Universal HbA1c measurement in early pregnancy to detect type 2 diabetes reduces ethnic disparities in antenatal diabetes screening: a population-based observational study
Authors: Authors: Hughes RC et al.
Summary: Summary: This observational study compared inter-ethnic antenatal screening practices, including the uptake of
both the first-antenatal blood screen and the universal two-step gestational diabetes (GDM) screen recommended
at 24–28 weeks’ gestation, to establish the potential benefit of universal HbA1c testing in early pregnancy to detect
unrecognised type 2 diabetes and prediabetes. The study included 11,580 pregnancies in Christchurch, New Zealand,
during 2008–2010. Electronic databases were used to match maternal characteristics to first-antenatal bloods,
HbA1c, and GDM screens (glucose challenge tests and oral glucose tolerance tests). Overall uptake of the firstantenatal
bloods versus GDM screening was 83.1% and 53.8%, respectively. GDM screening was lowest in Māori
(39.3%), resulting in an incidence proportion ratio (IPR) of 0.77 (95% CI, 0.71 to 0.84) compared with Europeans.
By including HbA1c with the first-antenatal bloods, the number screened for diabetes increased by 28.5% in
Europeans, 40.0% in Māori, 28.1% in Pacific People, and 26.7% in ‘Others’ (majority of Asian descent). The combined
prevalence of unrecognised type 2 diabetes and prediabetes by New Zealand criteria, HbA1c ≥5.9% (41 mmol/mol),
was 2.1% in Europeans, 4.7% in Māori (adjusted IPR 2.59; 95% CI, 1.71 to 3.93), 9.5% in Pacific People (aIPR 4.76;
95% CI, 3.10 to 7.30), and 6.2% in ‘Others’ (aIPR 2.99; 95% CI, 2.19 to 4.07). When these prevalence data were
applied to the 2013 NZ national birthing data, routine antenatal HbA1c testing could have identified type 2 diabetes in
0.44% and prediabetes in 3.96% of women.
Reference: Reference: PLoS One. 2016;11(6):e0156926
Abstract
Cognitive neuropsychological functioning in New Zealand Māori diagnosed with schizophrenia
Authors: Authors: Kake TR et al.
Summary: Summary: Cognitive neuropsychological functioning was examined in 54 adult Māori diagnosed with schizophrenia
and 56 controls, matched on sociodemographic variables, handedness and premorbid cognitive ability. The study
also analysed associations between cognition, medication and symptoms of psychosis in the schizophrenia group.
In neuropsychological testing of attention, executive ability, motor, premorbid ability, verbal/non-verbal memory and
verbal fluency (English/Māori versions), performance was significantly poorer in the schizophrenia group versus the
control group on all tests, except the test of attention. Effect sizes were moderate to large: 0.78 for motor function;
1.3 for executive ability, verbal fluency and visual memory; 1.6 for verbal learning and 1.8 for verbal memory.
These differences persisted in analyses that adjusted for multiple comparisons and covariates. A higher dose of
antipsychotic medication and a higher anticholinergic load were associated with greater verbal memory impairment
(r = −0.38 and r = −0.38, respectively). A longer duration of illness was associated with greater impairment of verbal
memory (rho = −0.48), verbal learning (rho = −0.41) and visual memory (rho = −0.44).
Reference: Reference: Aust N Z J Psychiatry. 2016;50(6):566-76
Abstract