• Atlantic DIP: Diabetes in Pregnancy: a comparative study of stress and wellbeing in women with established diabetes, gestational diabetes, and those without diabetes

      Lydon, K; McGuire, B; Owens, LA; Sarma, K; Avalos, G; Carmody, L; O'Connor, C; Nestor, L; Dunne, F; Department of Medicine, National University of Ireland, Galway, Galway, Ireland, 2School of Psychology, National University of Ireland, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09-15)
      Background and aims: Diabetes in pregnancy increases the risk of maternal and perinatal morbidity and mortality. The experience of diabetes during pregnancy may be a significant source of stress, both because of the impact of the illness and associated treatments on the expectant mother and because of concern about the impact on the unborn child. In order to examine stress associated with diabetes during pregnancy, we carried out a prospective study in women with pre-existing (Type 1 or Type 2) Diabetes (PDM), Gestational Diabetes Mellitus (GDM), and non-diabetic pregnant controls (NDM). Materials and methods: The participants were 210 pregnant women - 25 with pre-existing diabetes (PDM), 77 with GDM and 108 healthy controls (NDM). All were attending antenatal services in six health care centres in Ireland. We measured stress and wellbeing with several standardised psychological questionnaires including The Pregnancy Experience Scale; The Depression Anxiety Stress Scale; the Multidimensional Perceived Social Support Scale; the Illness Perception Questionnaire-Diabetes; the Diabetes Self-Efficacy Scale; the SF-8 and the Problem Areas in Diabetes Scale. We hypothesized that diabetic women would report higher levels of stress than healthy controls and we also hypothesized that social support may confer a protective role. Results: We found a non-significant trend of increased stress and lower quality of life among diabetic women compared to non-diabetic controls. Women with PDM perceived their illness as having a higher impact on their lives than those with GDM (p<0.0001). However, women with pre-existing diabetes also reported significantly greater self-efficacy in relation to their diabetes management compared to their gestational diabetes counterparts (p<0.05). The results of the remaining questionnaires demonstrate a general trend towards higher distress in diabetic women compared to controls. The healthy controls reported higher perceived social support which may confer a protective role against psychological stress. Conclusion: These preliminary results suggest that pregnant diabetic women perceive themselves as having a lower quality of life and higher levels of stress in pregnancy, especially women with pre-existing diabetes. This may indicate a need for psychological support in these patients. However, further research is required.
    • The benefit of a pre-pregnancy care program in women with Type 1 and Type 2 diabetes: continued improvement

      Mustafa, E; Khalil, S; Kirwan, B; Carmody, L; Gallacher, T; Mitchell, Y; Todd, M; Hoashi, S; Durkan, M; Dunne, F; et al. (Royal Academy of Medicine in Ireland, 2011)
    • Gestational diabetes is more prevalent in women from lower socio-economic backgrounds.

      Owens, L; Cullinane, J; Gillespie, P; Avalos, G; O'Sullivan, EP; Dennedy, C; O'Sullivan, EP; O'Reilly, M (Diabetic Pregnancy Study Group, 2011)
      The link between socio-economic disadvantage and poor health has been observed across many spectrums of medicine. There is little evidence however, suggesting that Diabetes in Pregnancy is more prevalent in women from poorer backgrounds. This study was completed by the Atlantic Diabetes in Pregnancy partnership, which offered universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on women who delivered in 5 antenatal centres between 2007 and 2009. The calculated socio-economic background is based on a deprivation index derived from area of residence and national census data. The Deprivation Index is scored from 1-5, from least to most deprived, using various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. Using a ‘bivariate probit with sample selection’ model we controlled for poor attendance amongst women from disadvanted areas. We found that incidence of gestational diabetes is significantly higher for women living in the poorest areas, compared to women living in the richest areas. This gradient disappears when diabetes risk factors are controlled for, suggesting personal, clinical and lifestyle factors correlated with socioeconomic status are significant determinants for the development of Gestational Diabetes. These risk factors include; Body Mass Index, family history, smoking, sedentary lifestyle and higher immigrant population. Gestational Diabetes is more prevalent amongst women from lower socio-economic backgrounds.
    • Gestational diabetes mellitus results in a higher prevalence of small for gestational age babies

      Avalos, G; Owens, LA; Dennedy, C; O'Sullivan, EP; O'Reilly, MW; Dunne, F; Department of Medicine, National University of Ireland, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09)
      Background and aims: Gestational Diabetes Mellitus (GDM) is associated with increased foetal and maternal morbidity and mortality. Previous studies have shown that babies of diabetic mothers are more likely to be large for gestational age (LGA). This retrospective study aimed to assess whether the converse may also be true, that there may also a higher rate of small for gestational age (SGA) amongst babies of mothers with GDM. Materials and methods: This retrospective study offered universal screening for GDM to pregnant women in 5 hospitals between 2007-2009. During this time 5,500 women underwent testing for GDM using a 75g Oral Glucose Tolerance Test at 24-28 weeks gestation. GDM was defined by the International Association of the Diabetes and Pregnancy Study Groups guidelines (IADPSG). Results: The prevalence of GDM was 12.4%. 4.5% of babies were small for gestational age (SGA) at birth in live births. Babies of mothers with GDM were more likely to have SGA than babies of non-diabetic women, OR 1.5, p=0.03, 95% CI {1.02-2.24. Mean Body Mass Index (BMI) was lower in mothers of SGA babies than mothers of babies who were average (AGA) or large for gestational age (LGA), 26.3 compared to 27.1, p<0.0001. Smoking (OR 3.1, p=0.000)) pre-ecampsia (OR 3.99,p=0.000), gestational hypertension, low parity (OR 0.8.p= 0.005), non-Caucasion ethnicity were also predictive of SGA These SGA babies had a worse clinical outcome, including; higher caesarean section rate, higher requirement for neonatal intensive care , higher rates of hypoglycaemia and respiratory distress. 76% of diabetic women were treated with insulin. Insulin treatment did not affect rates of SGA when compared with dietary management. Conclusion: This study shows another important negative outcome associated with GDM. Further research is required to identify the causative factor(s).
    • Gestational diabetes mellitus results in a higher prevalence of small for gestational babies

      Dunne, F; Owens, LA; Avalos, G; Dennedy, C; O'Sullivan, EP; O'Reilly, M; Department of Medicine, National University of Ireland, Galway, Galway, Ireland. (Diabetic Study Pregnancy Group (DSPG), 2011)
      Background and aims: Gestational Diabetes Mellitus (GDM) is associated with increased foetal and maternal morbidity and mortality. Previous studies have shown that babies of diabetic mothers are more likely to be large for gestational age (LGA). This retrospective study aimed to assess whether the converse may also be true, that there may also a higher rate of small for gestational age (SGA) amongst babies of mothers with GDM. Materials and methods: This retrospective study offered universal screening for GDM to pregnant women in 5 hospitals between 2007-2009. During this time 5,500 women underwent testing for GDM using a 75g Oral Glucose Tolerance Test at 24-28 weeks gestation. GDM was defined by the International Association of the Diabetes and Pregnancy Study Groups guidelines (IADPSG). Results: The prevalence of GDM was 12.4%. 4.5% of babies were small for gestational age (SGA) at birth in live births. Babies of mothers with GDM were more likely to have SGA than babies of non-diabetic women, OR 1.5, p=0.03, 95% CI {1.02-2.24}. Mean Body Mass Index (BMI) was lower in mothers of SGA babies than mothers of babies who were average (AGA) or large for gestational age (LGA), 26.3 compared to 27.1, p<0.0001. Smoking (OR 3.1, p=0.000)) pre-eclampsia (OR 3.99,p=0.000) , low parity (OR 0.8.p= 0.005), non- Caucasian ethnicity were also predictive of SGA These SGA babies had a worse clinical outcome, including; higher caesarean section rate, higher requirement for neonatal intensive care , higher rates of hypoglycaemia and respiratory distress. 76% of diabetic women were treated with insulin. Insulin treatment did not affect rates of SGA when compared with dietary management. Conclusion: This study shows another important negative outcome associated with GDM. Further research is required to identify the causative factor(s).
    • High prevalence of abnormal glucose tolerance postpartum is reduced by breastfeeding in women with prior gestationIal diabetes mellitus

      O'Reilly, MW; Avalos, G; Dennedy, MC; O'Sullivan, EP; Dunne, F; Department of Medicine, National University of Ireland and University College Hospital, Galway, Ireland. (2011)
      Background and aims: Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes. It identifies women at risk of pre-diabetes, type 2 diabetes (T2DM) and cardiovascular risk in later life. Recent studies have suggested that breastfeeding may confer a beneficial effect on postpartum maternal glucose tolerance in both women with GDM and normal glucose tolerance (NGT) in pregnancy. Materials and methods: We compared results from 300 women with GDM and 220 women with NGT according to IADPSG criteria using a 75g oral glucose tolerance test (OGTT) at 24-28 weeks gestation by repeating the 75g OGTT postpartum to reassess glucose status. We also tested for postpartum metabolic syndrome (MetS) according to international criteria. Binary logistic regression was used to identify maternal factors that increased the risk of persistent glucose intolerance. Postpartum lactation status was categorised as breastfeeding alone, bottle-feeding alone, or both. Results: 520 women were tested. OGTT results were classified as normal (FPG<5.6mmol/l; 2h<7.8mmol/l) or abnormal (IFG; 5.6-6.9, IGT; 2h 7.8-11.0, IFG+IGT; T2DM FPG 7 ± 2h 11.1). Six of 220 (2.7%) women with NGT in pregnancy had postpartum dysglycaemia compared to 57 of 300 women (19%) with GDM in pregnancy (P<0.001). Non-Caucasian ethnicity (OR 3.40, 95% CI 1.45-8.02, P=0.005), family history of T2DM (OR 2.14, 95% CI 1.06-4.32, P=0.034) and insulin use in pregnancy (OR 2.62, 95% CI 1.17-5.87, P=0.019) were all predictive of persistent dysglycaemia. MetS was present postpartum in 31 of 300 women (10.3%) with GDM compared to 18 (8.2%) of 220 women with NGT (P=0.4). The prevalence of persistent dysglycaemia was lower in women who breast-fed versus bottle-fed their babies, or employed both techniques (7.1% v 18.4% and 11.2%, respectively, p<0.001). Conclusion: In this Irish population the prevalence of persistent glucose intolerance in women with GDM in pregnancy is 19% compared to 2.7% in NGT women. Breast-feeding confers a beneficial effect on postpartum glucose tolerance. The precise mechanism behind this association is unclear and requires further study.
    • Investigating the role of healthcare accessibility and socio-economic background on the decision to attend for screening for gestational diabetes mellitus in Ireland

      Owens, L; Cullinane, J; Gillespie, P; Avalos, G; O'Sullivan, EP; O'Reilly, M; Dennedy, C; Dunne, F; Department of Medicine, National University of Ireland, Galway 2Department of Economics, National University of Ireland, Galway (Diabetic Pregnancy Study Group, 2011)
      Gestational diabetes mellitus (GDM) is associated with increased maternal and neonatal morbidity and mortality. We investigated the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. We also aimed to assess whether Irish women of lower socio-economic status were less likely to attend for screening for Diabetes in Pregnancy than their higher status counterparts. This study was completed through the Atlantic Diabetes in Pregnancy (DIP) partnership, which offers universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on all women who delivered in 5 antenatal centres along the Irish Atlantic Seaboard between 2007-2009. Patients were ‘geocoded’, in order to provide precise spatial (x,y) coordinates for their residential locations. This facilitates geographic information systems -based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibilityrelated variables, as well as a number of individual-level variables relating to personal, socioeconomic, clinical and lifestyle characteristics. The socio-economic status is based on the deprivation score derived from the 2006 Census of Population for the Republic of Ireland. The Deprivation Index is constructed from a combination of various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. 9,043 pregnant women offered screening, 5,218 (58%) of whom participated in testing. The probability of attending for screening was reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. Using the deprivation index 60% of those who scored 1 (most affluent) attended for screening, 58% in score 2, 56% in score 3, 53% in score 4 and 46% in the score 5 (most deprived) group attended, p=0.0001. This shows a clear decrease in attendance levels in those who are deemed to be more disadvantaged. The most disadvantaged women overall were 40% less likely to attend than their most affluent counterparts (OR0.6, 95%CI {0.55-0.71},p=0.001). Accessibility to healthcare centres and socio-economic background both affect the decision to attend for screening for Gestational Diabetes Mellitus in Ireland.
    • The Perceptions of Patients, their Parents and Healthcare Providers on the Transition of Young Adults with Type 1 Diabetes to Adult Services in the West of Ireland.

      Walsh, Ó; Wynne, M; O Donnell, M; Geoghegan, R; O Hara, Mary Clare; Paediatric Department, University Hospital Galway, School of Medicine, National University of Ireland Galway, Research and Development, HSE Strategic Planning and Transformation (Irish Medical Journal, 2018-07)
      This study aims to describe the perceptions of young adults’, parents of young adults’ and health care professionals’ (HCPs) of the transition process for young adults with Type 1 Diabetes in the West of Ireland.
    • The prevalence of diabetes, pre-diabetes and metabolic syndrome in Irish travellers and the impact of lifestyle modification

      Slattery, D; Brennan, M; Canny, C; O'Shea, P; Dennedy, MC; Dunne, F; Galway University Hospitals (Royal Academy of Medicine in Ireland, 2011)
    • A prospective study of risk factors for foot ulceration: The West of Ireland Diabetes Foot Study.

      Hurley, L; Kelly, L; Garrow, Ap; Glynn, Lg; McIntosh, C; Alvarez-Iglesias, A; Avalos, G; Dinneen, Sf; Diabetes Centre, Galway University Hospitals and Galway Primary Community and Continuing Care, Health Services Executive West. (2013-09-25)
      BackgroundThis is the first study to examine risk factors for diabetic foot ulceration in Irish general practice.AimTo determine the prevalence of established risk factors for foot ulceration in a community-based cohort, and to explore the potential for estimated glomerular filtration rate (eGFR) to act as a novel risk factor.DesignA prospective observational study.MethodsPatients with diabetes attending 12 (of 17) invited general practices were invited for foot screening. Validated clinical tests were carried out at baseline to assess for vascular and sensory impairment and foot deformity. Ulcer incidence was ascertained by patient self-report and medical record. Patients were re-assessed 18 months later. ResultsOf 828 invitees, 563 (68%) attended screening. On examination 23-25% had sensory dysfunction and 18-39% had evidence of vascular impairment. Using the Scottish Intercollegiate Guidelines Network risk stratification system we found the proportion at moderate and high risk of future ulceration to be 25% and 11% respectively. At follow-up 16/383 patients (4.2%) developed a new foot ulcer (annual incidence rate of 2.6%). We observed an increasing probability of abnormal vascular and sensory test results (pedal pulse palpation, doppler waveform assessment, 10g monofilament, vibration perception and neuropathy disability score) with declining eGFR levels. We were unable to show an independent association between new ulceration and reduced eGFR [Odds ratio 1.01; p=0.64].ConclusionsOur data show the extent of foot complications in a representative sample of diabetes patients in Ireland. Use of eGFR did not improve identification of patients at risk of foot ulceration.
    • The provision of diabetes care in nursing homes in Galway city and county: a survey of nursing homes

      Hurley, Lorna; Dinneen, Sean; Galway Primary Community & Continuing Care & the Diabetes and Endocrinology Service, University Hospital Galway (Galway Primary Community & Continuing Care & the Diabetes and Endocrinology Service, University Hospital Galway, 2014-03)
      In addition to the increasing prevalence of diabetes, our population is growing older and living longer. This survey aimed to determine the care provided to residents with diabetes in Nursing Homes. All 44 Nursing Homes in County Galway were sent postal surveys and 75% (n=33) responded. Of these, 18% (n=6) were Health Service Executive (HSE) Nursing Homes and 82% (n=27) were private Nursing Homes. Nursing Homes had an average of 38.2 residents, 5.2 of whom had diabetes. This equates to a prevalence of 14%. 42% of Nursing Homes had a policy on diabetes management, 56% had access to diabetes care guidelines and 97% had diabetes care plans. Retinal screening, dietetic and chiropody/podiatry services were accessed by 70%, 89% and 97% respectively. A third of residents with diabetes were managed on insulin. Titration of insulin was performed in collaboration with the diabetes specialist (60%) and/or the GP (60%) while 20% report titration of insulin in-house without additional support. One third of Nursing Homes do not keep a record of the residents’ blood test results. These are held by the GP. Management of hypoglycaemia was reported to be a frequent or very frequent occurrence in 19% of homes. One third of residents with diabetes attend the diabetes outpatient clinic and the rate was highest in private Nursing Homes (p=0.01). 36% of Nursing Homes had staff with diabetes training. Access to education was the most cited opportunity for improving diabetes care (88%), followed by access to services (67%). A focus group and interviews were carried out with Nursing Home managers to further explore the data and issues arising. Findings from this qualitative research highlight variations in the level and standard of diabetes care provided in nursing homes. Level of support from general practice varies depending on the GP. Ancillary services provided in-house are usually from private sources with transport being identified as a barrier to accessing public ancillary services. Although education and training is provided in-house by a variety of sources preferences for education by practicing specialists and tailored to the people with diabetes in specific homes were expressed. This is the first report on the status of diabetes care in Nursing Homes in an Irish setting and may help inform policy.
    • Strength in Numbers: an international consensus conference to develop a novel approach to care delivery for young adults with type 1 diabetes, the D1 Now Study

      O’Hara, Mary Clare; Hynes, L.; O’Donnell, M.; Keighron, C.; Allen, G.; Caulfield, A.; Duffy, C.; Long, M.; Mallon, M.; Mullins, M.; et al. (BioMed Central, 2017-12-04)
      Abstract: Background A 3-day international consensus meeting was hosted by the D1 Now study team in Galway on June 22–24, 2016 called “Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes”. The aim of the meeting was to bring together young adults with type 1 diabetes, healthcare providers, policy makers and researchers to reach a consensus on strategies to improve engagement, selfmanagement and ultimately outcomes for young adults living with type 1 diabetes. Methods This diverse stakeholder group participated in the meeting to reach consensus on (i) a core outcome set (COS) to be used in future intervention studies involving young adults with type 1 diabetes, (ii) new strategies for delivering health services to young adults and (iii) potential digital health solutions that could be incorporated into a future intervention. Results A COS of 8 outcomes and 3 key intervention components that aim to improve engagement between young adults with type 1 diabetes and service providers were identified. A digital health solution that could potentially compliment the intervention components was proposed. Conclusion The outputs from the 3-day consensus conference, that held patient and public involvement at its core, will help the research team further develop and test the D1 Now intervention for young adults with type 1 diabetes in a pilot and feasibility study and ultimately in a definitive trial. The conference represents a good example of knowledge exchange among different stakeholders for health research and service improvement.
    • To establish trimester-specific reference ranges for glycated haemoglobin (HbA1c) in pregnancy

      O'Connor, CM; O'Shea, P; Owens, LA; Carmody, L; Avalos, G; Nestor, L; Lydon, K; Dunne, F; Department of Endocrinology, National University of Ireland, Galway, Ireland, 2Department of Clinical Biochemistry, University College Hospital, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09)
      Background and aims: Diabetes in Pregnancy imposes additional risks to both mother and infant. These poor outcomes are considered to be primarily related to glycaemic control which is monitored longitudinally through pregnancy by means of HbA1c. The correlation between HbA1c levels with clinical outcomes emphasises the need to measure HbA1c accurately, precisely and for data interpretation comparison to appropriately defined reference intervals. From July 1st 2010, the HbA1c assay in Irish laboratories became fully metrologically traceable to the IFCC standard, permitting HbA1c to be reported in IFCC units (mmol/mol) and derived DCCT/NGSP units (%) using the IFCC-DCCT/NGSP master equation (DCCT = Diabetes Control and Complications Trial, NGSP = National Glycohemoglobin standardisation program). The aim of this project is to establish trimester-specific reference ranges in pregnancy for IFCC standardised HbA1c in non-diabetic Caucasian women. This will allow us to define the goal for HbA1c during pregnancy complicated by diabetes. Materials and methods: Following informed consent blood was collected from 234 pregnant and 36 age -matched controls into EDTA and Fluoride oxalate tubes for HbA1c, haemoglobin and glucose measurement. Pregnancy trimester was defined as follows: T1 (up to 12 weeks), T2 (13 to 27 weeks), T3 (>28 weeks to term). The Menarini HA8160 automated haemoglobin (Hb) analyser was used to assay HbA1c. Results: Non-parametric analysis of the data was performed. The 95% IFCC HbA1c (DCCT) reference interval for Controls (n=59) 29-37mmol/mol (4.8-5.5%), Trimester 1 (n=27) 36mmol/mol (4.6-5.4%), Trimester 2 (n=107) 25-35mmol.mol (4.4-5.4%) and Trimester 3 (n=110) 28- 39 mmol/mol (4.7-5.7%). A statistically significant difference between the median HbA1c concentration of the control and Trimester 2 subjects, p <0.0001 was determined (Mann-Whitney test). Conclusion: As HbA1c changes throughout pregnancy, trimester-specific HbA1c reference intervals are required to manage diabetes in pregnancy appropriately.
    • Trimester-specific reference ranges for glycated haemoglobin in pregnancy

      O'Connor, C; O'Shea, P; Owens, L; Carmody, L; Avalos, G; Lydon, K; Nestor, L; Dunne, F; Department of Endocrinology, Galway University Hospitals, Galway 2Department of Clinical Biochemistry, Galway University Hospitals, Galway (Diabetic Pregnancy Study Group, 2011)
      Background and Aims: Diabetes in Pregnancy imposes additional risks to both mother and infant. These poor outcomes are considered to be primarily related to glycaemic control which is monitored longitudinally through pregnancy by means of HbA1c. The correlation between HbA1c levels with clinical outcomes emphasises the need to measure HbA1c accurately, precisely and for data interpretation comparison to appropriately defined reference intervals. From July 1st 2010, the HbA1c assay in Irish laboratories became fully metrologically traceable to the IFCC standard, permitting HbA1c to be reported in IFCC units (mmol/mol) and derived DCCT/NGSP units (%) using the IFCC-DCCT/NGSP master equation (DCCT = Diabetes Control and Complications Trial, NGSP = National Glycohemoglobin standardisation program). The aim of this project is to establish trimester-specific reference ranges in pregnancy for IFCC standardised HbA1c in non-diabetic Caucasian women. This will allow us to define the goal for HbA1c during pregnancy complicated by diabetes. Materials and methods: Following informed consent blood was collected from 234 pregnant and 36 age -matched controls into EDTA and Fluoride oxalate tubes for HbA1c, haemoglobin and glucose measurement. Pregnancy trimester was defined as follows: T1 (up to 12 weeks), T2 (13 to 27 weeks), T3 (>28 weeks to term). The Menarini HA8160 automated haemoglobin (Hb) analyser was used to assay HbA1c. Results: Non-parametric analysis of the data was performed. The 95% IFCC HbA1c (DCCT) reference interval for Controls (n=59) 29-37mmol/mol (4.8-5.5%), Trimester 1 (n=26) 36mmol/mol (4.6-5.4%), Trimester 2 (n=107) 25-35mmol.mol (4.4-5.4%) and Trimester 3 (n=107) 28- 39 mmol/mol (4.7-5.7%). A statistically significant difference between the median HbA1c concentration of the control and Trimester 2 subjects, p <0.0001 was determined (Mann-Whitney test). Conclusion: Trimester-specific HbA1c reference intervals are required to manage diabetes in pregnancy as HbA1c changes throughout pregnancy.
    • Validation of a diabetes risk score in identifying patients at risk of progression to abnormal glucose tolerance post partum

      Noctor, E; Crowe, C.; Carmody, LA; Wickham, B; Avalos, G; Gaffney, G; O'Shea, P; Dunne, F; Galway University Hospitals (Royal Academy of Medicine in Ireland, 2011)