Seeking answers to an old question

Dr. Edmond Ryan and Heather Rylance help examine the benefits of a medication for pregnant women with type 2 diabetes

Dr. Edmond Ryan and Heather RylanceFor many people who have type 2 diabetes, maintaining a proper balance of diet, insulin and exercise can be a daily challenge. Add on top of that being pregnant, where some women with type 2 diabetes must not only try to maintain their health but the health of their baby as well. While pregnant, it can be difficult to control blood sugars levels and weight gain. High blood sugar levels can cause the baby to grow bigger than average, which can make the delivery difficult with the possibility of injuring the mother and child. After birth, the baby may have adverse health effects such as breathing difficulties and low blood sugar which may require a trip to the intensive care unit.

Currently, there is a drug called metformin that is not approved by Health Canada for use in pregnancy but some physicians prescribe to pregnant women who have type 2 diabetes. Metformin may help with blood sugar control, lower the dose of insulin needed, decrease weight gain and improve the baby’s health outcomes. There is no concrete evidence on whether metformin actually helps these women, or if there are any unknown adverse health effects for either the mother or child. That is why the metformin in women with type 2 diabetes in pregnancy (MiTy) study was created.

There are 21 centres across Canada and one in Australia participating in the MiTy study funded by CIHR. Dr. Edmond Ryan is the lead of the Edmonton centre. When he found out about the study, he immediately knew that Edmonton needed to be involved: “We need to answer the question of whether metformin is beneficial or not. For our own sake, and for the world.”

In 2012, Ryan heard about the MiTy trial and knew that Edmonton, a leader in islet cell transplant, would be a perfect place to have a centre. A year later through WCHRI’s Supported Platforms for Integrated Research (SPIR), WCHRI Research Coordinator Heather Rylance joined to become the Edmonton site coordinator and work with the other centres across Canada. “These are labour intensive studies that take highly-skilled professionals like Heather,” states Ryan. “Without the support of WCHRI, we would have had to pull out of the study.”

Ryan and Rylance have been working to recruit patients over the years. They work with the mothers throughout their pregnancy and Rylance continues to track the children up to two years of age through another study called MiTy Kids. To date, MiTy has released a protocol paper documenting the study’s design. The team knew it was important to release the protocol paper so people realize there is a group in Canada studying the benefits of metformin before it becomes too commonly used in medical practice. “We shouldn’t be giving medications to women that we don’t know are safe and the only way to properly do that is through trials like MiTy,” says Rylance.

The hope for this study is that it will answer the longtime question of whether metformin is beneficial. “We just want the truth,” explains Ryan. “I envision that the outcome would be positive and we would be able to say that the use of metformin is associated with less insulin and better outcomes. That would be huge.”

It would certainly be “huge” for women who have type 2 diabetes. Each year, more young people and children (typically type 2 affects older adults) are diagnosed with type 2 due to rising obesity rates. That means that physicians can expect to see more women who have type 2 trying to get pregnant. With the growing number of people with type 2, there is a growing need to know if metformin will help these women. “One day we’ll know the answer, and it will change practice,” says Rylance.

Edmond Ryan’s research has been facilitated through the Support Platforms for Integrated Research through WCHRI and funded by supporters of the Lois Hole Hospital for Women.

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