Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial.

Angela O'Dea,Marie Tierney,Andrii Danyliv,Fidelma P Dunne,Eoin Noctor,Liam G Glynn,Brian E Mcguire,Irene Gibson,John Newell,Susan B Connolly

doi:10.1155/2015/798460

Abstract

Objective. To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM). Design. A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n = 24) or wait control (n = 26) and postintervention qualitative interviews with participants. Main Outcome Measures. Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up. Results. At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance. Conclusions. Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.

Highlights

Women with a history of gestational diabetes (GDM) are at increased risk of developing type 2 diabetes compared to those with normoglycaemic pregnancies [1]
Studies investigating glucose function in the early postnatal period have shown the prevalence of type 2 diabetes to be as high as 38% in the first year postpartum [2] and as high as 60% in women followed for up to 16 years postpartum [3]
Some risk factors such as weight, elevated blood glucose, and triglycerides are potentially modifiable though diet, exercise, and lifestyle change [4]; for example, modest weight loss has been shown to be effective in reducing the risk of developing type 2 diabetes in at-risk populations [5]

Summary

Introduction

Women with a history of gestational diabetes (GDM) are at increased risk of developing type 2 diabetes compared to those with normoglycaemic pregnancies [1]. The postpartum period is a very important time in determining the future risk of type 2 diabetes in women with GDM; there is a strong rationale for preventive interventions at this time. Some risk factors associated with the development of type 2 diabetes are nonmodifiable such as such as age, ethnicity, or a family history of diabetes. Some risk factors such as weight, elevated blood glucose, and triglycerides are potentially modifiable though diet, exercise, and lifestyle change [4]; for example, modest weight loss has been shown to be effective in reducing the risk of developing type 2 diabetes in at-risk populations [5]

Methods

Results

Discussion

Conclusion