Diabetes Mellitus Prevention Program Research Articles

Body mass index trajectories and time in target range after delivery and long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus.

This study aims to determine whether postpartum body mass index (BMI) trajectories and its time in target range (TTR) are associated with long-term type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM). The present study included 1057 women with a history of GDM who participated in the Tianjin Gestational Diabetes Mellitus Prevention Program (TGDMPP). Oral glucose tolerance tests or physician-diagnosed information were used to diagnose type 2 diabetes after a median follow-up period of 8.47 years. Latent class modelling was applied to identify trajectories of BMI after delivery. TTR was defined as the proportion of time that BMI was within the standard range (18.5 ≤ BMI < 24.0 kg/m2). The associations of BMI trajectories and TTR with type 2 diabetes risk were analysed using multivariable Cox modelling. Five distinct trajectories of postpartum BMI were identified. Compared with low-stable class, the multivariable-adjusted hazard ratios of type 2 diabetes were 2.02 (95% confidence interval 0.99-4.10) for median-stable class, 3.01 (1.17-7.73) for high-stable class, 2.15 (0.63-7.38) for U-shape class and 7.15 (2.08-24.5) for inverse U-shape class (p for trend = 0.012), respectively. Multivariable-adjusted hazard ratios of type 2 diabetes associated with postpartum BMI TTR of 100%, >43.4%-<100%, >0%-≤43.4% and 0% were 1.00, 1.84 (0.72-4.73), 2.75 (1.23-6.15) and 2.31 (1.05-5.08) (p for trend = 0.039), respectively. Postpartum BMI trajectories of high-stable and inverse U-shape class as well as lower TTR were associated with an increased risk of type 2 diabetes among women with a history of GDM. Reducing BMI to a normal range in the early postpartum period and maintaining stable over time could attenuate the development of long-term type 2 diabetes.

1183-P: Effects of an Early Postpartum Lifestyle Intervention on Long-Term Risk of Diabetes in Women with Gestational Diabetes Mellitus

Few randomized controlled trials (RCT) that have thus far been published have not unequivocally found that early postpartum lifestyle intervention can prevent or delay the onset of type 2 diabetes in women with prior gestational diabetes mellitus (GDM) . The aim of the present large-scale, long-term RCT was to assess whether an early postpartum lifestyle intervention can reduce or delay type 2 diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus Prevention Program in China. A total of 1180 women who were diagnosed with GDM from 20to 20were randomly assigned to either a 4-year lifestyle intervention (n = 586) or a control group (n = 594) . Major elements of the intervention included six face-to-face meetings with study dietitians in the first year, and two additional sessions and two telephone calls in each subsequent year. The mean follow-up was 4.5 years. During the trial, overweight women with GDM in the intervention group compared with the control group were more likely to lose weight. The incidence of diabetes was 0.87 and 1.46 per 100 person-years in the lifestyle intervention and control groups, respectively; the lifestyle intervention reduced the incidence by 45 percent (P = 0.023) . An early postpartum healthy lifestyle management markedly reduced the incidence of diabetes among women with prior GDM. Disclosure G.Hu: None. X.Yang: None. J.Tuomilehto: Stock/Shareholder; Orion Pharma. H.Liu: None. J.Leng: None. L.Wang: None. S.Zhang: None. W.Li: None. W.Li: None. L.Qi: None. Z.Yu: None. Funding This study is supported by the grant from European Foundation for the Study of Diabetes (EFSD) /Chinese Diabetes Society (CDS) /Lilly program for Collaborative Research between China and Europe. Dr. Hu is partly supported by the grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790) and the National Institute of General Medical Sciences (U54GM104940) of the National Institutes of Health.

Body Mass Index and Waist Circumference was Risk Factors for Increased Fasting Blood Sugar, and Hemoglobin A1c in Korean Adults without Diabetes Mellitus

Purpose: This study confirmed the effects of body mass index (BMI) and waist circumference (WC) on fasting blood glucose (FBS) and hemoglobin A1c (HbA1c) in adults without diabetes mellitus (DM). Methods: The subjects were 4,659 adults (≥20 years), and data were extracted from the 6th National Health and Nutrition Survey 2015 (KNHANES VI-3). The subject’s data were analyzed using a complex sample t-test, χ2-test, and multiple logistic regression analysis (SPSS 24.0). Results: The incidence of the high FBS group was increased 1.60 times in males with a WC ≥90 cm and 1.78 times in females with a WC ≥85 cm. The incidence of the high HbA1c group was increased 1.54 times in those who were overweight and 2.22 times in those who were obese. The incidence of the high HbA1c group was increased 1.99 times in males with a WC ≥90 cm and 1.87 times in females with a WC ≥85 cm. Conclusion: This study presented evidence that interventions for BMI and WC should be included in DM prevention programs. It also suggested that these findings can be utilized for early detection of DM.

Gambaran Karakteristik Penderita Diabetes Mellitus Pada Beberapa Puskesmas di Kabupaten Gorontalo

Diabetes Mellitus is a chronic metabolic disorder caused by inadequate insulin produced of the pancreas, or a state of the body that cannot use insulin effectively. During the last decade the prevalence of diabetes in low and middle income countries has increased. In 2018, Gorontalo Province ranks eighth for the highest prevalence of Diabetes Mellitus in Indonesia. The purpose of this study aims to description of the characteristics patient with Diabetes Mellitus in several Health Center in Gorontalo District. The study was an observational with descriptive design. The sample in this study was 313 people with diabetes mellitus who were selected as samples in Gorontalo District, who were selected by stratified random sampling technique. Univariate data analysis. The results of this study indicate that there are five health center studied, namely Limboto, Dungaliyo, Tabongo, Batudaa, and Pulubala Health Center. From the 313 respondents suffering from Diabetes Mellitus, 224 people (71.6%) were female, 230 people (73.5%) in the adult category, 271 people (86.6%) were married, 202 people (64.5) %) not working, 94 people (30%) have education levels only up to elementary school level, and 265 people (84.7%) with new status suffer from diabetes mellitus (&lt;10 years). By looking at patient characteristics from the results of the study, it is expected that the health center as a health service provider can improve the Diabetes Mellitus prevention program, especially for preventive and promotive programs.

Evaluation of a Digital Diabetes Prevention Program Adapted for Low-Income Patients, 2016-2018.

IntroductionWe examined the effects of a digitally delivered, type 2 diabetes mellitus prevention program (DPP) for a low-income population.MethodsWe conducted a nonrandomized clinical trial with matched controls. The intervention group was offered a digital DPP, a web-based and mobile-based program including 52 weeks of participation in an educational curriculum, health coaching, and peer support.ResultsA total of 227 participants enrolled. At baseline, 34.6 was the mean body mass index, and 5.8 was the mean HbA1c. For the intervention group, mean weight loss was 4.4% at the 12-month follow-up.ConclusionThe modified DPP successfully engaged participants and resulted in weight loss. Low-income patients with prediabetes benefitted from a digitally delivered diabetes intervention. This prevention method should be accessible to a low-income population.

Genetic susceptibility, lifestyle intervention and glycemic changes among women with prior gestational diabetes.

Women with prior gestational diabetes mellitus (GDM) or high genetic susceptibility are prone to development of type 2 diabetes. We examined whether a lifestyle intervention modified the genetic effect on changes in glycemic markers among women with prior GDM. This study included 560 women with prior GDM from a randomized controlled trial, the Tianjin Gestational Diabetes Mellitus Prevention Program, who were assigned into an intervention arm (improved physical activity and healthy dietary intakes) or a control arm. We assessed associations of GDM related genetic variants in/near the CDKAL1 (rs7754840) and MTNR1B (rs10830962) genes with changes in fasting levels of glucose and insulin, β-cell function (HOMA-B) and insulin resistance (HOMA-IR) at 1 year and 2 years after the baseline. We found significant interactions between CDKAL1 variant rs7754840 and lifestyle intervention on changes in fasting insulin and HOMA-IR at 1 year (P for interactions=0.008 and 0.006, respectively). The GDM-increasing C allele was associated with a 0.07-unit greater increase in fasting insulin (P=0.048) and HOMA-IR (P=0.045) in the control group, while opposite-directional associations were observed in the intervention group; women with the C allele seemed to decrease more in these glycemic markers than the non-C-carriers (both P≤0.06). The interactions between the CDKAL1 genetic variant and lifestyle intervention on changes in fasting insulin (P=0.035) and HOMA-IR (P=0.024) remained significant over the 2-year period, even though the effects of lifestyle intervention were attenuated at 2-year. The MTNR1B variant rs10830962 did not show interaction with lifestyle intervention on changes in the glycemic markers. Healthy lifestyle intervention may be beneficial for women with the GDM predisposing CDKAL1 genetic variant in improvement of insulin resistance. ClinicalTrials.gov NCT01554358. URL OF REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01554358.

Lifestyle intervention modifies the effect of the MC4R genotype on changes in insulin resistance among women with prior gestational diabetes: Tianjin Gestational Diabetes Mellitus Prevention Program

A history of gestational diabetes mellitus (GDM) has been related to an elevated risk of type 2 diabetes. The melanocortin-4 receptor (MC4R) genotype has been related to glycemic changes in women with prior GDM. The objective of this study was to analyze whether lifestyle intervention modified the association between the MC4R genotype and changes in insulin sensitivity among women with prior GDM. We genotyped MC4R rs6567160 and measured glucose and insulin in fasting plasma samples at baseline and during the first 2 follow-up visits in 1128 women with prior GDM. They were randomly assigned to either a 4-y lifestyle intervention involving both diet and physical activity or a control group from a randomized clinical trial, the Tianjin Gestational Diabetes Mellitus Prevention Program. We analyzed the interaction between the MC4R genotype and lifestyle intervention on changes in insulin resistance. From baseline to 1.28 y, the MC4R genotype was related to changes in fasting insulin, HOMA-IR, and homeostasis model assessment of β cell function (HOMA-B) in the intervention group. Each risk allele (C) of rs6567160 was associated with a 0.08-unit greater decrease in log(insulin), log(HOMA-IR), and log(HOMA-B) (P=0.02, 0.04, and 0.04, respectively), whereas in the control group, each C allele tended to be associated with a greater increase in HOMA-IR (P=0.09). We found significant interactions between the MC4R genotype and lifestyle intervention on 1.28-y changes in fasting insulin and HOMA-IR (P=0.006 and 0.008, respectively), and such interaction remained significant when we analyzed the trajectory of changes in insulin and HOMA-IR from baseline to 2.55 y (both P=0.03). The exploratory results from the first 2 follow-up visits indicate that women with prior GDM carrying a diabetes-increasing MC4R genotype (CC or TC) may obtain better improvement than the TT genotype in insulin resistance through lifestyle intervention. This trial was registered at clinicaltrials.gov as NCT01554358.

Uric acid and diabetes risk among Chinese women with a history of gestational diabetes mellitus.

To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and prediabetes among women with prior gestational diabetes mellitus (GDM). We performed a cross-sectional study of 1262 GDM women at 1-5 years after delivery using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Program. Logistic regression models were used to estimate the association of different levels of serum UA with the risks of type 2 diabetes and prediabetes. The multivariable-adjusted odds ratios (ORs) across quartiles of serum UA were 1.00, 1.23 (95% confidence interval [CI] 0.55-2.78), 2.05 (95% CI 0.96-4.39), and 3.17 (95% CI 1.54-6.55) (Ptrend < 0.001) for type 2 diabetes, and 1.00, 1.50 (95% CI 1.03-2.19), 2.28 (95% CI 1.58-3.30), and 2.88 (95% CI 1.99-4.17) (Ptrend < 0.001) for prediabetes, respectively. Restricted cubic splines models showed positive linear associations of serum UA as a continuous variable with the risks of type 2 diabetes and prediabetes. This positive association was significant when stratified by healthy weight and overweight participants. Serum UA levels have a graded positive association with the risks of type 2 diabetes and prediabetes among Chinese with a history of GDM.

Association between hypertensive disorders of pregnancy and the risk of postpartum hypertension: a cohort study in women with gestational diabetes.

Previous studies in general people indicated that hypertensive disorders of pregnancy (HDP) increased the risk of subsequent hypertension after delivery. Some studies found that women with gestational diabetes mellitus (GDM) had an increased risk of HDP. However, very few studies have assessed the association between HDP and the risk of postpartum hypertension among GDM women. To evaluate the association between HDP and the risk of postpartum hypertension among GDM women, a retrospective cohort study was conducted in 1261 women with prior GDM at their postpartum 1–5 years using the baseline data from Tianjin Gestational Diabetes Mellitus Prevention Program. Cox regression models were applied to assess the single and joint associations of having a history of HDP, maternal pre-pregnancy Body mass index (BMI) (normal weight, overweight and obesity), and weight change from preconception to post-delivery with the risk of subsequent hypertension among the GDM women. We found that GDM women with a history of HDP, high pre-pregnancy BMI and weight gain more than 7 kg from preconception to post-delivery had an increased risk of postpartum hypertension. Joint effects analysis revealed that the positive association between a history of HDP in the index pregnancy and the risk of postpartum hypertension was consistent in GDM women with different levels of pre-pregnancy BMI or weight gain from preconception to post-delivery. In conclusion, a history of HDP, high pre-pregnancy BMI and weight gain more than 7 kg from preconception to post-delivery increase the risk of subsequent hypertension in postpartum 1–5 years among GDM women.

Abstract P274: Pregnancy-induced-hypertension and the Risk of Postpartum Hypertension Among Gestational Diabetes Women

Background: Previous studies in the general people indicated that pregnancy-induced hypertension (PIH) increased the risk of subsequent hypertension after delivery. Some studies found that women with gestational diabetes mellitus (GDM) had an increased risk of PIH. However, very few studies have assessed the association between PIH and the risk of postpartum hypertension among GDM women. Aims: To evaluate the association between PIH and the risk of postpartum hypertension among GDM women. Methods: We performed a retrospective cohort study in 1261 GDM mother at 1-5 years after delivery using the baseline data from Tianjin Gestational Diabetes Mellitus Prevention Program. Cox regression models were applied to assess the single and joint associations of having a history of PIH, maternal pre-pregnancy BMI (normal weight, overweight and obesity), and weight change from pre-pregnancy to postpartum with the risk of subsequent hypertension among the GDM women. Results: GDM people with a history of PIH, high pre-pregnancy BMI, and weight gain more than 7 kg from pre-pregnancy to postpartum were associated with an increased risk of postpartum hypertension. Joint effects analysis revealed that the positive association between a history of PIH in the index pregnancy and the risk of postpartum hypertension was consistent in GDM women with different levels of pre-pregnancy BMI or weight gain from pre-pregnancy to postpartum. Conclusion: A history of PIH increases the risk of subsequent hypertension in postpartum 1-5 years among GDM women. We suggest highlight the pregnancy guide in different stages and pay more attention on this group of people.

Overcoming the Challenges in Implementing Type 2 Diabetes Mellitus Prevention Programs Can Decrease the Burden on Healthcare Costs in the United States.

Theoretically, identifying prediabetics would reduce the diabetic burden on the American healthcare system. As we expect the prevalence rate of prediabetes to continue increasing, we wonder if there is a better way of managing prediabetics and reducing the economic cost on the healthcare system. To do so, understanding the demographics and behavioral factors of known prediabetics was important. For this purpose, responses of prediabetic/borderline diabetes patients from the most recent publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. The findings showed that there was a correlation between household income, geographic residence in the US, and risk for developing diabetes mellitus type 2, aside from the accepted risk factors such as high BMI. In conclusion, implementation of the National Diabetes Prevention Program is a rational way of reducing the burden of DM on the healthcare system both economically and by prevalence. However, difficulties arise in ensuring patient compliance to the program and providing access to all regions and communities of the United States. Technology incorporation in the NDPP program would maintain a low-cost implementation by the healthcare system, be affordable and accessible for all participants, and decrease economic burden attributed to diabetes mellitus.

1 year weight losses in the Tianjin Gestational Diabetes Mellitus Prevention Program: a randomised trial

BackgroundGestational diabetes affects about 8% of pregnant women in urban areas of China, and is an important indicator of risks of type 2 diabetes and impaired glucose tolerance later in life. The Tianjin Gestational Diabetes Mellitus Prevention Program aims to investigate the extent to which a postpartum lifestyle intervention given soon after delivery can reduce risk or delay onset of type 2 diabetes in women with gestational diabetes. Here, we report weight loss after the first year of the trial. MethodsThe Tianjin Gestational Diabetes Mellitus Prevention Program is a randomised trial done at Tianjin Women's and Children's Health Center, Tianjin, China. We recruited women (aged >24 years) with gestational diabetes diagnosed on the basis of WHO criteria from six urban districts in Tianjin between July 1, 2005, and June 30, 2009. After participants completed the baseline survey administered by health workers from the study centre, eligible participants were randomly assigned (1:1) to receive a 4 year lifestyle intervention (intervention group) or standard care (control group). Statistical Package for the Social Science (SPSS) was used to generate a list of 1200 random allocation statuses, and the list of random assignments was kept centrally by an independent person. Major elements of the intervention included six face-to-face sessions with study dietitians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. Weight loss after the first year of the trial was analysed in patients with complete data. Ethics approval was granted by the human subjects committee of Tianjin Women's and Children's Health Center, and all participants provided written informed consent. This trial is registered with ClinicalTrials.gov, number NCT01554358, and is ongoing. FindingsBetween Aug 1, 2009, and July 31, 2011, we recruited and randomly assigned 1180 women into the intervention group (n=586) or the control group (n=594). At the end of year 1, mean weight loss was 0·8 kg (SD 3·5; 1·1% [SD 5·4] of initial weight) in the intervention group and 0·1 kg (3·3; 0·03% [5·0%] of initial weight) in the control group (p<0·001). In prespecified subgroup analysis, weight loss was more pronounced in women who were overweight (BMI ≥24 kg/m2) at baseline: mean weight loss was 2·0 kg (4·3; 2·9% [6·1%] of initial weight) in the intervention group and 0·44 kg (4·0; 0·5% [5·5%] of initial weight) in the control group (p<0·001). Compared with those in the control group, women in the intervention group had a greater decrease in body fat (0·50% vs 0·05% increase; p=0·001) and waist circumference (1·76 cm vs 0·73 cm; p=0·003). InterpretationThe 1 year lifestyle intervention led to significant weight loss after delivery in women who had gestational diabetes, and such an effect was more pronounced in those who were overweight. Our findings indicate that lifestyle intervention is feasible and effective in women with gestational diabetes. FundingEuropean Foundation for the Study of Diabetes–Chinese Diabetes Society–Lilly programme for Collaborative Research between China and Europe, Tianjin Women's and Children's Health Center, Tianjin Public Health Bureau, and the National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health (R01DK100790).

Tianjin Gestational Diabetes Mellitus Prevention Program: Study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program

ObjectiveTo assess whether lifestyle intervention can reduce type 2 diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus (GDM) Prevention Program. Methods1180 women who were diagnosed with GDM from 2005 to 2009 were randomly assigned to either a lifestyle intervention (n=586) or a control group (n=594). Major elements of the intervention include six face-to-face meetings with study dietitians in the first year, and two additional sessions and two telephone calls in second year. ResultsDuring the first year, average body weight loss in the first 404 subjects was 1.40kg (2.1%) in the intervention group vs 0.21kg (0.3%) in the control group (P=0.001), and the decrease was more significant among baseline overweight women (body bass index [BMI]≥24kg/m2) in the intervention (2.91kg/4.2%) compared with that in the control group (0.51kg/0.7%) (P<0.001). In addition, women in the intervention group, compared with those in the control group, have decreased BMI, body fat, waist circumference, and plasma insulin levels, and have improved behaviors including increased leisure time activity and dietary fiber intake and decreased sedentary time and fat consumptions. ConclusionThe interim results support the efficacy and feasibility of the lifestyle intervention program.

The ARIC predictive model reliably predicted risk of type II diabetes in Asian populations

BackgroundIdentification of high-risk individuals is crucial for effective implementation of type 2 diabetes mellitus prevention programs. Several studies have shown that multivariable predictive functions perform as well as the 2-hour post-challenge glucose in identifying these high-risk individuals. The performance of these functions in Asian populations, where the rise in prevalence of type 2 diabetes mellitus is expected to be the greatest in the next several decades, is relatively unknown.MethodsUsing data from three Asian populations in Singapore, we compared the performance of three multivariate predictive models in terms of their discriminatory power and calibration quality: the San Antonio Health Study model, Atherosclerosis Risk in Communities model and the Framingham model.ResultsThe San Antonio Health Study and Atherosclerosis Risk in Communities models had better discriminative powers than using only fasting plasma glucose or the 2-hour post-challenge glucose. However, the Framingham model did not perform significantly better than fasting glucose or the 2-hour post-challenge glucose. All published models suffered from poor calibration. After recalibration, the Atherosclerosis Risk in Communities model achieved good calibration, the San Antonio Health Study model showed a significant lack of fit in females and the Framingham model showed a significant lack of fit in both females and males.ConclusionsWe conclude that adoption of the ARIC model for Asian populations is feasible and highly recommended when local prospective data is unavailable.

Impact of the Bienestar School-Based Diabetes Mellitus Prevention Program on Fasting Capillary Glucose Levels: A Randomized Controlled Trial—Correction

Impact of the Bienestar School-Based Diabetes Mellitus Prevention Program on Fasting Capillary Glucose Levels: A Randomized Controlled Trial—Correction