Supervisor: Alexandra Kautzky-Willer
Committee: Dagmar Bancher-Todesca, Richard Crevenna
Department: Internal Medicine III, Division of Endocrinology & Metabolism, Gender Medicine Unit
Tel: +43 (0)1 40400 - 43150
Current academic degree: Master of Science, M.D.
Previous University and Subject: Medical University of Vienna / Medicine, Gender Medicine
Thesis since: 05/2010
Jürgen Harreiter had his doctoral viva
and succesfully graduated.
Prevention of Type 2 Diabetes Mellitus with Special Focus on Prediabetic Individuals, Pregnant Women at High Risk and Their Offspring
Type 2 diabetes and obesity are severe diseases causing higher morbidity and mortality and increasing costs for health economies worldwide. Prevalence assumptions have calculated a nearly doubling risk in the next 20-30 years for diabetes, and nearly similar expectations for obesity are reported, with the WHO estimating 700 million people suffering in 2015, compared to about 400million in 2005. Overweight and obesity have strong associations to prediabetes and development of gestational diabetes mellitus with both abnormalities to be known to consecutively develop to the metabolic syndrome or type 2 diabetes or other chronic disease. Around 50-70% of women with prior gestational diabetes mellitus progress to type 2 diabetes within 5-10 years after pregnancy. Control groups of large prevention trials indicate that without adequate intervention the progression rate from prediabetes to T2D is up to 20% per year. Only lifestyle intervention, such as changes in nutrition or physical activity, or other preventive interventions, as vitamin D supplementation in pregnancy or oral antidiabetics in prediabtic state, are known to or might reduce risk substantially in both groups at risk, women with gestational diabetes and subjects with prediabetes. Despite the vigilance for women with a history of gestational with a recommendation for routine screening of women with previous GDM for T2D much less attention has been paid for the follow-up of individuals born form GDM pregnancies. Prenatal exposure to hyperglycaemia is a strong predictor of impaired glucose tolerance (IGT) and obesity by adolescence, furthermore children exposed to GDM have higher risk for overweight, insulin resistence and cardiovascualar disease in later life. Both mothers and babies are prone to T2D and cardiovascular diseases.
The DALI Project (Vitamin D And Lifestyle Intervention for Gestational Diabetes mellitus Prevention, http://www.dali-project.eu/), funded by EU FP7, aims to develop effective preventive measures for GDM. DALI will investigate the actual spreading of the disease by using standardized diagnostic methods. One of the objectives of the EU-project DALI is to develop uniform European standards for interventions and to collect reliable data on GDM. Also, the effectiveness of three different intervention strategies to prevent diabetes during pregnancy will be analyzed. In a first phase, appropriate recommendations for these strategies - balanced diet, physical activity, and Vitamin D - will be worked out. Then, in a pilot phase, a small group of obese pregnant women will be tested in each participating center. After that the intervention study will start. For this purpose, 880 pregnant women throughout Europe with a body mass index over 29kg/m² are asked to volunteer. Basically, advisory service and motivation will be provided. Each center has special trained coaches who accompany and motivate the pregnant women to change their behavior.
The objective of the project 'Sex-Specific differences in diabetes prevention: a systematic review and metaanalysis', funded by the Scientific Fund of the Mayor of Vienna, is to assess differences in effectiveness and risk of harms of commonly used interventions to prevent T2D between men and women diagnosed with prediabetes. To our knowledge no studies have assessed systematically whether sex-specific differences need to be considered for interventions used to prevent T2D in people with prediabetes.
The EFSD New Horizons Collaborative Research Initiative project 'Phenotypic and Genotypic Characterization of Individuals born from Gestational Diabetes Mellitus Pregnancies' aims to investigate the risk for GDM offspring for further T2D progression and further provide information about genetic, pheotypic or metabolic risk factors in the offspring. Genotypic risk variants for T2D that might also be considered as maternal risk variants for GDM will be tested in children born of GDM pregnancies. The examination of intrahepatic liver fat, intracardiac fat, as well as subcutaneous and abdominal fat in offspring of GDM pregnancies and healthy controls will give further insight in early metabolic disturances. Also novel biomarkers known to be differnent in GDM women or T2D diabetics as compared to healthy individuals will be investigated in cord blood samples, giving potential information of early detectable derrangements in the offspring.
All projects will serve as basis for the PhD thesis 'Prevention of Type 2 Diabetes mellitus with special focus on prediabetic individuals, pregnant women at high risk and their offspring' as they follow the same major goals of either assessing or testing preventive intervention methods for prevention of T2D development in patients at high risk ( prediabetes, obesity, GDM) or it is the identification of early metabolic disturbances in offspring of GDM pregnancies.
Methods and Skills: