Aims Women with remote histories of gestational diabetes mellitus (GDM) can reduce their diabetes risk through lifestyle changes, but the effectiveness of interventions in women with more recent histories of GDM has not been reported. Therefore, we conducted a pilot study of a low-intensity web-based pedometer program targeting glucose intolerance among women with recent GDM. Methods Women with a GDM delivery within the past 3 years were randomized to a 13-week intervention consisting of a structured web-based pedometer program which gave personalized steps-per-week goals, pedometers, and education regarding lifestyle modification vs. a letter about diabetes risk reduction and screening after delivery for GDM (control condition). The main outcome measures were change in fasting plasma glucose (FPG) and 2-hour glucose levels on a 75-gram oral glucose tolerance test (OGTT) between baseline and 13-week follow-up. Weight was a secondary outcome and behavioural constructs (self-efficacy, social support, risk perception) were also assessed. Results Forty-nine women were enrolled. At 13 week follow-up, women randomized to the intervention did not have significant changesin behavioural constructs, physical activity, or anthropometrics compared to women in the control group. Changes in FPG(−0.046 mmol/lvs. 0.038 mmol/l, p=0.65), 2-hour glucose values (−0.48 mmol/l vs. −0.42 mmol/l, p=0.91)and weight (−0.14 kg vs. −1.5 kg, p=0.13)were similar between the control and intervention groups, respectively. Conclusions Structured web-based education utilizing pedometersis feasible although uptake may be low. Such programs may need to be supplemented with additional measures in order to be effective for reduction of diabetes risk.

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease.

Estrogens and T predicted diabetes risk in men but not in women. SHBG and its polymorphisms did not predict risk in men or women. Diabetes risk is more potently determined by obesity and glycemia than by sex hormones.

Diabetes is a greater risk factor for ischemic heart disease (IHD) in women than in men (1,2). In the U.S., IHD-related mortality has declined among men with and without diabetes (3). Among women, a decrease in IHDrelated mortality has been observed only for those without diabetes (3). This difference may be attributable to biological (4) and behavioral factors (5) or possibly differences in the quality of health care received (3). We investigated whether there were differences between men and women regarding the quality of health care related to IHD prevention in a population-based cohort of patients with diabetes, aged 20 -80 years and sampled from 10 managed care health plans and 68 provider groups in the U.S. (6). RESEARCH DESIGN ANDMETHODS -Participants were surveyed using a standardized computerassisted telephone interview or selfadministered written instrument. Of contacted eligible people, 91% responded to the survey. We examined data from the participants for whom medical records were available to document diabetes care. Interrater reliability () for the main quality measures derived from medical record data ranged from 0.85 to 0.92. The quality of diabetes care related to IHD prevention received by patients during a 12-month period was measured by the frequency of selected process of care measurements: 1) current use of aspirin, lipid-lowering medications, and antihypertensive medications (documented by review of the medical records); 2) received recommendation to take aspirin to lower cardiovascular disease (CVD) risk (among those not using aspirin; ascertained by self-report); and 3) received lipid profile testing (among those not using lipid-lowering medications), urine microalbumin/protein testing (among those not using antihypertensive medications), and HbA 1c testing (documented by medical record review). History of CVD was defined according to selfreported myocardial infarction, stroke, coronary artery bypass, or angioplasty. Hierarchical logistic regression models with random intercepts for health plan, to account for the multilevel study design (health plan, provider group, and patient levels), were used to estimate the predicted probability of receiving each process of care measure after adjusting for the proportion of men in the health plans. We then calculated the risk difference (and 95% CI) between men and women regarding these predicted probabilities.RESULTS -There were 1,302 women and 1,564 men with a CVD history and 3,385 women and 2,506 men without a CVD history. Because women had a history of CVD (27.8%) less often than men (38.4%), analyses were stratified by CVD history. Among patients with a CVD history and patients without a CVD history, as compared with men, women were more likely to be aged Ͼ65 years (55.5 vs. 51.6% and 36.5 vs. 31.1%, respectively), to be from U.S. minority racial/ethnic groups (56.6 vs. 50.9% and 61.9 vs. 57.7%), to report less than high school education (33.4 vs. 25.0% and 24.4 vs. 17.6%), to have a diabetes duration Ն10 years (59.9 vs. 52.2% and 44.8 vs. 38...

Objective Although gestational diabetes mellitus (GDM) is associated with an increased risk of type 2 diabetes mellitus (T2DM) compared to normoglycemic pregnancies, the biochemical pathways underlying the progression of GDM to T2DM are not fully elucidated. The purpose of this exploratory study was to utilize metabolomics with an oral glucose tolerance test (OGTT) to examine the amino acid response in women with prior GDM to determine if a relationship between these metabolites and established risk factors for T2DM exists. Materials/Methods Thirty-eight non-pregnant women without diabetes but with prior GDM within the previous 3 years were recruited from a community-based population. A 75 g-OGTT was administered; fasting and 2-hr plasma samples were obtained. Metabolite profiles of 23 amino acids or amino acid derivatives were measured with gas chromatography-mass spectrometry. Measures of insulin resistance were derived from the OGTT and risk factors for T2DM were obtained by self-report. Results Twenty-two metabolite levels decreased significantly in response to the OGTT (p<0.05). The clinical covariates most powerfully associated with metabolite level changes included race, body mass index (BMI), and duration of prior breastfeeding, (mean ± SD of standardized β-coefficients, β = −0.38 ± 0.05, 0.25 ± 0.08, and 0.44 ± 0.03, respectively, all p<0.05). Notably, a prior history of breastfeeding was associated with the greatest number of metabolite changes. Conclusions Greater change in metabolite levels after a glucose challenge was significantly associated with a longer duration of breastfeeding and higher BMI. Further exploration of these preliminary observations and closer examination of the specific pathways implicated are warranted.