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

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.

World diabetes day 2017 focus: antepartum hyperglycaemia (or gestational prediabetes) is more in women below 40 years

“…4 Yet, much discourse has been focused on women with GDM. [5][6][7][8] This is despite the reported finding of a high FBS level during pregnancy as "the risk factor most commonly associated with future risk of type 2 diabetes". 5 Indeed, there are few studies on women with prediabetes following GDM, but the notion of prediabetes in pregnancy being potential predisposition to postpartum diabetes has yet to be given necessary attention.…”

“…5 Indeed, there are few studies on women with prediabetes following GDM, but the notion of prediabetes in pregnancy being potential predisposition to postpartum diabetes has yet to be given necessary attention. 7,9 That is, while gestation diabetes leading to postpartum prediabetes and onward type 2 diabetes is relatively established; it needs to be appreciated that antepartum prediabetes is predictor of postpartum type 2 diabetes. 5,10 In other words, it is high time to appreciate antepartum hyperglycaemia as gestational prediabetes.…”

Women's views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice

“…They needed to preserve energy, not use it on exercise. Alternatively, physical activity became more sustainable when it became a 'daily habit' [31], such as a mother 'always walk[ing] upstairs to change her baby's diaper' [28]. Similar views were held when considering attending a programme, particularly if the woman needed to travel or the time was inconvenient.…”

“…They needed to support and join in eating healthily: 'They'll tease you about how you can't eat this food, and they put it in front of you. O'Dea et al [31] reported that childcare was the biggest barrier to attending lifestyle interventions, women without a partner could not attend, and the partner needed to support attendance. .…”

“…In particular, physical activity was frequently viewed as distinct from the other parenting demands: for many it required 'set[ting] aside time' [34] and 'taking time out for themselves' [24] away from children and housework (their priorities). Alternatively, physical activity became more sustainable when it became a 'daily habit' [31], such as a mother 'always walk[ing] upstairs to change her baby's diaper' [28]. Alternatively, physical activity became more sustainable when it became a 'daily habit' [31], such as a mother 'always walk[ing] upstairs to change her baby's diaper' [28].…”