Background Exposure to gestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes (T2DM) in mothers, and poor cardiovascular health among offspring. Identifying effective methods to mitigate T2DM risk has the potential to improve health outcomes for mothers with a history of GDM and their children. The goal of the EPIC El Rio Families Study is to implement and evaluate the effects of a 13-week behavioral lifestyle intervention on T2DM risk factors in at-risk mothers and their 8- to 12-year-old children. We describe herein the rationale for our specific approach, the adaption of the DPP-based curriculum for delivery to patients of a Federally Qualified Health Center (FQHC), and the study design and methodology. Methods The effects of the intervention on reduction in excess body weight (primary outcome), hemoglobin A1c, blood pressure, and changes in lifestyle behaviors associated with weight trajectory and T2DM risk in mother-child dyads will be evaluated during a 13-week, group randomized trial wherein 60 mothers and their children will be recruited to the intervention or wait-listed control conditions at one of two FQHC locations. Intervention participants (n = 30) will begin the group program immediately, whereas the wait-listed controls (n = 30) will receive a booklet describing self-guided strategies for behavior change. Associated program delivery costs, acceptability of the program to participants and FQHC staff, and potential for long-term sustainability will also be evaluated. Discussion Successful completion in our aims will produce a scalable program with high potential for replication and dissemination, and estimated intervention effects to inform T2DM prevention efforts on families who use the FQHC system. The results from this study will be critical in developing a T2DM prevention model that can be implemented and scaled across FQHCs serving populations disproportionately burdened by T2DM. Trial registration ClinicalTrials.gov NCT03781102; Date of registration: 19 December 2018.

Background: Maternal obesity and gestational diabetes mellitus (GDM) contribute to increased risk for type 2 diabetes mellitus (T2DM) among both mothers and their offspring. Randomized trials demonstrated T2DM risk reduction in adults following lifestyle behavior change and modest weight loss; the evidence base for at-risk children remains limited. Purpose: Evaluate the feasibility, acceptability, and preliminary efficacy of a T2DM prevention intervention for mother-child dyads delivered by Federally Qualified Health Center staff. Methods: A group randomized design tested the effects of a behavioral lifestyle intervention on T2DM risk factors in women with a history of GDM and their 8- to 12-year-old children. Mother-child dyads were recruited and randomized to intervention or wait-listed control conditions. Intervention participants completed the 13-week intervention; control participants received standard of care. Baseline and 13-week measures assessed program acceptability and feasibility, and explored effects on body weight, waist circumference, hemoglobin A1c, and lifestyle behaviors. Results: Forty-two dyads were randomized and 35 (83%) completed pre-/post-measurements. Participants and program leaders positively rated content and engagement. Nearly all strongly agreed that activities were enjoyable (97%), applicable (96%), useful (97%), and motivational (96%). Attendance averaged 65% across 2 cohorts; delivery costs were approximately $225/dyad. There were no significant differences in body weight, BMI (or BMI z-score), waist circumference, hemoglobin A1c, diet quality, physical activity, sleep, or home environment changes between intervention and control groups. Conclusions: A family T2DM prevention program was feasibly delivered by FQHC staff, and acceptable to mothers and children. Program efficacy will be evaluated in an adequately powered clinical trial.

Background: The association between marital status and health status among the elderly has been at the forefront of investigation for a long time. However, the study on the effects of marital status on health care utilisation is limited. This study assesses the association between use of inpatient health services and marital status among older adults in India from the perspective of sex. Methods: Data used in the study have been obtained from the 75th Round of National Sample Survey (NSS) on "Social Consumption: Health" with the sample size of 42,762 individuals aged 60 years or above. The study implements the Andersen's behavioural framework controlling the predisposing, enabling, and need characteristics and uses binary logistic regression models to assess the effect of marital status on inpatient health service. Results: There is a significant difference in inpatient healthcare use between married and widowed elderly by age, educational level, perceived health and mobility for both sexes. The unadjusted regression analysis shows that widowed are more likely to use inpatient health services both for women (OR=1.57; CI 95%= 1.47, 1.68) and men (OR=1.11; CI 95%= 1.02, 1.2). However, after controlling the predisposing, enabling, and need factors, a strong association between healthcare services and marital status has been found for women, but not for men. Widowed women (OR=1.43; CI 95%=1.33, 1.54) are more likely to use inpatient health care than married women. Conclusion: The present study has reported the association between the utilisation of inpatient health services and marital status for the elderly in India. Our study advocates that there is a sex difference in the utilisation of inpatient health services by the marital Status in India. Older widowed women should get more focus on health and elderly policy perspectives.