Abstract
Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined. We report a pilot study of a convenient, home based exercise program with telephone support, suited to the early post-partum period. Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week randomised controlled trial of Usual Care (n = 13) versus Supported Care (individualised exercise program with regular telephone support; n = 15). Baseline characteristics (Mean ± SD) were: Age 33 ± 4 years; Weight 80 ± 20 kg and Body Mass Index (BMI) 30.0 ± 9.7 kg/m2. The primary outcome, planned physical activity {Median (Range)}, increased by 60 (0–540) mins/week in the SC group versus 0 (0–580) mins/week in the UC group (P = 0.234). Walking was the predominant physical activity. Body weight, BMI, waist circumference, % body fat, fasting glucose and insulin did not change significantly over time in either group. This intervention designed to increase physical activity in post-partum women with previous gestational diabetes proved feasible. However, no measurable improvement in metabolic or biometric parameters was observed over a three month period.
Highlights
Strategies to prevent the progression from impaired glucose tolerance to overt diabetes in middleaged and older adults have been developed by a number of groups worldwide, drawing on the results of major randomised controlled trials [1,2,3]
In women with previous GDM, metformin led to a 50% reduction of the risk of progression from impaired glucose tolerance to overt diabetes, whereas lifestyle intervention was associated with a 53% risk reduction
Typical of an Australian GDM cohort, the women were generally in their early thirties and their mean body mass index (BMI) at six weeks postpartum was in the obese range
Summary
Strategies to prevent the progression from impaired glucose tolerance to overt (principally type 2) diabetes in middleaged and older adults have been developed by a number of groups worldwide, drawing on the results of major randomised controlled trials [1,2,3]. The pressures of caring for a new baby tend to dominate the early postpartum period, with Australian women potentially experiencing difficulty focusing on their own long-term health, and their exercise, in this context This belief is supported by a recent qualitative study conducted in the USA that found that having young children/child was a major barrier to an active lifestyle in the first 12 months postpartum [8]. Several intervention studies based on the Social Cognitive Theory [13] have demonstrated success in increasing and even maintaining physical activity among individuals with type 2 diabetes [14] This pilot study sought to evaluate the feasibility and efficacy of an individualised programme, based on the social cognitive theory, to assist women to be more physically active in the early post natal period
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