Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM)

Abstract

BackgroundGestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions.MethodsWe hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation.ResultsTwo factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention.ConclusionsWomen with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population.Trial registrationCurrent Controlled Trials ISRCTN41202110

Preconception Care Education for Women With Diabetes: A Systematic Review of Conventional and Digital Health Interventions

“…However, constraints such as inadequate resources, time, and distance to health facilities have been shown to inhibit women’s ability to adequately access such PCC interventions [48,50], and for many women around the world, this has negative implications for PCC uptake. Furthermore, no studies were carried out in developing countries; reflecting the existent inequality in PCC service provision.…”

“…International clinical guidelines [29,38-41] recommend PCC education from adolescence for all women with DM as an effective strategy to facilitate behavior change and improve pregnancy outcomes. However, barriers such as inadequate resources, busy clinics, time, and distance to health facilities [48,50] can inhibit and restrict the extent to which women engage in PCC. Hence, eHealth could be of value in overcoming these limitations and extending the reach of health interventions.…”

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

“…Both intensive lifestyle modification and use of metformin can help prevent T2DM, but remain underutilized [10]. Prior studies have demonstrated low participation rates in lifestyle interventions during the postpartum period [11][12][13].…”

A mixed methods study of interventions and experiences to prevent type 2 diabetes mellitus following gestational diabetes mellitus

“…Infanti et.al. noted a lower than expected rate of participation in women with previously diagnosed GDM in a lifestyle intervention study and found that women over 34 years and not managed with insulin therapy during their pregnancy were more likely to participate (65). The participants in this RCT also were similar in age; however a difference in this study was the majority had been managed with insulin therapy during their pregnancy.…”

“…A combination of diet and exercise may support weight loss in this population (52), however, women have shown to experience barriers to engaging in lifestyle intervention programs (65).…”