectiveness of condoms or birth control. If this is a consideration, talk to your doctor about other methods of preventing pregnancy.

    Oral medications must be prescribed by your doctor. Single-dose and multi-dose medication might be needed to treat more severe symptoms.

    As a non-medicinal way to help get rid of a yeast infection, change your underwear often to stay dryer.

    If left untreated, a yeast infection may go away on its own, often when menstruation begins. But for women with diabetes, yeast infections may return frequently. A small percentage of women suffer four or more yeast infections a year, a sign of recurrent vulvovaginal candidiasis (RVVC), which is more common in women with diabetes. If you believe you have RVVC, talk to your doctor about treatment options for you. You might need to begin a medication regimen, possibly up to six months of treatment, to prevent future infections.

    Men can get yeast infections, too.

    While it’s less common, men can develop yeast infections on the penis, and men with diabetes are at higher risk. Yeast infections aren’t usually spread through sexual contact, but if you have a yeast infection, it is possible to pass it to your sex partner, who then can reinfect you. Your partner won’t always need to be tested or treated for a yeast infection, but if you suffer frequent infections, you may both need to be treated. Talk to your doctor if this is a concern.

    Uncontrolled blood sugar isn’t the only cause of yeast infections—three out of every four women will get one in their life—but it contributes to frequent, recurring infections. Bottom line? Do everything you can to keep your diabetes under control to reduce your risk for yeast infections.

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    What is Diabetology?

    Diabetology deals with the etymology, prevention, treatment and research of various metabolic diseases associated with high blood sugar levels. These include, in particular, type 1 diabetes mellitus with absolute insulin deficiency and type 2 diabetes mellitus with a relative insulin deficiency due to insulin resistance.In addition, the field deals with other forms of diabetes, such as genetic defects or diseases of the pancreas, which is responsible for the production of insulin.

    Who is the Diabetology Specialist?

    Diabetologists are primarily specialists who have successfully completed training in the field of internal medicine. Within this field, diabetologists specialize in diseases such as diabetes mellitus. Diabetes can also fall under the purview of endocrinology, which specializes in metabolic diseases in the human body.

    What diseases do diabetologists treat?

    In addition to type 1 and 2 diabetes, diabetologists treat complications that can arise from abnormal blood sugar levels.

    Prolonged hyperglycemia (high blood sugar) can result in the following conditions:

    • Diabetic neuropathy
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    • Diabetic retinopathy
    • Diabetic foot syndrome (DFS)

    Diabetologists even deal with some monogenic forms of diabetes, such as “adult-onset diabetes mellitus in young people” (MODY 1-3).These diseases are caused by a gene defect and are characterized by elevated blood glucose levels.

    At the same time, there are also diseases caused by a defect in the insulin gene (insulin resistance type A, leprechaunism, Rabson-Mendenhall syndrome, Lawrence lipoatrophic diabetes). These specialists also treat diseases of the pancreas, which is responsible for the production of insulin (chronic pancreatitis). It also includes metabolic diseases (for example, acromegaly, Itsenko-Cushing’s disease, pheochromocytoma, hyperthyroidism, glucagonomas).In addition, diabetologists are working on rare immune-mediated forms of diabetes such as insulin receptor antibodies and stiffness syndrome. Genetic syndromes (genetic diseases with multiple symptoms) such as Down syndrome, Klinefelter syndrome and Turner syndrome, which can also be associated with high blood sugar levels, also fall within the purview of diabetology.

    Why should you see a diabetologist?

    Diabetes mellitus is important to diagnose correctly, as it can lead to serious illnesses and problems.Thus, in the presence of diabetes mellitus, it is best to consult specialists such as diabetologists or endocrinologists. Only a properly regulated blood sugar level, which is ideally matched to the patient and his needs, can ensure a “long normal life”. In addition, the attending physician should include other factors in therapy that may affect blood sugar levels. The administration of an agent for maintaining difficult-to-control blood sugar levels within the normal range, which is an insulin substitute, can be carried out using an insulin pump.Here, the diabetes care specialist is also the person who will determine if an insulin pump is needed for the person with diabetes.

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    Professional management of pregnancy by an experienced specialist and the woman’s observance of all recommendations of the attending gynecologist-endocrinologist allow giving birth to a baby without the risk of developing diabetic deviations. The main condition for the successful course of pregnancy is satisfactory compensation for carbohydrate metabolism disorders.

    Stable metabolic compensation in the case of diabetes can only be achieved if medical prescriptions are followed and a healthy lifestyle is maintained, so planning is the second prerequisite for a successful pregnancy. It is necessary to plan a pregnancy, since all the central systems and organs of the child are laid in the first trimester of pregnancy, more precisely, in the first 6 weeks, and an increased sugar content can provoke very serious violations during organogenesis.

    Types of diabetes

    There are three main types of diabetes mellitus: insulin-dependent (type 1 diabetes), non-insulin dependent (type 2 diabetes) and gestational. There are very few patients with non-insulin dependent diabetes among pregnant women, almost 90% of all cases are occupied by pregnancy with type 1 diabetes.

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    • obesity or overweight woman;
    • the age of the pregnant woman is over 25 years old;
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    • Family history of diabetes mellitus.

    Pregnancy is a huge burden even for absolutely healthy women, and for patients suffering from diabetes mellitus, cardinal changes in the body are almost at the border of possibilities.The specialists of the Clinic of Modern Medicine have many years of experience in the successful management of pregnancy with diabetes of any type.

    The use of advanced methods of treatment and the preparation of individual programs for the management of pregnancy make it possible to present a happy motherhood to any woman with this endocrine disorder.

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    During pregnancy with diabetes mellitus, there is a need for maximum attention to the health of the expectant mother, both from the medical side and from the woman herself.In the absence of adequate therapy and stable compensation for the disease, a disorder of carbohydrate metabolism in the body of a woman carrying a baby can lead to various complications in the course of pregnancy and to significant disturbances in the development of the fetus:

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    Pregnancy complicated by diabetes mellitus is always more difficult than physiological. In such women, severe toxicosis develops much more often, nephropathy develops, a very frequent complication is fetal macrosomia (large fetus).The risk of complications can be minimized by competent management of pregnancy and careful adherence to medical recommendations by a woman.

    Pregnancy management in diabetes mellitus

    Pregnancy management in diabetes mellitus is always carried out by an obstetrician-gynecologist in conjunction with an endocrinologist. A woman expecting a child should remember that all trimesters of pregnancy, without exception, are equally important and need close attention to health:

    1. 1 trimester (1-14 weeks) – there is an intensive formation of fetal organs, and the expectant mother’s insulin sensitivity significantly increases.In this trimester, careful stabilization of carbohydrate metabolism is required to achieve an adequate level of glucose in the body: the sugar concentration should not exceed 4-4.5 mmol / L before meals and be above 6.7 mmol / L after meals.
    2. 2 trimester (15-28 weeks) – the pancreas begins to work intensively in the fetus, so it is very important to carefully monitor carbohydrate metabolism, preventing an increase in sugar levels. At 20 weeks of gestation, the placenta synthesizes large quantities of counterinsular hormones, which causes the dosage of insulin to be adjusted.At 20-22 weeks, an ultrasound of the fetus is certainly carried out in order to exclude congenital malformations.
    3. 3 trimester (28-40 weeks) – in this trimester, the sugar level is especially carefully monitored, a clinical blood test is certainly done twice a month and an ultrasound scan is performed every month to determine the volume of amniotic fluid and to identify abnormalities in the development of the fetus.

    Pregnancy management in diabetes mellitus in the “Clinic of Modern Medicine” is carried out by competent specialists, gynecologists-endocrinologists of the highest category, doctors and candidates of sciences, who have vast experience of successful observation of complicated pregnancy.Pregnancy management in our clinic is advanced equipment, a powerful laboratory and instrumental diagnostic base and an advanced approach to the treatment and prevention of diabetes mellitus.

    Our medical center provides the widest range of services. You can always contact us regarding the management of pregnancy with somatic pathology. We are ready to provide you with services for pregnancy management with thyroid pathologies and pregnancy management for varicose veins.

    90,000 Treatment of type 1 and 2 diabetes mellitus, selection of individual treatment regimens in Lipetsk

    Diabetes mellitus is an endocrine disease caused by a lack of the hormone insulin in the body or its low biological activity. It is characterized by a violation of all types of metabolism, damage to large and small blood vessels and is manifested by hyperglycemia.

    In any type of diabetes, blood sugar control becomes one of the primary tasks of the patient and his attending physician.The closer the sugar level is to the normal range, the less the symptoms of diabetes appear, and the less the risk of complications.

    Diabetes mellitus is a metabolic disorder that occurs due to insufficient formation of its own insulin in the patient’s body (type 1 disease) or due to a violation of the effect of this insulin on tissues (type 2). Insulin is produced in the pancreas, and therefore diabetic patients are often among those who have various disorders in the work of this organ.

    Patients with type 1 diabetes mellitus are called “insulin-dependent” – they are the ones who need regular injections of insulin, and very often they have a congenital disease. Typically, type 1 disease manifests itself already in childhood or adolescence, and this type of disease occurs in 10-15% of cases. Typically, type 1 diabetes occurs in thin people under the age of 30. In such cases, patients are given additional doses of insulin to prevent ketoacidosis and maintain a normal standard of living.

    Type 2 diabetes develops gradually and is considered “diabetes of the elderly”. This type is almost never found in children, and is usually typical for people over 40 years old who are overweight. This type of diabetes occurs in 80-90% of cases, and is inherited in almost 90-95% of cases. Diabetes mellitus type 2 affects up to 85% of all patients with diabetes mellitus, mainly people over 50 years old (especially women). Overweight people with diabetes of this type are characterized by overweight: more than 70% of these patients are obese.It is accompanied by the production of a sufficient amount of insulin, to which the tissues gradually lose sensitivity.
    The reasons for the development of type I and II diabetes are fundamentally different. In people with type I diabetes, the beta cells that produce insulin break down due to viral infection or autoimmune aggression, which develops insulin deficiency with all the dramatic consequences. In patients with type II diabetes, beta cells produce a sufficient or even increased amount of insulin, but tissues lose the ability to perceive its specific signal.

    Diabetes is one of the most common endocrine disorders with a steadily increasing prevalence (especially in developed countries). This is the result of a modern lifestyle and an increase in the number of external etiological factors, among which obesity stands out.

    Causes of diabetes mellitus:

  • Overeating (increased appetite) leading to obesity is one of the main factors in the development of type 2 diabetes. If among persons with normal body weight the incidence of diabetes mellitus is 7.8%, then with an excess of body weight by 20%, the incidence of diabetes is 25%, and with an excess of body weight by 50%, the frequency is 60%.
  • Autoimmune diseases (an attack by the body’s immune system on its own tissues) – glomerulonephritis, autoimmune thyroiditis, hepatitis, lupus, etc. can also be complicated by diabetes mellitus.
  • Hereditary factor. As a rule, diabetes mellitus is several times more common in relatives of diabetic patients. If both parents are sick with diabetes, the risk of developing diabetes for their children throughout their life is 100%, if one of the parents is sick – 50%, in the case of diabetes in a brother or sister – 25%.
  • Viral infections that destroy insulin-producing cells in the pancreas. Among the viral infections that can cause the development of diabetes can be listed: rubella, viral parotitis (mumps), chickenpox, viral hepatitis, etc.
  • A person with a hereditary predisposition to diabetes may never become a diabetic throughout his life if he controls himself, leading a healthy lifestyle: proper nutrition, physical activity, supervision by a doctor, etc.p.


    If the following signs coincide, the diagnosis of diabetes is established:

  • The concentration of glucose in the blood (on an empty stomach) has exceeded the norm of 6.1 millimoles per liter (mol / l). After a meal, two hours later – above 11.1 mmol / l;
  • If the diagnosis is in doubt, a glucose tolerance test is performed in a standard repeat, and it shows an excess of 11.1 mmol / L;
  • Excess of the level of glycosylated hemoglobin – more than 6.5%;
  • Presence of sugar in urine;
  • The presence of acetone in urine, although acetonuria is not always an indicator of diabetes.
  • What sugar indicators are considered the norm?

  • 3.3 – 5.5 mmol / L is the blood sugar norm regardless of your age.
  • 5.5 – 6 mmol / l is prediabetes, impaired glucose tolerance.
  • If the sugar level showed a mark of 5.5 – 6 mmol / l – this is a signal from your body that a violation of carbohydrate metabolism has begun, all this means that you have entered a danger zone. The first thing to do is to lower your blood sugar level, get rid of excess weight (if you are overweight).Limit yourself to 1800 kcal per day, include diabetic foods in your diet, give up sweets, steam.

    Currently, the treatment of diabetes mellitus in the overwhelming majority of cases is symptomatic and is aimed at eliminating the existing symptoms without eliminating the cause of the disease, since an effective treatment for diabetes has not yet been developed.

    Depending on the type of diabetes mellitus, patients are prescribed insulin administration or oral administration of drugs that have a sugar-reducing effect.Patients should follow a diet, the qualitative and quantitative composition of which also depends on the type of diabetes mellitus.

    In type 2 diabetes mellitus, a diet and drugs that lower blood glucose levels are prescribed: glibenclamide, glurenorm, gliclazide, glibutide, metformin. They are taken orally after the individual selection of a specific drug and its dosage by a doctor.

    In type 1 diabetes mellitus, insulin therapy and diet are prescribed. The dose and type of insulin (short, medium or long-acting) is selected individually in the hospital, under the control of sugar in the blood and urine.

    Diabetes mellitus diet is a necessary part of treatment, as well as the use of hypoglycemic drugs or insulins. Without diet, it is impossible to compensate for carbohydrate metabolism. It should be noted that in some cases of type 2 diabetes, only diet is sufficient to compensate for carbohydrate metabolism, especially in the early stages of the disease. In type 1 diabetes, adherence to a diet is vital for the patient, a violation of the diet can lead to a hypo- or hyperglycemic coma, and in some cases to the death of the patient.

    At present, the prognosis for all types of diabetes mellitus is conditionally favorable, with adequate treatment and adherence to the diet, the ability to work remains. The progression of complications is significantly slowed down or completely stopped. However, it should be noted that in most cases, as a result of treatment, the cause of the disease is not eliminated, and the therapy is only symptomatic.

    Walking Away From Diabetes: 7 Questions From Readers – Endocrinologist Answers | HEALTH

    Tatiana Gracheva, chief endocrinologist of the Sverdlovsk region, head of the endocrinology department of OKB # 1, answers questions from readers of AiF-Ural within the framework of the project “Tell me, doctor …”

    Who is at risk for diabetes

    Diabetes is a disease of the elderly, that is, in your youth you can not be afraid of it?

    L. Shipovnikova, Rezh

    Diabetes mellitus begins and proceeds in different ways: type 1 diabetes, in which there is always an insulin dependence, is diabetes of young people, including children and adolescents; type 2 diabetes usually occurs in people of mature age – after 40 years. But today there is a trend towards rejuvenation of type 2 diabetes, and young people are also getting sick with it.

    Today, diabetes mellitus is called the pandemic of the 21st century, and it is precisely due to the increase in the number of patients with type 2 diabetes, since the number of patients with type 2 diabetes becomes more and more, while the number of patients with type 1 diabetes remains more constant.

    I have type 2 diabetes, does this mean that my children will definitely get it?

    N. Shishkanova, Yekaterinburg

    If one of the parents has type 1 diabetes, then the probability that the child will get it is low – 2–6%.But in type 2 diabetes, genetic predisposition plays a significant role in the likelihood of the disease occurring.

    But predisposition does not determine the fatal inevitability of diabetes. If you lead a healthy lifestyle, eat right, exercise, there is a chance to prevent the development of type 2 diabetes, and if it develops, to achieve remission. That is, in addition to predisposition, other risk factors also influence the development of diabetes.

    I have a bad family history, what can I do to avoid diabetes?

    M.Karchuk, Nizhny Tagil

    The main factors in the prevention of the disease are at the same time the components of treatment for type 2 diabetes. This is physical activity and proper nutrition. By physical activity, we mean daily, basic, physical activity. Plus, at least 150 minutes a week (about 30 minutes a day), we should be doing something that looks like walking at an average pace (when I walk and can speak, but I can not sing anymore). That is, this is a fairly fast walking or any other type of load, as a result of which we should get a little tired.This is the kind of load we should have most of the days of the week. In this case, there should be a combination of basic activity and aerobic load.

    In addition, we need to have strength training that will allow our muscles to be toned and properly involved in metabolism. The muscle that works absorbs glucose, and having enough muscle tissue shifts the metabolism in the right direction. Following these recommendations not only prevents diabetes, but also allows you to lose weight and, importantly, reduces biological age.

    As for food, everything is very simple here. There are no hard limits, but there are reasonable rules that apply to everyone. It is appropriate to say here that over the age of 45, anyone is at risk for diabetes. In other words, we all run the risk of developing diabetes at some stage in our lives, but the more healthy we eat, the less this risk.

    What does it mean to eat right? The main thing, and I want everyone to get used to it, is to give up sugary drinks: they supply most of the unnecessary glucose to our body.In addition, if you are overweight and at risk of developing type 2 diabetes, you are advised to simply cut your regular serving in half. These measures will be a big step towards proper nutrition.

    What and when to eat and how much weight can be considered superfluous

    How much weight is considered “overweight” and is already a factor in the development of diabetes?

    Y. Ivanchenko, Kamyshlov

    This is a question clearly from an advanced reader, because really, being overweight is a relative concept.That is, not only weight speaks about how healthy a person is from a metabolic point of view. It is important, due to what this weight is “extra” and how fat is distributed in the body.

    More accurately reflects whether a person has metabolic disorders, metabolic syndrome, waist circumference. A waist circumference of more than 88 cm in a woman and more than 94 cm in a man indicates that a person has abdominal obesity – an accumulation of visceral (internal) fat in the waist, in the abdomen. This fat also has a negative effect on human health.

    I have type 2 diabetes. I often want to eat at night and if I don’t eat, I won’t be able to sleep. How to solve this problem?

    G.I. Yekaterinburg

    This is a real problem and you shouldn’t be shy about it. There may be several reasons for this need.

    • First of all, it might just be a habit associated with sleep disturbance. In this case, it is worth trying to change the structure of activity during the day, change the time of falling asleep.
    • The second reason may be a violation of the diet. For example, a person does not eat breakfast in the morning, but shifts the main meal to the evening. In order not to feel hungry at night, I recommend a protein meal, as protein provides a small amount of sugar (glucose), and this sugar is gradually released during the night, which prevents nighttime hunger attacks.
    • The third possible reason is that overweight people with a history of diabetes, even before the development of the disease, may have such a phenomenon as an increased level of insulin in the blood.In this situation, I would recommend to be examined by an endocrinologist. But our reader, who already has type 2 diabetes, must also inform the endocrinologist about night hunger, who will decide whether a correction of therapy is needed or the problem can be solved by adjusting the diet.

    How vaccination works with diabetes

    I am 82 years old, since 2002 I have diabetes and hypertension. Can I get the coronavirus vaccine?

    V. Andreiko, Yekaterinburg

    I will voice the position of the Federal Research Center for Endocrinology.The main contraindications for vaccination against coronavirus infection for patients with diabetes are exactly the same as for all other people. Namely: a history of severe allergic reactions, as well as an acute infectious disease.

    In addition, diabetes adds another contraindication to vaccination – acute decompensation of diabetes mellitus, that is, acute complications of diabetes. In these situations, a person is not vaccinated. Otherwise, patients with both type 1 and type 2 diabetes are the priority group for vaccination.Coronavirus infection in patients with diabetes mellitus, especially if sugar control is not very good, is more severe, they develop more complications. So, again, this is the priority group for vaccination.

    Being examined, doctors suspect type 2 diabetes. If the diagnosis is confirmed, will I have to go on a strict diet?

    L. Kruglikova, Kamyshlov

    Dear patients, please do not perceive an endocrinologist as a doctor who will forbid you everything! We, endocrinologists, adhere to the basics of proper nutrition, experience the possibility or impossibility of following our recommendations.The nutritional guidelines we make are not just for people with diabetes, they are for everyone. And there are no unnatural strict restrictions like “eat only buckwheat”, “forget about potatoes”, “take the bread off the table”. The word “prohibited” has disappeared from our recommendations, we say and write “limit as much as possible”.

    In addition, if you play sports, have enough physical activity, the filling of your plate may expand. Even sweets during exercise of medium and high intensity will not hurt, since at the time of physical exertion, the sweets are utilized.

    In a word, you do not have to sit on a rigid diet. You will have to learn about the fact that there are easily digestible and hard-to-digest carbohydrates, figure out what fats you can eat so as not to increase the risk of heart attack and stroke, and also figure out the amount of food you eat, because, even without violating the principles of a healthy diet , we often sin by eating too much.

    90,000 Eight hidden symptoms of diabetes mellitus and one real way to prevent it

    In this program, you will learn what evidence can be used to expose diabetes mellitus in yourself or your relatives, and what modern science thinks about its prevention.

    Official statistics and the real number of patients with diabetes mellitus in Russia differ threefold. Officially, 3 million 300 thousand Russians are diagnosed, but about 5.5% of the population, that is, 9 million people, actually get sick. It turns out that about 6 million Russians do not even suspect that they are suffering from this deadly disease.

    8 symptoms that can mean an imperceptible course of diabetes (of course, the final diagnosis must be made by an endocrinologist):

    1.Thirst and increased urination

    If you have to go to the bathroom a lot, it could mean your kidneys are working hard to expel excess glucose. And the more they remove sugar in urine, the more thirsty we become.

    2. Increased appetite.

    If you notice that you have a particularly strong appetite, in which you lose weight, this is a sign of hormonal disorders. Hunger attacks can occur due to surges in blood glucose.

    3. Fatigue and irritability

    Yes, these symptoms may also be associated with diabetes. Sudden jumps in glucose, poor sleep, frequent urge to go to the toilet – all this affects the mood and exhausts a person.

    4. Skin changes

    Itching, dryness, irritation, pallor – all this means that the normal nutrition of cells is impaired. The skin is nourished according to the “residual” principle. When diabetes disrupts the nutrition of all tissues, the skin suffers the very first.

    5. Slow and poor wound healing and recovery from disease

    Excess sugar damages the walls of blood vessels, blood microcirculation is disturbed and wounds take much longer to heal.

    6. Fungal infections

    The logic is the same: impaired circulation and microcirculation makes the skin especially susceptible to fungal diseases.

    7. Visual impairment

    This may be a sign of circulatory and nutritional problems in the eyes, which are very often associated with diabetes.

    8. Tingling or numbness

    Signs that diabetic changes are affecting the nerves. A similar symptom is muscle pain.

    For more information on the signs of diabetes and its prevention, see our video.

    The carotid artery “gave out” the biological age of a person

    Biological age is a concept that reflects the state of the body. For a healthy average person, it corresponds to his chronological age, i.e.e. age “according to the passport”. In the process of aging, these two indicators may diverge due to various factors: the environment, bad habits, manifestations of hereditary diseases. Today, there is no single way to identify biological age. Both scientists and physicians are in search of a criterion that would accurately and stably reflect the state, if not of the entire organism as a whole, then at least of its individual systems.

    The study was based on the data of ultrasound of the human carotid artery and tonometry.Using machine learning, a formula was obtained that can predict age in healthy people with an accuracy of 6.9 years for men and 5.9 years for women. The study also conducted tests on patients with hypertension and type 2 diabetes. The test results showed that the biological age of those suffering from these diseases is, on average, three years higher than their real age.

    “They have been trying to solve the problem of determining the biological age of a person for more than a decade.The most accurate methods to date, based on data on the state of the DNA of cells (the so-called “epigenetic clock”), make it possible to predict age with an average error of less than three years). However, they require expensive equipment and training of specialists, and therefore are still not used in medical practice. Our methodology is based on the information that any modern clinic can get about a patient ”, – says Alexey Moskalev , head of the laboratory of genetics of aging and life expectancy at the Center for Life Sciences of the Moscow Institute of Physics and Technology.

    The authors of the study chose the cardiovascular system as a source of information about the body, namely, such parameters as the minimum thickness of the middle layer in the tissue of the carotid artery, pulse wave velocity, width of the carotid artery (degree of stenosis) and augmentation index – the ratio of pressure peaks in the pulse wave. All of them individually are widely used for diagnostics and are indicators of atherosclerosis, hypertension, calcification, diabetes and other diseases. The choice was made after conducting correlation analysis – a method by which the tightness of the relationship between different variables is measured.

    The result of the work of scientists was a formula in which the biological age is expressed with some coefficients through these four parameters. The selection of coefficients was carried out using machine learning, namely robust regression. We used data on 303 patients aged 23 to 91 who were examined at the Center for Preventive Medicine in Moscow in 2012. Among them, 199 are women and 104 are men. The essence of the robust regression method is similar to the least squares method familiar to us from school – it is an attempt to approximate the experimental dependence with a certain formula, that is, to select the variables in the formula so that the resulting curve matches the experimental data as much as possible.However, there are fundamental differences that make robust regression preferable. Machine learning methods have long been used to estimate biological age. Recently, deep neural networks have become popular, which allow you to build high quality models. However, their use is not always justified. For example, training them requires a huge number of measurements, which is not always achievable in clinical practice.

    Bioinformatics Alexander Fedintsev , Researcher, Institute of Molecular Biology.V. A. Engelgardt RAS, the first author of the article, specifies: “We applied nonlinear robust regression, which does not use a priori assumptions about the distribution of the dependent variable, therefore it is resistant to outliers and, due to the small number of selected factors, can be trained using a small amount of data … This model, in addition to good accuracy, also demonstrates a simple interpretation of the result: you can definitely say how much the predicted age will change when the measured parameters change.It’s worth noting that quality data still plays a critical role. Thanks to a large database with many biomarkers, we were able to highlight the strongest factors that helped to achieve a low prediction error, even with a relatively simple and compact model. ”

    As a test of the correctness of the new technique, the scientists decided to compare the indicators of biological age, calculated by them, with other methods for assessing the state of the body. The correlation between the calculated biological age and the Framingham CVD score, an estimate of cardiovascular disease risk not based on echography of the aorta, was higher than the correlation with chronological age.A comparison was also made with other methods of processing the same data that scientists used in their study: the results of the work were compared with the statistical method of Clemera-Dubal. Again, the correlation of results with biological age turned out to be higher than with chronological one.

    Co-author of the article, director of the Russian Gerontological Research and Clinical Center Olga Tkacheva comments : Since the source of information is only the cardiovascular system, clarification of biological age requires additional research that takes into account other factors.However, recent studies have shown that the relationship between the state of blood vessels and biological age turned out to be even higher than the relationship with the chemical composition of blood ”.

    In combination with the fact that according to the statistics of the World Health Organization, it is diseases of the cardiovascular system that become the main cause of death during aging, it can be argued that the technique developed by scientists is an effective method for determining biological age. And the ability to quickly and reliably recognize the biological age is the key to the successful development of the fight against aging.