Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes

Abstract

Latina women with prior gestational diabetes mellitus (GDM) are at elevated risk for type 2 diabetes mellitus and cardiovascular disease. Few primary prevention programs are designed for low socioeconomic status, Spanish-speaking populations. We examined the effectiveness of a Diabetes Prevention Program (DPP) translation in low-income Latinas with a history of GDM. Eighty-four Latinas, 18-45 years old with GDM in the past 3 years, underwent an 8-week peer-educator-led group intervention, with tailoring for Latino culture and recent motherhood. Lifestyle changes and diabetes and cardiovascular risk factors were assessed at study baseline, month 3 and month 6. Participants showed significant improvements in lipids, blood pressure, physical activity, dietary fat intake, and fatalistic and cultural diabetes beliefs (p<0.05). [7,8] and can modify CVD risk factors [9,10] in highrisk individuals. In the DPP, lifestyle intervention was effective in reducing diabetes risk by 50 % over 3 years [7]. A handful of community-based DPP translations have shown promising results over relatively short time frames [11,12]. However, limited efforts have been made to translate the DPP for women with a history of GDM [13,14], especially those with low socioeconomic status (SES). This represents a critically missed opportunity [15] given that a GDM diagnosis identifies individuals at a very high risk for future T2DM [1,16] and that lifestyle intervention is an effective diabetes prevention strategy for women with history of GDM [16]. Further, few community-based adaptations of the DPP have been tested in Latinos [17] who, on the whole, experience unique socioeconomic and cultural circumstances that may affect response to traditional intervention programs [18,19].The current single-group pilot study evaluated the feasibility, acceptability, and effectiveness of a group format, peer-educator-administered DPP-adapted lifestyle intervention to reduce T2DM and CVD risk among low SES Latinas with a history of GDM. Peer education models have been shown to be a cost and clinically effective approach to health

Perspectives on Prevention of Type 2 Diabetes After Gestational Diabetes: A Qualitative Study of Hispanic, African-American and White Women

“…Such barriers could make it difficult for women to participate in intensive, group-based classes such as offered under the Diabetes Prevention Program. Prior studies have described low uptake and adherence in class-based interventions among this population [42,43]. In contrast, interventions that could be done during flexible hours within the home (e.g., delivered via the internet) may have higher uptake among women with GDM.…”

Diabetes Prevention in U.S. Hispanic Adults: A Systematic Review of Culturally Tailored Interventions

“…Several studies employed study-specific items measuring dietary behavior, or did not report details of measures used. Four studies reported reduction in dietary fat intake, 16,18,24,25 two reported reduction in sugar consumption/glycemic load, 16,22 and three reported increases in consumed fruit and vegetable servings. 15,16,22,25,26 Given the inconsistency of constructs measured and heterogeneity in measurement method and timeline, effect sizes could not be calculated for these outcomes.…”

“…In fact, it is unclear whether any single measurement of diet or physical activity was utilized across more than one study. Seven studies examined changes in physical activity, all measured by participant self-report, 15,18,21–24,26 with some utilizing validated, reliable measures for Hispanic populations (e.g., Global Physical Activity Questionnaire, International Physical Activity Questionnaire, Rapid Assessment of Physical Activity) and others employing study-specific individual physical activity items. Four studies reported significant changes in physical activity levels post-intervention 15,18,23,26 (Appendix Table 1).…”

“…Seven studies examined changes in physical activity, all measured by participant self-report, 15,18,21–24,26 with some utilizing validated, reliable measures for Hispanic populations (e.g., Global Physical Activity Questionnaire, International Physical Activity Questionnaire, Rapid Assessment of Physical Activity) and others employing study-specific individual physical activity items. Four studies reported significant changes in physical activity levels post-intervention 15,18,23,26 (Appendix Table 1). Nine studies measured some aspect of dietary intake or nutrition, via participant self-report only, 15,16,18,21–26 and eight reported significant changes in dietary behaviors due to the intervention.…”

“…Four studies reported significant changes in physical activity levels post-intervention 15,18,23,26 (Appendix Table 1). Nine studies measured some aspect of dietary intake or nutrition, via participant self-report only, 15,16,18,21–26 and eight reported significant changes in dietary behaviors due to the intervention. 15,16,18,22–26 Similar to physical activity, dietary and nutrition patterns were measured in a variety of ways across studies, including reliable and validated assessments such as the Fat-Related Dietary Habits Questionnaire and non-validated measures.…”