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Dennison RA, Oliver-Williams C, Qi HLJ, Kotecha D, Seed L, Ward RJ, Griffin SJ. The effectiveness of pharmacological and lifestyle interventions to reduce the risk of diabetes and hyperglycaemia following gestational diabetes: A systematic review and meta-analysis. Diabet Med 2024; 41:e15316. [PMID: 38553834 DOI: 10.1111/dme.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 05/12/2024]
Abstract
AIMS To synthesize the available evidence to better understand the effectiveness of interventions to prevent or delay hyperglycaemia and Type 2 diabetes mellitus (T2DM) postnatally in women with current or previous gestational diabetes mellitus (GDM). METHODS We searched five databases up to December 2020 for primary peer-reviewed articles reporting postpartum glycaemic outcomes in women with (previous) GDM following pharmacological or lifestyle intervention. Outcomes were relative risk of T2DM or continuous measures of glycaemia, change or at follow-up. A minimum of two studies evaluating the same intervention-outcome combination were needed to conduct meta-analyses, otherwise studies were described narratively. Meta-regression was used to evaluate whether associations varied by additional variables. We assessed risk of bias using the Critical Appraisal Skills Programme checklist. PROSPERO record CRD42018102380. RESULTS We included 31 studies in the review with a total sample size of 8624 participants, and 26 studies in meta-analyses. Two-thirds of studies followed up participants at 1 year or less. Pharmacological interventions were associated with reduced risk of T2DM (0.80 [95% CI 0.64-1.00], n = 6 studies), as were lifestyle interventions albeit with a smaller effect size (0.88 [95% CI 0.76-1.01], n = 12 studies). Dietary and physical activity interventions were associated with a small reduction in fasting plasma glucose, particularly in longer interventions, but inconsistent effects were seen for other continuous outcomes. CONCLUSIONS Although possibly due to chance, interventions to reduce hyperglycaemia after GDM may be effective. Future research should improve understanding of how interventions affect glucose control and how to optimise interventions for this population.
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Affiliation(s)
- Rebecca A Dennison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Helen Lin Jia Qi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Deeya Kotecha
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Lydia Seed
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rebecca J Ward
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Andersson-Hall U, Hossein Pour D, Grau S, Börjesson M, Holmäng A. Exercise, aerobic fitness, and muscle strength in relation to glucose tolerance 6 to 10 years after gestational diabetes. Diabetes Res Clin Pract 2022; 191:110078. [PMID: 36099975 DOI: 10.1016/j.diabres.2022.110078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
AIMS We sought to identify self-reported exercise and objectively measured fitness variables associated with glucose tolerance and metabolic health 6-10 years after gestational diabetes (GDM) METHODS: Women (n = 84) underwent oral glucose tolerance testing (OGTT), body composition measurements, and lifestyle questionnaires 6 and 10 years after GDM. In a subset (n = 45), peak oxygen uptake (VO2peak), peak fat oxidation, and maximal isometric strength of five muscle groups were tested. RESULTS At 10 years, 41 women (49%) had impaired glucose metabolism or type 2 diabetes (T2D). VO2peak and muscle strength were lowest in the T2D group. In a regression analysis, VO2peak and all strength measurements were associated negatively with HbA1c and waist-hip ratio and positively with high-density lipoprotein cholesterol. However, only muscle strength was associated with fasting and area-under-the-curve glucose. For changes between the 6- and 10-year follow-ups, only muscle strength was associated with HbA1c change, whereas both VO2peak and strength were associated with high-density lipoprotein level and changes in waist-hip ratio. Peak fat oxidation and self-reported physical activity showed no or weak relationships with glycemic variables. CONCLUSION Objectively measured fitness variables, particularly muscle strength, were strongly associated with glycemic and other metabolic outcomes in a high-risk group after GDM.
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Affiliation(s)
- Ulrika Andersson-Hall
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden.
| | - Denise Hossein Pour
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Stefan Grau
- Centre for Health and Performance, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Centre for Health and Performance, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden; Department of Acute and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of MGA, Sahlgrenska University Hospital, Region of Västra Götaland, Gothenburg, Sweden
| | - Agneta Holmäng
- Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
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Mohd Sa’id II, Papachristou Nadal I, Forbes A, Goldsmith K, Ismail IZ, Hassan F, Ching SM, Guess N, Murphy H, Prina M, Mohd Yusoff BN, Basri NI, Binti Salim MSF, Mahamad Sobri NH, Har Yap PP, Ismail K, Chew BH. A Protocol of Process Evaluations of Interventions for the Prevention of Type 2 Diabetes in Women With Gestational Diabetes Mellitus: A Systematic Review. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2021. [DOI: 10.1177/16094069211034010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Process evaluations of randomised controlled trials (RCTs) can provide insight and inform us on the intervention implementation, the causal mechanisms and the contextual factors. This will inform about interventions’ success or failure due to their implementation or the interventions themselves. We aim to consolidate the methodology from previous process evaluations of complex interventions upon their findings on facilitators and barriers to address the prevention of type 2 diabetes mellitus among women with gestational diabetes mellitus (GDM). Methods Comprehensive search will be conducted on electronic databases and reference lists of recent reviews for RCTs of complex interventions which address process evaluations of diabetes prevention intervention (DPI) for women with GDM in healthcare settings. There is no restriction on the language of the papers and year of publication until December 2020. Data from each study will be extracted by two reviewers independently using standardised forms. Data extracted include descriptive items on the study design and the outcomes of process evaluations from the three dimensions: (1) implementation; (2) mechanism of impact and (3) context. The quality of the studies will be assessed using mixed methods appraisal tool which is designed for the appraisal of mixed studies in systematic reviews. A narrative and framework analysis of the findings will be presented to inform the contents of a new DPI for women with GDM. Discussion The findings from this process evaluation findings are valuable in determining whether a complex intervention should be scaled up or modified for other contexts in future plan. It will give deeper understanding of potential challenges and solutions to aid in the implementation of effective DPIs for GDM in Malaysia.
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Affiliation(s)
- Iklil Iman Mohd Sa’id
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Angus Forbes
- Care of Long-term Conditions Division, King’s College London, London, UK
| | - Kimberley Goldsmith
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Irmi Zarina Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Faezah Hassan
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nicola Guess
- Research Centre for Optimal Health, University of Westminster, London, UK
| | - Helen Murphy
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich
- UK/Division of Women’s Health, St Thomas’ Campus, Kings College London, London, UK
- UK/Honorary Consultant Physician, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital, UK
| | - Matthew Prina
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Barakatun Nisak Mohd Yusoff
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurul Iftida Basri
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura SF Binti Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nur Hafizah Mahamad Sobri
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Pamela Phui Har Yap
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Khalida Ismail
- Department of Psychological Medicine, King’s College London, London, UK
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia (HPUPM Teaching Hospital), Serdang, Malaysia
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Hedeager Momsen AM, Høtoft D, Ørtenblad L, Friis Lauszus F, Krogh RHA, Lynggaard V, Juel Christiansen J, Terkildsen Maindal H, Vinther Nielsen C. Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00230. [PMID: 34277958 PMCID: PMC8279604 DOI: 10.1002/edm2.230] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Aims To present an overview of reviews of interventions for the prevention of diabetes in women after gestational diabetes mellitus (GDM) with the overall aim of gaining information in order to establish local interventions. Methods Six databases were searched for quantitative, qualitative or mixed‐methods systematic reviews. All types of interventions or screening programmes were eligible. The outcomes were effectiveness of reducing diabetes incidence, encouraging healthy behavioural changes and enhancing women's perceptions of their increased risks of developing type 2 diabetes following GDM. Results Eighteen reviews were included: three on screening programmes and seven on participation and risk perceptions. Interventions promoting physical activity, healthy diet, breastfeeding and antidiabetic medicine reported significantly decreased incidence of postpartum diabetes, up to 34% reduction after any breastfeeding compared to none. Effects were larger if the intervention began early after birth and lasted longer. Participation in screening rose up to 40% with face‐to‐face recruitment in a GDM healthcare setting. Interventions were mainly based in healthcare settings and involved up to nine health professions, councillors and peer educators, mostly dieticians. Women reported a lack of postpartum care and demonstrated a low knowledge of risk factors for developing type 2 diabetes. Typical barriers to participation were lack of awareness of increased risk and low levels of support from family. Conclusions Lifestyle interventions or pharmacological treatment postpartum was effective in decreasing diabetes incidence following GDM. Women's knowledge of the risk of diabetes and importance of physical activity was insufficient. Early face‐to‐face recruitment increased participation in screening. Programmes aimed at women following a diagnosis of GDM ought to provide professional and social support, promote screening, breastfeeding, knowledge of risk factors, be long‐lasting and offered early after birth, preferably by face‐to‐face recruitment.
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Affiliation(s)
- Anne-Mette Hedeager Momsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Diana Høtoft
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark
| | - Lisbeth Ørtenblad
- DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
| | - Finn Friis Lauszus
- Department of Gynaecology and Obstetrics Gødstrup Hospital Gødstrup Denmark
| | | | - Vibeke Lynggaard
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Cardiovascular Research Unit Department of Cardiology Gødstrup Hospital Herning Denmark
| | - Jens Juel Christiansen
- Steno Partner Collaboration between Gødstrup Hospital and Steno Diabetes Center Aarhus Herning Denmark.,Department of Medicine Gødstrup Hospital Herning Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health Aarhus University Aarhus Denmark.,Steno Diabetes Center Copenhagen Health Promotion Research Gentofte Denmark
| | - Claus Vinther Nielsen
- Section for Clinical Social Medicine and Rehabilitation Gødstrup Hospital Herning Denmark.,DEFACTUM - Social & Health Services and Labour Market Corporate Quality, Central Denmark Region Aarhus Denmark.,Department of Public Health Aarhus University Aarhus Denmark
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Bougioukas KI, Vounzoulaki E, Mantsiou CD, Savvides ED, Karakosta C, Diakonidis T, Tsapas A, Haidich AB. Methods for depicting overlap in overviews of systematic reviews: An introduction to static tabular and graphical displays. J Clin Epidemiol 2020; 132:34-45. [PMID: 33309886 DOI: 10.1016/j.jclinepi.2020.12.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE To introduce potential static tabular and graphical techniques for visually presenting overlap between systematic reviews (SRs) included in overviews of systematic reviews (OoSRs). METHODS The graphical approaches described include Venn and Euler diagrams, as well as matrix-based, node-link, and aggregation-based techniques. We used fundamental concepts of mathematics from set and network theory to develop our novel graphical approaches. The graphical displays were created using R. RESULTS Overview authors have the flexibility to choose from a variety of visualizations, depending on the characteristics of their study. If the OoSRs include few SRs, a Venn or an Euler diagram can be used. In case of OoSRs with more SRs, Upset plots, heatmaps, and node-link graphs are more appropriate for visualizing overlapping SRs. Stacked bar plots constitute an aggregation-based technique of illustrating overlap. Strengths and limitations of each graphical approach are presented. CONCLUSION The degree of overlap should be explored for the entire study and for specific outcomes of interest. The proposed graphical techniques may assist methodologists and authors in identifying overlap, which in turn may improve validity and transparency in OoSRs. More research is needed to understand which technique would be most useful and easiest to understand.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK; National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Chrysanthi D Mantsiou
- Second Medical Department, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eliophotos D Savvides
- 1st Department of Urology, Medical School, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Karakosta
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Theodoros Diakonidis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Apostolos Tsapas
- Second Medical Department, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Medical Department, Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
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Dimnjakovic J, Poljicanin T, Svajda M. Breastfeeding: A standard or an intervention? Review of systematic reviews. Med Hypotheses 2020; 141:109737. [DOI: 10.1016/j.mehy.2020.109737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
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Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies. Prev Med Rep 2019; 14:100877. [PMID: 31110933 PMCID: PMC6510702 DOI: 10.1016/j.pmedr.2019.100877] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Women with previous Gestational Diabetes Mellitus (GDM) have seven times the risk of Type 2 diabetes later in life compared to women without GDM. Physical activity can reduce this risk and most women with previous GDM are not physically active. Aims To explore: (1) effectiveness of physical activity interventions for women with previous GDM; (2) factors that women with previous GDM perceive influence their physical activity; (3) how these factors are addressed by the interventions. Methods A systematic review of quantitative (aim 1) and qualitative (aim 2) studies with a mixed-methods synthesis (aim 3) was conducted in October 2017 following Cochrane methodology. Of 8101 articles identified, twenty-eight studies were included in total: 18 in Review 1 and 10 in Review 2. Results Four interventions significantly increased physical activity and 14 had either mixed effectiveness or no changes in physical activity. Reporting of intervention components and study quality varied greatly. Relevant qualitative factors included accounting for childcare issues, social support and cultural sensitivities. Interventions that incorporated these factors were associated with effectiveness. Education about how to reduce future risk of Type 2 diabetes and using pedometers in interventions were not associated with intervention effectiveness. Other factors that future interventions should address consist of ‘putting others before yourself’; ‘putting off lifestyle change’; ‘lack of support from healthcare professionals’ and ‘being a healthy role model for families’. Conclusion Combining the results of qualitative and quantitative studies can provide a nuanced understanding of the effectiveness of physical activity and lifestyle interventions. Women with previous gestational diabetes are at high risk for type 2 diabetes. Interventions to increase physical activity have not worked for this group. Mixed-methods reviews allow us to identify effective intervention components. Childcare, social support and cultural relevance are part of successful interventions. Interventions should incorporate this review's results to improve effectiveness.
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