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Vu A, Turk N, Duru OK, Mangione CM, Panchal H, Amaya S, Castellon-Lopez Y, Norris K, Moin T. Association of Type 2 Diabetes Risk Perception With Interest in Diabetes Prevention Strategies Among Women With a History of Gestational Diabetes. Diabetes Spectr 2022; 35:335-343. [PMID: 36072816 PMCID: PMC9396721 DOI: 10.2337/ds21-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were to identify predictors of perception of type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM) and to determine factors associated with interest in evidence-based strategies for type 2 diabetes prevention. RESEARCH DESIGN AND METHODS We surveyed women with a history of GDM who had not progressed to type 2 diabetes from a large academic medical center. We used multivariate logistic regression to assess predictors of high levels of perception of type 2 diabetes risk. We also tested associations between risk perception and interest in a lifestyle change program and/or metformin therapy. RESULTS In our diverse sample of 264 women, 28% were unaware that GDM is a risk factor for incident type 2 diabetes after pregnancy, and 48% believed their personal risk of type 2 diabetes was low. In multivariate analyses, family history of diabetes (odds ratio [OR] 2.2, 95% CI 1.2-4.4) and knowledge of GDM as a risk factor for incident type 2 diabetes (OR 4.5, 95% CI 2.1-9.8) were significant predictors of greater perception of type 2 diabetes risk. Women with higher risk perception were more likely to express interest in a lifestyle change program compared with women with lower risk perception (OR 2.4, 95% CI 1.3-4.5). CONCLUSION Although some women are aware that GDM is a risk factor for incident type 2 diabetes, many still perceive their own risk of developing type 2 diabetes as low. Higher risk perception predicted interest in an evidence-based diabetes prevention program, highlighting the importance of personalized risk assessment and communication about risk for women who have had GDM.
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Affiliation(s)
- Amanda Vu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- Corresponding author: Amanda Vu,
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - O. Kenrik Duru
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Carol M. Mangione
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Hemali Panchal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Sarah Amaya
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Keith Norris
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health System, Los Angeles, CA
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Gray KL, Clifton PM, Keogh JB. Weight Loss Barriers and Dietary Quality of Intermittent and Continuous Dieters in Women with a History of Gestational Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910243. [PMID: 34639544 PMCID: PMC8508568 DOI: 10.3390/ijerph181910243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/17/2022]
Abstract
Weight-loss after gestational diabetes (GDM) lowers the risk of type-2 diabetes (T2DM). Intermittent energy restriction (IER) produces comparable weight-loss to continuous energy restriction (CER), but long-term adherence remains difficult in this population. This exploratory secondary analysis of a 12-month trial comparing IER to CER following GDM examined weight-loss and dietary quality associated with barriers to weight-loss or T2DM risk perception as assessed in a Likert scale questionnaire at baseline. The participants had a median (IQR) BMI of 32.6 (9.4) kg/m2 and 3 (4) years postpartum (n = 121). Forty-five percent (n = 54) of the participants thought they were at a high risk of developing T2DM. Greater affordability of healthy food was related with greater weight-loss at 3 months (p = 0.044, n = 85). At 12 months, there was no significant relationship between weight-loss and the barriers to weight-loss (p > 0.05). CER had superior improvement in dietary quality at 12 months (CER 11 ± 10, IER 6 ± 5.6, n = 42, p = 0.05). Under the Theoretical Domains Framework, the barriers were predominantly related to behavioral regulation (n = 83, 69%; n = 76, 63%) and environmental context and resources (n = 67, 56%). Interventions for diabetes prevention in this population should include behavioral regulation strategies, consider the family home environment, and ensure that the risk of T2DM is conveyed. Women choosing IER may benefit from education to improve their dietary quality.
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Affiliation(s)
- Kristy L. Gray
- UniSA, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (P.M.C.); (J.B.K.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
- Correspondence:
| | - Peter M. Clifton
- UniSA, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (P.M.C.); (J.B.K.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
| | - Jennifer B. Keogh
- UniSA, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (P.M.C.); (J.B.K.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
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Women's engagement with diabetes prevention activities and the influence of contact by the Australian national gestational diabetes register. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Malih N, Sohrabi MR, Abadi A, Arshi S. Determinants of Adherence to Diabetes Screening in Iranian Adults With a Positive Family History of Diabetes. J Prev Med Public Health 2021; 54:190-198. [PMID: 34092065 PMCID: PMC8190546 DOI: 10.3961/jpmph.20.496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/14/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes. METHODS This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study. RESULTS Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members' advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55). CONCLUSIONS Knowledge of the adverse effects of diabetes, physicians' and healthcare providers' advice about the benefits of early disease detection, and family members' advice were independent predictors of screening adherence.
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Affiliation(s)
- Narges Malih
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Sohrabi
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abadi
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnam Arshi
- Social Determinants of Health Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Versace VL, Beks H, Wesley H, McNamara K, Hague W, Anjana RM, Mohan V, Khunti K, Dunbar JA. Metformin for Preventing Type 2 Diabetes Mellitus in Women with a Previous Diagnosis of Gestational Diabetes: A Narrative Review. Semin Reprod Med 2021; 38:366-376. [PMID: 33860488 DOI: 10.1055/s-0041-1727203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at greater risk of developing type 2 diabetes mellitus (T2DM) when compared with women who have not had GDM. To delay or prevent T2DM, guidelines recommend regular screening in the primary care setting and lifestyle interventions that are largely focused on dietary and physical activity modifications. As the postpartum period can be challenging for women, uptake and engagement in screening and lifestyle interventions have been poor. Poor uptake and engagement places women with a history of GDM at heightened risk for future morbidity and development of T2DM. Metformin has been a longstanding and safe treatment for the control of blood glucose in people with T2DM. Research has supported the efficacy of metformin, used as an adjunct to a lifestyle intervention or as a stand-alone treatment, in preventing T2DM in people at high risk of T2DM. Findings from longitudinal studies have demonstrated the potential for metformin to reduce conversion to T2DM when used by women with a previous diagnosis of GDM. This review examines the potential effectiveness of metformin to reduce the incidence of T2DM among women with a previous diagnosis of GDM in the "real-world" setting.
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Affiliation(s)
| | - Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | - Hannah Wesley
- School of Medicine, Deakin University, Geelong, Australia.,Madras Diabetes Research Foundation, Chennai, India
| | - Kevin McNamara
- School of Medicine, Deakin University, Geelong, Australia
| | - William Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - James A Dunbar
- School of Medicine, Deakin University, Geelong, Australia
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Development and Validation of an Online Survey to Assess Perception of Diabetes Risk and Barriers and Facilitators to Weight Loss Following Gestational Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020480. [PMID: 33435536 PMCID: PMC7827434 DOI: 10.3390/ijerph18020480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/16/2022]
Abstract
Our objective was to describe the development and validation of a survey investigating barriers to weight loss, perception of diabetes risk, and views of diet strategies following gestational diabetes (GDM). The survey underwent three stages of development: generation of items, expert evaluation, and pilot testing. A content validation index (CVI) was calculated from expert responses regarding item relevance, coherence, clarity, and response options. Experts also responded to the domain fit of questions linked to the Theoretical Domains Framework (TDF). Pilot responders answered the survey and responded to review questions. Six experts in the field of nutrition, midwifery, psychology, or other health or medical research completed the expert review stage of the survey. In the pilot test, there were 20 responders who were women with previous GDM and who were living in Australia. The overall CVI from the expert review was 0.91. All questions except one received an I-CVI of >0.78 for relevance (n = 35). Fourteen of the 27 items linked to the TDF received an agreement ratio of <1.0. Twenty-seven of the 31 pilot questions were completed by ≥90% of responders. Pilot review questions revealed an agreement percentage of ≥86% (n = 12) regarding the survey's ease to complete, understand, importance, length, and interest level. The final survey tool consists of 30 items and achieved content validation through expert evaluation and pilot testing.
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Gray KL, McKellar L, O’Reilly SL, Clifton PM, Keogh JB. Women's Barriers to Weight Loss, Perception of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249180. [PMID: 33302602 PMCID: PMC7764030 DOI: 10.3390/ijerph17249180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/07/2023]
Abstract
Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM); however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged ≥18 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders (n = 322) had overweight or obesity, and 34% (n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as individual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the "5:2 diet"), but only 12% (n = 34) had tried it. Open comments (n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM; however, views vary.
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Affiliation(s)
- Kristy L. Gray
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (K.L.G.); (L.M.); (P.M.C.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
| | - Lois McKellar
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (K.L.G.); (L.M.); (P.M.C.)
| | - Sharleen L. O’Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland;
| | - Peter M. Clifton
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (K.L.G.); (L.M.); (P.M.C.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
| | - Jennifer B. Keogh
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (K.L.G.); (L.M.); (P.M.C.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA 5001, Australia
- Correspondence:
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Wood A, MacKay D, Fitzsimmons D, Derkenne R, Kirkham R, Boyle JA, Connors C, Whitbread C, Welsh A, Brown A, Shaw JE, Maple-Brown L. Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030720. [PMID: 31979123 PMCID: PMC7037226 DOI: 10.3390/ijerph17030720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/24/2023]
Abstract
Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
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Affiliation(s)
- Anna Wood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Diana MacKay
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
| | - Dana Fitzsimmons
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Ruth Derkenne
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Jacqueline A. Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | | | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
| | - Alison Welsh
- Northern Territory Department of Health, Darwin, NT 8000, Australia
| | - Alex Brown
- South Australia Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA 5005, Australia
| | - Jonathan E. Shaw
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (A.W.)
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT 0810, Australia
- Correspondence:
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Muhwava LS, Murphy K, Zarowsky C, Levitt N. Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting. PLoS One 2019; 14:e0225431. [PMID: 31765431 PMCID: PMC6876752 DOI: 10.1371/journal.pone.0225431] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Background Lifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- income countries. The aim of the study was to explore women’s lived experiences of GDM and the feasibility of sustained lifestyle modification after GDM in a low-income setting. Methods This was a descriptive qualitative study on the lived experiences of women with prior GDM, who received antenatal care at a public sector tertiary hospital in Cape Town, South Africa. Nine focus groups and five in-depth interviews were conducted with a total of thirty-five women. Data were analysed using content analysis and the COM-B (Capabilities, Opportunities, Motivations and Behaviour) model to identify factors influencing lifestyle change during and beyond the GDM pregnancy. Results The results suggest that the COM-B model’s concepts of capability (knowledge and skills for behaviour change), opportunity (resources for dietary change and physical activity) and motivation (perception of future diabetes risk) are relevant to lifestyle change among GDM women in South Africa. The results will contribute to the design of a postpartum health system intervention for women with recent GDM. Conclusion Our findings highlight the need for health services to improve counselling and education for women with GDM in South Africa. Support from family and health professionals is essential for women to achieve lifestyle change. The experience of GDM imposed a significant psychological burden on women, which affected motivation for lifestyle change. To achieve long-term lifestyle change, behaviour interventions for women with prior GDM need to address their capability, opportunity and motivation for lifestyle change during and beyond pregnancy.
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Affiliation(s)
- Lorrein Shamiso Muhwava
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
- * E-mail:
| | - Katherine Murphy
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
| | - Christina Zarowsky
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
- University of Montreal, Hospital Research Centre and University of Montreal School of Public Health, Montreal, Canada
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Chronic Diseases Initiative for Africa, Cape Town, South Africa
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Guo J, Tang Y, Zhang H, Lommel L, Chen JL. The risk, perceived and actual, of developing type 2 diabetes mellitus for mothers of preschool children in urban China. PLoS One 2019; 14:e0222839. [PMID: 31560718 PMCID: PMC6764680 DOI: 10.1371/journal.pone.0222839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/08/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The perceived risk of developing type 2 diabetes mellitus (T2DM) can motivate individuals to adopt preventive health behaviors. Compared with fathers, mothers of young children often experience unique risk factors for developing T2DM: pregnancy-related weight gain, lifestyle changes related to child care, and the increased incidence of gestational diabetes mellitus. Understanding how actual risk factors affect the perceived risk of developing T2DM can foster effective diabetes prevention interventions for this population. The aims of this study were to describe the risk, perceived and actual, of developing T2DM and to explore the influencing factors of perceived risk for Chinese mothers of preschool children in China. METHODS A multisite, cross-sectional survey was conducted and included 176 mothers (mean age of 31.19 years old) of preschool children (aged 3-7 years old) from four preschools in Changsha, the capital city of Hunan Province, China. The overall perceived risk of developing T2DM was measured by one item "Your own personal health risk is at almost no risk, slight risk, moderate risk or high risk from diabetes" from the Risk Perception Survey for Developing Diabetes (RPS-DD). PRS-DD and the Chinese version of the Canadian Diabetes Risk Assessment Questionnaire (CHINARISK) were used to assess perceived risk related worry, personal control, optimistic bias, and diabetes risk knowledge and actual risk of T2DM. Mothers also reported their height, weight, and waist circumference followed by the NIH protocol. Pearson correlation and stepwise multivariate linear regression were used to explore how the actual risk factors affected the perceived risk of developing diabetes (RPS-DD)). RESULTS Nearly 90% of mothers perceived almost no/slight risk for developing diabetes. Nearly half of the mothers had parents or siblings with diabetes. Roughly 70% of the mothers did not eat five servings of fruits and vegetables per day, and more than 50% did not exercise at least 30 minutes a day. In the five stepwise multivariate linear regression models, young mothers (95% CI .400-1.311) and those with a family history of diabetes (95% CI -0.74- .000) were founded a higher overall perceived risk. Mothers who reported more sedentary time (95% CI -0.029- -0.008) and less physical activity had less personal control (95% CI -0.354- -0.046). Mothers with more sedentary time had more worries about developing T2DM(95% CI 0.008-0.035) . Mothers who were older (95% CI -0.440-0.055) or had more physical activities (95% CI 0.003-0.048) had more optimistic bias of not developing T2DM. Mothers who had a higher education level (95% CI .354-1.422) and a family history of diabetes (95% CI .029-2.231) had more diabetes risk knowledge of developing T2DM. CONCLUSION This study found that Chinese mothers of preschool children in urban areas reported low perceived risk of developing T2DM, although they have actual risk factors. These women did not associate anthropometric, health history, or health behavior factors with the risk of developing T2DM. Anthropometrics and risk factors associated with behavioral risk factors may be the focus of diabetes prevention programs.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China
- * E-mail:
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, PR China
| | - Honghui Zhang
- Department of Hepatobiliary Surgery, Hunan General Hospital, Changsha, Hunan, PR China
| | - Lisa Lommel
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, CA, United States of America
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Purno NH, Thorpe K, Mukerji G, Ray J, Lowe J, Feig DS, Lipscombe LL. Effect of postpartum glucose tolerance results on subsequent weight retention in women with recent gestational diabetes: A retrospective cohort study. Diabetes Res Clin Pract 2019; 151:169-176. [PMID: 31004671 DOI: 10.1016/j.diabres.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/27/2019] [Accepted: 04/12/2019] [Indexed: 01/11/2023]
Abstract
AIMS Glucose tolerance normalizes postpartum in most women with gestational diabetes (GDM), which may provide false reassurance and decrease weight-reducing behaviours. We evaluated whether awareness of normal postpartum glucose tolerance was associated with higher weight retention than being unaware of glucose tolerance. METHODS This cohort study of women with GDM collected survey data during pregnancy and in the first and second postpartum year. We compared women who reported normal glucose tolerance ('aware, normal') in the first year to those reporting no testing or unsure of results ('unaware'). The primary outcome was self-reported weight in the second year compared between groups using multivariable linear regression. RESULTS Among 319 women, 110 (34.5%) were 'aware, normal'; 183 (57.4%) were 'unaware'; and 26 (8.2%) were 'aware, abnormal'. After adjusting for baseline weight and covariates, women with normal results had a mean 3.66 kg higher weight (CI 1.08-6.24 kg, p = 0.0056) by the second year than those unaware of results. CONCLUSIONS Women with GDM with normal postpartum glucose tolerance had significantly higher weight by the second year than those unaware of their results. Normal glucose tolerance after pregnancy may be misinterpreted as resolution of diabetes risk and decrease risk-reducing behaviours.
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Affiliation(s)
- Nabila H Purno
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kevin Thorpe
- Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Geetha Mukerji
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Sinai Health System, Toronto, Canada
| | - Joel Ray
- Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Julia Lowe
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Denice S Feig
- Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada; Sinai Health System, Toronto, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
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12
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Liu ZY, Zhao JJ, Gao LL, Wang AY. Glucose screening within six months postpartum among Chinese mothers with a history of gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth 2019; 19:134. [PMID: 30999888 PMCID: PMC6472025 DOI: 10.1186/s12884-019-2276-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/31/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for diabetes mellitus. The 75-g, 2-h oral glucose tolerance test is recommended for mothers with a history of GDM to screen for diabetes in the postnatal period. The aim of this study was to investigate the rate of glucose screening within 6 months postpartum among Chinese mothers with a history of GDM, and to identify its predictors. METHODS A prospective cohort study was conducted in a regional teaching hospital in Guangzhou, China, between July 2016 and June 2017. The participants were Chinese mothers (n = 237) who were diagnosed with GDM, were aged 18 years or older with no serious physical or mental disease and had not been diagnosed with type 1 or type 2 diabetes prior to their pregnancy. The revised Chinese version of the Champion's Health Belief Model Scale and social-demographic and perinatal characteristics factors were collected and used to predict postpartum glucose screening (yes or no). Adjust odds ratio (AOR) and 95% confidence interval (95% CI) were calculated. RESULTS The mean age of the 237 mothers was 32.70 years (range from 22 to 44). Almost half of the mothers (45.6%) were college graduates or higher. Chinese mothers reported a high level of perceived benefits, self-efficacy, and health motivation towards postpartum glucose screening, with a mean score above 3.5. Chinese mothers were more likely to undertake postpartum glucose screening if they were a first-time mother [AOR 2.618 (95% CI: 1.398-4.901)], had a high perceived susceptibility score [AOR 2.173 (95% CI: 1.076-4.389)], a high perceived seriousness score [AOR 1.988 (95%CI: 1.020-3.875)] and high perceived benefits score [AOR 2.978 (95%CI: 1.540-5.759)]. CONCLUSION The results of this study will lead to better identification of mothers with a history of GDM who may not screen for postpartum glucose abnormality. Health care professionals should be cognizant of issues that may affect postpartum glucose screening among mothers with a history of GDM, including parity, perceived susceptibility, perceived seriousness and perceived benefits.
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Affiliation(s)
- Zhu-Yun Liu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Juan-Juan Zhao
- School of Nursing, Sun Yat-sen University, 74#, Zhongshan Road II, Guangzhou, 510089, China
| | - Ling-Ling Gao
- School of Nursing, Sun Yat-sen University, 74#, Zhongshan Road II, Guangzhou, 510089, China.
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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13
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Dasgupta K, Terkildsen Maindal H, Kragelund Nielsen K, O'Reilly S. Achieving penetration and participation in diabetes after pregnancy prevention interventions following gestational diabetes: A health promotion challenge. Diabetes Res Clin Pract 2018; 145:200-213. [PMID: 29684615 DOI: 10.1016/j.diabres.2018.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/06/2018] [Indexed: 02/06/2023]
Abstract
AIM Health behaviour change interventions have potential to reduce diabetes after pregnancy (DAP) rates following gestational diabetes mellitus (GDM). Recruitment success is arguably as important as intervention effectiveness, but receives less attention. We examined penetration into target populations and participation in DAP prevention interventions in women with a GDM history. METHODS Five databases were searched for studies published up to December 2017. Studies were reviewed by at least three reviewers and data were qualitatively synthesized. Penetration (invited/target population) and participation (enrolled/invited) rates were calculated after data extraction. RESULTS Among 2859 records, 33 intervention studies were identified, among which 16 had sufficient information to calculate penetration or participation. Penetration proportion (n = 9 studies) was between 85 and 100% for two-thirds of studies included. Participation proportion (n = 16 studies) varied substantially; when recruitment occurred during pregnancy or early postpartum, participation was 40% or more, especially if face-to-face contact was used within the GDM care setting, compared to under 15% in mid/late postpartum with mailed invitation and/or telephone contact. CONCLUSIONS Although penetration and participation reporting is sub-optimal, penetration is generally high while participation is variable. Leveraging and structuring recruitment within standard GDM care and settings appears to be important to engage women in DAP prevention activities.
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Affiliation(s)
- Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark; Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
| | - Karoline Kragelund Nielsen
- Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
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Boyle DIR, Versace VL, Dunbar JA, Scheil W, Janus E, Oats JJN, Skinner T, Shih S, O’Reilly S, Sikaris K, Kelsall L, Phillips PA, Best JD. Results of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk. PLoS One 2018; 13:e0200832. [PMID: 30089149 PMCID: PMC6082534 DOI: 10.1371/journal.pone.0200832] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world's first national gestational diabetes register. RESEARCH DESIGN AND METHODS Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included-other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported. RESULTS Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up. CONCLUSIONS GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP's for type 2 diabetes follow-up testing proved ineffective.
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Affiliation(s)
- Douglas I. R. Boyle
- Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent L. Versace
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - James A. Dunbar
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - Wendy Scheil
- Public Health & Clinical Systems, SA Health, Adelaide, South Australia, Australia
- Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Edward Janus
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- General Internal Medicine Unit, Western Health, St Albans, Victoria, Australia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Sophy Shih
- Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia
| | - Sharleen O’Reilly
- School of Agriculture and Food Science, University College, Dublin, Ireland
| | - Ken Sikaris
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - Liza Kelsall
- Health Intelligence Unit, System Intelligence & Analytics, Department of Health and Human Services, Melbourne, Victoria, Australia
| | | | - James D. Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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15
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Barry E, Greenhalgh T, Fahy N. How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review. BMC Med 2018; 16:121. [PMID: 30049283 PMCID: PMC6062879 DOI: 10.1186/s12916-018-1107-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 06/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several countries, including England, have recently introduced lifestyle-focused diabetes prevention programmes. These aim to reduce the risk of individuals with pre-diabetes developing type 2 diabetes. We sought to summarise research on how socio-cultural influences and risk perception affect people's behaviour (such as engagement in lifestyle interventions) after being told that they have pre-diabetes. METHODS Using the RAMESES standards for meta-narrative systematic reviews, we identified studies from database searches and citation-tracking. Studies were grouped according to underlying theorisations of pre-diabetes. Following a descriptive analysis, the studies were synthesised with reference to Cockerham's health lifestyle theory. RESULTS In total, 961 titles were scanned, 110 abstracts assessed and 35 full papers reviewed. Of 15 studies included in the final analysis, 11 were based on individual interviews, focus groups or ethnography and five on structured questionnaires or surveys. Three meta-narratives emerged. The first, which we called biomedical, characterised pre-diabetes as the first stage in a recognised pathophysiological illness trajectory and sought to intervene with lifestyle changes to prevent its progression. The second, which we called psychological, focused on the theory-informed study of the knowledge, attitudes and behaviours in people with pre-diabetes. These studies found that participants generally had an accurate perception of their risk of developing diabetes, but this knowledge did not directly lead to behavioural change. Some psychological studies incorporated wider social factors in their theoretical models and sought to address these through action at the individual level. The third meta-narrative we termed social realist. These studies conceptualised pre-diabetes as the product of social determinants of health and they applied sociological theories to explore the interplay between individual agency and societal influences, such as the socio-cultural context and material and economic circumstances. They recommended measures to address these structural influences on lifestyle choices. CONCLUSIONS The study of pre-diabetes to date has involved at least three research disciplines (biomedicine, psychology and sociology), which up to now have operated largely independently of one another. Behavioural science and sociology are increasing our understanding of how personal, social, cultural and economic aspects influence health-related behaviours. An interdisciplinary approach with theoretically informed multi-level studies could potentially improve the success of diabetes prevention strategies. TRIAL REGISTRATION Prospero Registration Number: CRD42018088609 .
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Affiliation(s)
- Eleanor Barry
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG, UK.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG, UK
| | - Nicholas Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG, UK
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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17
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The Impact of Health Education Intervention for Prevention and Early Detection of Type 2 Diabetes in Women with Gestational Diabetes. J Community Health 2018; 42:500-510. [PMID: 27743337 DOI: 10.1007/s10900-016-0282-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to investigate the impact of a health belief model (HBM)-based educational intervention on knowledge, beliefs, self-reported practices, gestational and postpartum weight in women with gestational diabetes mellitus (GDM). SUBJECTS AND METHODS A cluster randomized controlled trial was performed, with randomization at the level of Primary Health Care centers in three Egyptian cities. Eligible women with GDM were enrolled at 24 weeks pregnancy. The intervention group (n = 103) received health education intervention based on the HBM construct. Control subjects (n = 98) received the usual care. The outcomes measured were: women's knowledge, beliefs, self-reported practices, gestational weight gain (GWG), and postpartum weight retention. Patients were investigated at baseline, at end of pregnancy, and at 6 weeks postpartum. RESULTS After the intervention, percentages of women who had high knowledge and beliefs scores had significantly increased from less than 50 % to more than 70 % in the intervention group (p < 0.001). More women in the intervention group reported practicing exclusive breast feeding (85.4 %) and screening for T2DM (43.7 %) at 6 weeks postpartum compared to the control group (63.3 and 19.4 % respectively) (p < 0.001). More women with excessive body mass index in the intervention group (65 %) compared to the control group (11.6 %) were meeting recommended GWG (p < 0.001), and postpartum weight (37.7, and 20.3 % respectively) (p < 0.01). CONCLUSION This intervention significantly improved knowledge, beliefs, self-reported practices, and gestational and postpartum weight in patients with GDM. Further research is needed for investigating the effectiveness of applying early, multi-phase, and longer intervention.
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Abstract
All racial/ethnic groups are at higher risk for type 2 diabetes compared to whites, but it is unknown if young adults recognize their risk. Risk knowledge and individual risk perception were examined in 1579 multiracial urban college students. Students have little knowledge of diabetes risk factors; identifying less than three of ten. Considerable variation exists in the understanding of risk; only .02 % of Asian, 14.0 % of Hispanic and 22.8 % of black students recognized that their race increased risk. Among those with ≥3 risk factors (n = 541) only 39 % perceived their risk. These under-estimators had lower knowledge scores (p = .03) than those who acknowledged their risk; indicating that the cause of under-estimating risk may be, at least, in part due to a lack of information. There is a pressing need to heighten understanding of type 2 diabetes risk among young adults to decrease the future burden of this disease.
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Gupta SS, Teede H, Aroni R. Spicing up your advice for South Asian and Anglo-Australians with type 2 diabetes and CVD: Do cultural constructions of diet matter? Appetite 2018; 120:679-697. [DOI: 10.1016/j.appet.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
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Moore AP, D'Amico MI, Cooper NAM, Thangaratinam S. Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: An online survey with mothers and health professionals. Eur J Obstet Gynecol Reprod Biol 2017; 220:106-112. [PMID: 29202393 DOI: 10.1016/j.ejogrb.2017.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to identify what components of a postpartum lifestyle intervention would engage postpartum mothers who had a diagnosis of gestational diabetes. STUDY DESIGN Two online surveys were conducted, one involving postnatal mothers with GDM (n=83), and a second for health professionals (n=46). RESULTS Seventy-eight percent of mothers were aware that healthy eating, exercise and weight management were all important to reduce risk of subsequent type 2 diabetes. However, 80% of women in this survey were not ready to engage in a postpartum lifestyle intervention within the first 6 months of giving birth; in contrast 52% of health professionals recommended they should be engaged in the first six weeks. Group sessions were the most commonly chosen format to deliver an intervention (30%). A community setting was preferred to a medical one. Mothers wanted recipe ideas (95%) in preference to general dietary advice (76%) or cooking skills courses (39%). Walking was the main form of exercise for 79% of mothers in this sample. Women highlighted difficulty in focusing on their own health goals because of competing demands of looking after a baby (41% agreed, Median 3, IQR 2), tiredness (65% agreed, Md 4, IQR 1) and the need for childcare (64% agreed, Md 4, IQR 2). CONCLUSION A walking programme, recipe ideas and weight monitoring may be useful components when designing a postpartum lifestyle intervention. Barriers to engagement are evident and the intervention should allow women to engage at a time that is appropriate for them.
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Affiliation(s)
- Amanda P Moore
- The Diabetes and Nutritional Sciences Division, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Maria I D'Amico
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.
| | - Natalie A M Cooper
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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Ghajari H, Nouhjah S, Shahbazian H, Valizadeh R, Tahery N. Postpartum glucose testing, related factors and progression to abnormal glucose tolerance in a rural population with a known history of gestational diabetes. Diabetes Metab Syndr 2017; 11 Suppl 1:S455-S458. [PMID: 28404514 DOI: 10.1016/j.dsx.2017.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/31/2017] [Indexed: 01/04/2023]
Abstract
AIMS Gestational diabetes is a strong risk factor for postpartum progression to glucose intolerance. The aims of the study were to determine rate of postpartum glucose testing , its related factors and rate of progression to glucose intolerance in women who underwent postpartum glucose testing after pregnancy that complicated by gestational diabetes. MATERIALS this is a retrospective study and women with gestational diabetes who received prenatal care during 2005-2015 in 3 rural health centers of Khuramshahr (southwestern of Iran) were enrolled. Gestational diabetes mellitus diagnosed by FPG test only, 75g OGTT or GCT. The American Diabetes Association(ADA) criteria applied for definition of postpartum glucose intolerance (pre-diabetes or diabetes) . RESULTS Mean duration of follow-up was 29.7 months. BMI≥ 25 was detected in 73.3% and 78.7% of women during pre-pregnancy and postpartum respectively. Overall 45.8% (60/131) of women received postpartum glucose testing. Rate of progression to abnormal glucose tolerance was 23.3% (8.5% pre-diabetes and 15.2% diabetes). Advanced maternal age was associated with postpartum glucose testing (OR 1.066, CI 1.008-1.128, p=0.02). DISCUSSION high rate of overweight and obesity, sub optimal rate of postpartum glucose testing and high prevalence of glucose intolerance, highlights the importance of postpartum screening with a more sensitive test and implementation of an intervention program to prevent type 2 diabetes in rural population particularly older women with prior gestational diabetes.
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Affiliation(s)
| | - Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Rohollah Valizadeh
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Noorollah Tahery
- Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran & Abadan School of Medical Sciences, Abadan, Iran.
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Mukerji G, Kainth S, Pendrith C, Lowe J, Feig DS, Banerjee AT, Wu W, Lipscombe LL. Predictors of low diabetes risk perception in a multi-ethnic cohort of women with gestational diabetes mellitus. Diabet Med 2016; 33:1437-44. [PMID: 26499170 DOI: 10.1111/dme.13009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 01/11/2023]
Abstract
AIM To determine what proportion of women with gestational diabetes underestimate their diabetes risk and identify factors associated with low diabetes risk perception. METHODS Participants included pregnant adult women with gestational diabetes between 2009 and 2012 across seven diabetes clinics in Ontario, Canada. Data were collected through chart review and a survey that included a diabetes risk perception question. RESULTS Of the 614 of 902 women (68% response rate) with gestational diabetes, 89% correctly responded that gestational diabetes increases the risk for developing diabetes. However, 47.1% of women perceived themselves to be at low risk for developing diabetes within 10 years. On multivariable analysis, BMI < 25 kg/m(2) , absent previous gestational diabetes history, absent diabetes family history and absent insulin use were appropriately associated with low diabetes risk perception. However, compared with Caucasian ethnicity, high-risk ethnicity (Aboriginal, Latin American, West Indian, South Asian, Middle Eastern, Filipino, Black, Pacific Islander) [odds ratio (OR) 2.07; 95% CI 1.30-3.31] and East and South East Asian ethnicity (OR 2.01; 1.10-3.67) were associated with low diabetes risk perception. After further adjustment for immigration, only high-risk ethnicity remained a predictor of low diabetes risk perception (OR 1.86; 1.09-3.19), whereas East and South East Asian ethnicity did not (OR 1.67; 0.86-3.22). CONCLUSIONS Although the majority of women recognized gestational diabetes as a risk factor for diabetes, almost half underestimated their personal high diabetes risk despite prenatal care. Furthermore, women from high-risk ethnic groups were more likely to underestimate their risk, even after adjusting for immigration. Interventions tailored to these groups are necessary to enhance perceived diabetes risk.
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Affiliation(s)
- G Mukerji
- Women's College Hospital, Toronto.
- Department of Medicine, University of Toronto, Toronto.
| | - S Kainth
- University of Western Ontario, London
| | | | - J Lowe
- Department of Medicine, University of Toronto, Toronto
- Sunnybrook Health Sciences Centre, Toronto
| | - D S Feig
- Department of Medicine, University of Toronto, Toronto
- Mount Sinai Hospital, Toronto
| | | | - W Wu
- Women's College Research Institute, Toronto, Ontario, Canada
| | - L L Lipscombe
- Women's College Hospital, Toronto
- Department of Medicine, University of Toronto, Toronto
- Mount Sinai Hospital, Toronto
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Amason JS, Lee SY, Aduddell K, Hewell SW, Van Brackle L. Pilot Feasibility Study of an Educational Intervention in Women With Gestational Diabetes. J Obstet Gynecol Neonatal Nurs 2016; 45:515-27. [PMID: 27266962 DOI: 10.1016/j.jogn.2016.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To pilot test the feasibility of an educational intervention, Start Understanding Gestational Diabetes and Risk of Developing Type 2 Diabetes (SUGAR), in women with gestational diabetes mellitus (GDM). DESIGN A pretest-posttest, two-group study design. SETTING Three obstetrics and gynecology offices in the southeastern United States. PARTICIPANTS Twenty-three women with a first-time diagnosis of GDM. METHODS Women diagnosed with GDM were recruited and placed in a control group or educational intervention group. Women completed six self-report, standardized questionnaires at baseline (third trimester) and posttest (6-8 weeks postpartum). Women in the intervention group (n = 18) received the SUGAR educational intervention after the baseline data collection with a booster session at 2 to 4 weeks postpartum. Women in the control group (n = 5) received an attention control treatment. RESULTS Study participants had obesity, and most had a family history of type 2 diabetes mellitus. The attrition rate was low (n = 2; 8%). The educational intervention significantly increased diabetes mellitus knowledge for women in the SUGAR group. In addition, 39% of participants received the recommended postpartum glucose screening. CONCLUSION Although the effect of the SUGAR intervention with a small sample was not expected to produce statistically significant changes, we add our pilot study to the limited research of diabetes mellitus preventative care for women with GDM and provide preliminary findings to develop meaningful education and support for women diagnosed with GDM. Future researchers need to focus on prevention programs that center on self-efficacy, postpartum glucose screening, and adoption of healthy lifestyle behaviors.
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Abstract
AIM To report an analysis of the concept of risk perception in pregnancy. BACKGROUND Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women. DESIGN Walker and Avant's method was selected to guide this analysis. DATA SOURCES Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied. METHODS Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified. RESULTS The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept. CONCLUSION Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.
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Affiliation(s)
- Suzanne Lydia Lennon
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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25
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Perspectives on prevention of type 2 diabetes after gestational diabetes: a qualitative study of Hispanic, African-American and White women. Matern Child Health J 2016; 19:1526-34. [PMID: 25421329 DOI: 10.1007/s10995-014-1657-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women's focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.
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Van Ryswyk EM, Middleton PF, Hague WM, Crowther CA. Women's views on postpartum testing for type 2 diabetes after gestational diabetes: Six month follow-up to the DIAMIND randomised controlled trial. Prim Care Diabetes 2016; 10:91-102. [PMID: 26320407 DOI: 10.1016/j.pcd.2015.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/26/2015] [Accepted: 07/24/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study assessed the views of the women who participated in the DIAMIND randomised trial of postpartum SMS reminders to test for type 2 diabetes after gestational diabetes (GDM) on their preferred type of postpartum reminder system and barriers and facilitators to completion of postpartum diabetes testing. METHOD A written questionnaire was sent to women with recent GDM who participated in the DIAMIND trial (n=276) via post or email at six months after the birth of their baby. RESULTS 208 women (75%) returned the study questionnaires. Preferred postpartum reminder types were: SMS (67%), email (17%), postal (12%) and voice call (1%). Women who had not yet completed an OGTT indicated that they planned to undertake one in the future (61%). Common barriers to postpartum OGTT completion included: not having enough time (73%), inadequate childcare (30%), and a need to focus on the health of the baby (30%). The most common facilitator was having a shorter test (33%). CONCLUSIONS Improved childcare quality and access as well as more research into a shorter, more convenient test procedure for type 2 diabetes screening are needed. Reminder systems for postpartum diabetes screening should be electronic where possible.
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Affiliation(s)
- E M Van Ryswyk
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - P F Middleton
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - W M Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - C A Crowther
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia; Liggins Institute, The University of Auckland, Auckland, New Zealand.
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Guo J, Chen JL, Whittemore R, Whitaker E. Postpartum Lifestyle Interventions to Prevent Type 2 Diabetes Among Women with History of Gestational Diabetes: A Systematic Review of Randomized Clinical Trials. J Womens Health (Larchmt) 2015; 25:38-49. [PMID: 26700931 DOI: 10.1089/jwh.2015.5262] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at a higher risk of developing type 2 diabetes. Several postpartum lifestyle intervention studies have been conducted for this high-risk group; however, the randomized clinical trials have not been evaluated systematically. Thus, the aim of this article is to evaluate the outcomes of clinical trials that focus on diabetes prevention among women with DGM. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Chinese and US databases were searched. Randomized controlled trials of postpartum lifestyle interventions to prevent type 2 diabetes in women with prior GDM were reviewed. Outcomes included in this review are type 2 diabetes incidences, insulin insistence, and weight-related measures. The effect size of these outcomes in each study was computed. Data on intervention components were extracted, including type (in-person vs. technology-based), content (diet or physical activity or both), form (individual session vs. group session), duration, intensity, evaluation time point, and program delivery. A total of 12 studies met the inclusion criteria. The mean annual type 2 diabetes mellitus (T2DM) incidence of the intervention group was lower than that of the comparison group (6.0% vs. 9.3%), although there was no statistical difference between the two groups. About 50% of these studies and two-thirds of studies, respectively, reported a significant decrease in insulin resistance-related measures and weight-related measures in the intervention group compared with the comparison group. The median intervention duration and study length were 6 months. Postpartum lifestyle interventions can be effective in reducing T2DM development and insulin resistance, and decrease weight in women with GDM history, regardless of the intervention types (technology-based or in-person). Effective interventions typically include dietary changes while some physical activity changes can also improve outcomes. However, more interventions with long-term efficacy evaluation are warranted.
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Affiliation(s)
- Jia Guo
- 1 Xiangya School of Nursing, Central South University , Changsha, China
| | - Jyu-Lin Chen
- 2 School of Nursing, University of California , San Francisco, San Francisco, California
| | | | - Evans Whitaker
- 4 Medicine Library and Center for Knowledge Management, University of California , San Francisco, San Francisco, California
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Mukerji G, McTavish S, Glenn A, Delos-Reyes F, Price J, Wu W, Harvey P, Lipscombe LL. An Innovative Home-Based Cardiovascular Lifestyle Prevention Program for Women With Recent Gestational Diabetes: A Pilot Feasibility Study. Can J Diabetes 2015; 39:445-50. [PMID: 26482886 DOI: 10.1016/j.jcjd.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/25/2015] [Accepted: 08/04/2015] [Indexed: 01/11/2023]
Affiliation(s)
- Geetha Mukerji
- Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Sarah McTavish
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Andrea Glenn
- Women's College Research Institute, Toronto, Ontario, Canada
| | | | - Jennifer Price
- Women's College Hospital, Toronto, Ontario, Canada; Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
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Morrison M, Collins C, Lowe J, Giglia R. Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus. Women Birth 2015; 28:143-7. [DOI: 10.1016/j.wombi.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/04/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
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Peacock AS, Bogossian FE, Wilkinson SA, Gibbons KS, Kim C, McIntyre HD. A Randomised Controlled Trial to Delay or Prevent Type 2 Diabetes after Gestational Diabetes: Walking for Exercise and Nutrition to Prevent Diabetes for You. Int J Endocrinol 2015; 2015:423717. [PMID: 26089886 PMCID: PMC4452189 DOI: 10.1155/2015/423717] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/22/2014] [Indexed: 01/11/2023] Open
Abstract
Aims. To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) > 25 kg/m(2) to delay or prevent Type 2 Diabetes Mellitus. Methods. Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m(2) were randomized to an intervention (I) (n = 16) or a control (C) (n = 15) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours. Results. Median (IQR) results were as follows: weight: I -2.5 (2.3) kg versus C +0.2 (1.6) kg (P = 0.009), waist: I -3.6 (4.5) cm versus C -0.1 (3.6) cm (P = 0.07), and hip: I -5.0 (3.3) cm versus C -0.2 (2.6) cm (P = 0.002). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition. Conclusion. A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.
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Affiliation(s)
- A. S. Peacock
- School of Nursing and Midwifery, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
| | - F. E. Bogossian
- School of Nursing and Midwifery, The University of Queensland, Brisbane, QLD 4067, Australia
| | - S. A. Wilkinson
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
- Mater Health Services, Brisbane, QLD 4101, Australia
| | - K. S. Gibbons
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
| | - C. Kim
- University of Michigan, Ann Arbor, MI 48109, USA
| | - H. D. McIntyre
- Mater Health Services, Brisbane, QLD 4101, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
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Cosson E, Bihan H, Vittaz L, Khiter C, Carbillon L, Faghfouri F, Leboeuf D, Dauphin H, Lepagnol A, Reach G, Valensi P. Improving postpartum glucose screening after gestational diabetes mellitus: a cohort study to evaluate the multicentre IMPACT initiative. Diabet Med 2015; 32:189-97. [PMID: 25393823 DOI: 10.1111/dme.12631] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate a mobilization campaign, the IMPACT initiative, which included multidisciplinary meetings, provision of information and a systematic prescription of an oral glucose tolerance test to improve the rate of glucose screening in women with gestational diabetes mellitus in the four largest maternity units in our area, starting in March 2011. METHODS We retrospectively compared the level of self-reported screening during the first 6 months postpartum of women who gave birth after having been diagnosed with gestational diabetes before (January 2009 to December 2010) and after the IMPACT campaign (April 2011 to February 2012). RESULTS We included 961 women (589 in the period before and 372 in the period after the campaign was initiated) with a mean ± SD age of 33.2 ± 5.3 years and BMI of 27.8 ± 5.3 kg/m². Multivariate analysis, stratified using a propensity score in order to limit bias caused by imbalance between both periods, showed that the postpartum screening rate was higher after the campaign began (48.9 vs 33.3%, odds ratio 1.7, 95% CI 1.1-2.5; P = 0.019) and higher in women who received insulin treatment during pregnancy (odds ratio 2.3, 95% CI 1.5-3.6; P < 0.001), consumed fruit and vegetables daily (odds ratio 1.6, 95% CI 1.1-2.4; P = 0.035) and did not smoke (smoking vs non-smoking: odds ratio 0.3, 95% CI 0.1-0.7; P = 0.01). There was no interaction between the campaign effect and these particular conditions. The proportion of oral glucose tolerance tests performed in women who underwent screening increased from 6.3 to 33.0%. CONCLUSIONS The IMPACT campaign increased postpartum screening, and the use the oral glucose tolerance test in particular. The effect of this initiative might be reinforced in women who are non-daily consumers of fruit and vegetables, smokers and those who do not receive insulin treatment during pregnancy.
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Affiliation(s)
- E Cosson
- AP-HP, Jean Verdier Hospital, Department of Endocrinology, Diabetology and Nutrition, Université Paris 13, Sorbonne Paris Cité, Bondy; Sorbonne Paris Cité, UMR U1153 Inserm / U1125 Inra / Cnam / Université Paris 13, Bobigny, France
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The subjective impact of a diagnosis of gestational diabetes among ethnically diverse pregnant women: a qualitative study. Can J Diabetes 2014; 39:117-22. [PMID: 25512097 DOI: 10.1016/j.jcjd.2014.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Women diagnosed with gestational diabetes mellitus (GDM) require enhanced medical care, social support and health behaviour changes to reduce the complications of pregnancy and future adverse health outcomes. Little is known about how a GDM diagnosis positively and negatively impacts women, especially those of diverse ethnic backgrounds. This qualitative study sought to gain insight into the reactions and experiences of multiethnic women diagnosed with GDM. METHODS A qualitative descriptive approach was used to analyze semistructured telephone interviews conducted with 19 pregnant women of diverse backgrounds who were diagnosed with GDM. Interviews were recorded and transcribed and then coded and analyzed using content analysis. RESULTS This study identified 2 main themes and several subthemes. First, women reported many negative effects of a GDM diagnosis, including heightened pressure to fulfill multiple roles, financial impact, and a disconnect between diabetes-prevention recommendations and their cultural practices. Second, a GDM diagnosis also had positive effects on many women. Women indicated being motivated to make health behaviour changes after a GDM diagnosis and viewed it as a wake-up call to modify their lifestyles. CONCLUSIONS To help pregnant women with self-management of gestational diabetes, healthcare providers should pay greater attention to the adverse effects of GDM on women, including role expectations, cultural issues and financial barriers. Healthcare providers also need to focus on the positive effects and capitalize on women's motivation to make lifestyle changes to reduce their future risk for diabetes.
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Lipscombe LL, Banerjee AT, McTavish S, Mukerji G, Lowe J, Ray J, Evans M, Feig DS. Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design. Diabetes Res Clin Pract 2014; 106:57-66. [PMID: 25154309 DOI: 10.1016/j.diabres.2014.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/27/2014] [Accepted: 07/20/2014] [Indexed: 01/08/2023]
Abstract
AIMS Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study. METHODS The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change. CONCLUSIONS Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.
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Affiliation(s)
- Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6.
| | - Ananya Tina Banerjee
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8
| | - Sarah McTavish
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8
| | - Geetha Mukerji
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8
| | - Julia Lowe
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5
| | - Joel Ray
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology and Metabolism, St. Michael's Hospital, 61 Queen St. East, Toronto, ON, Canada, M5C 2T2; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8
| | - Marilyn Evans
- Faculty of Health Sciences, Western University, Arthur and Sonia Labatt Health Sciences Building, London, ON, Canada N6A 5B9
| | - Denice S Feig
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology, Mount Sinai Hospital, 60 Murray Street, Toronto, ON, Canada, M5T 3L9; Department of Obstetrics and Gyencology, University of Toronto, 123 Edward Street, Toronto, ON, Canada, M5G 1E2
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Bihan H, Cosson E, Khiter C, Vittaz L, Faghfouri F, Leboeuf D, Carbillon L, Dauphin H, Reach G, Valensi P. Factors associated with screening for glucose abnormalities after gestational diabetes mellitus: baseline cohort of the interventional IMPACT study. DIABETES & METABOLISM 2014; 40:151-7. [PMID: 24503190 DOI: 10.1016/j.diabet.2013.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although it is important to screen women who have had gestational diabetes mellitus (GDM) for abnormal post-partum glucose levels, such testing is rarely performed. The aim of this study was to use data from the first observational phase of the IMPACT study to determine rates of screening within 6 months of delivery in a multiethnic cohort, focusing in particular on the effects of social deprivation and the risk of future diabetes. PATIENTS AND METHODS To investigate the frequency of post-partum screening, charts were analyzed, and all women attending four centres located in a deprived area who had had GDM between January 2009 and December 2010 were contacted by phone. The Evaluation of Precarity and Inequalities in Health Examination Centres (EPICES) deprivation index and Finnish Diabetes Risk Score (FINDRISK) questionnaire were also evaluated. RESULTS Data were evaluable for 589 of the 719 women contacted (mean age: 33.4 ± 5.2 years; mean body mass index: 27.6 ± 5.4 kg/m(2)), and 196 (33.3%) reported having been screened. On multivariate analysis, factors associated with a lack of screening were smoking [odds ratio (OR): 0.42 (0.20-0.90), P<0.05], low consumption of fruit and vegetables [OR: 0.58 (0.39-0.82), P<0.01] and heavier offspring birth weight (P<0.05), although there were no differences in FINDRISK and EPICES scores between screened and unscreened women. CONCLUSION One-third of women who had had GDM reported having been screened for dysglycaemia at 6 months post-partum. However, it is expected that the interventional phase of the IMPACT study will increase screening rates, especially in women with the risk factors associated with lower screening rates during this observational phase.
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Affiliation(s)
- H Bihan
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Diabetology, Metabolic Diseases, CRNH-IdF, CINFO, Bobigny, France; Sorbonne Paris Cité, UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France.
| | - E Cosson
- Sorbonne Paris Cité, UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France; AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
| | - C Khiter
- De La Fontaine Hospital, Department of Obstetrics and Gynecology, Saint-Denis, France
| | - L Vittaz
- Ballanger Hospital, Department of Endocrinology-Diabetology, Aulnay-Sous-Bois, France
| | - F Faghfouri
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
| | - D Leboeuf
- Seine-Saint-Denis Private Hospital, Department of Obstetrics and Gynecology, Le Blanc Mesnil, France
| | - L Carbillon
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Gynaecology-Obstetrics, Bondy, France
| | - H Dauphin
- Ballanger Hospital, Department of Gynecology, Aulnay-Sous-Bois, France
| | - G Reach
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Diabetology, Metabolic Diseases, CRNH-IdF, CINFO, Bobigny, France
| | - P Valensi
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
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Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2014; 103:176-85. [PMID: 24300020 DOI: 10.1016/j.diabres.2013.11.003] [Citation(s) in RCA: 391] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS We estimated the number of live births worldwide and by IDF Region who developed hyperglycaemia in pregnancy in 2013, including total diabetes in pregnancy (known and previously undiagnosed diabetes) and gestational diabetes. METHODS Studies reporting prevalence of hyperglycaemia first-detected in pregnancy (formerly termed gestational diabetes) were identified using PubMed and through a review of cited literature. A simple scoring system was developed to characterise studies on diagnostic criteria, year study was conducted, study design, and representation. The highest scoring studies by country with sufficient detail on methodology for characterisation and reporting at least three age-groups were selected for inclusion. Forty-seven studies from 34 countries were used to calculate age-specific prevalence of hyperglycaemia first-detected in pregnancy in women 20-49 years. Adjustments were then made to account for heterogeneity in screening method and blood glucose diagnostic threshold in studies and also to align with recently published diagnostic criteria as defined by the WHO for hyperglycaemia first detected in pregnancy. Prevalence rates were applied to fertility and population estimates to determine regional and global prevalence of hyperglycaemia in pregnancy for 2013. An estimate of the proportion of cases of hyperglycaemia in pregnancy due to total diabetes in pregnancy was calculated using age- and sex-specific estimates of diabetes from the IDF Diabetes Atlas and applied to age-specific fertility rates. RESULTS The global prevalence of hyperglycaemia in pregnancy in women (20-49 years) is 16.9%, or 21.4 million live births in 2013. An estimated 16.0% of those cases may be due to total diabetes in pregnancy. The highest prevalence was found in the South-East Asia Region at 25.0% compared with 10.4% in the North America and Caribbean Region. More than 90% of cases of hyperglycaemia in pregnancy are estimated to occur in low- and middle-income countries. CONCLUSION These are the first global estimates of hyperglycaemia in pregnancy and conform to the new WHO recommendations regarding diagnosis and also include estimates of live births in women with known diabetes. They indicate the importance of the disease from a public health and maternal and child health perspective, particularly in developing countries.
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Affiliation(s)
- L Guariguata
- The International Diabetes Federation, Brussels, Belgium.
| | - U Linnenkamp
- The International Diabetes Federation, Brussels, Belgium
| | - J Beagley
- The International Diabetes Federation, Brussels, Belgium
| | - D R Whiting
- Directorate of Public Health, Medway Council, Chatham, United Kingdom
| | - N H Cho
- Department in Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Morrison MK, Lowe JM, Collins CE. Response to Letter to the Editor regarding "Australian women's experiences of living with gestational diabetes". Women Birth 2014; 27:72. [PMID: 24480014 DOI: 10.1016/j.wombi.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Melinda K Morrison
- Education & Prevention Division, Australian Diabetes Council, Sydney, NSW, Australia.
| | - Julia M Lowe
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health & Medicine, University of Newcastle, Australia.
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Infanti JJ, O’Dea A, Gibson I, McGuire BE, Newell J, Glynn LG, O’Neill C, Connolly SB, Dunne FP. Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM). BMC Med Res Methodol 2014; 14:13. [PMID: 24461045 PMCID: PMC3913964 DOI: 10.1186/1471-2288-14-13] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/20/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gestational 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. METHODS We 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. RESULTS Two 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. CONCLUSIONS Women 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 REGISTRATION Current Controlled Trials ISRCTN41202110.
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Affiliation(s)
- Jennifer J Infanti
- School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Angela O’Dea
- School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- Croí–The West of Ireland Cardiac Foundation, Croí Heart and Stroke Centre, Moyola Lane, Newcastle, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility, National University of Ireland Galway, University Road, Galway, Ireland
| | - Liam G Glynn
- Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland
| | - Ciaran O’Neill
- J.E. Cairnes School of Business & Economics, Cairnes Building, National University of Ireland Galway, Galway, Ireland
| | - Susan B Connolly
- Division of Cardiology Cardiothoracic and Thoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Fidelma P Dunne
- School of Medicine, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland
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Coriati A, Elisha B, Virassamynaik S, Phaneuf M, Ziai S, Gauthier MS, Rabasa-Lhoret R. Diagnosis of cystic fibrosis-related glucose abnormalities: Can we shorten the standard oral glucose tolerance test? Appl Physiol Nutr Metab 2013; 38:1254-9. [PMID: 24195626 DOI: 10.1139/apnm-2013-0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adult patients with cystic fibrosis (APCF) are at high risk of developing impaired glucose tolerance (IGT) and CF-related diabetes (CFRD) and thus an annual screening with a 2-h oral glucose tolerance test (OGTT) is recommended. This population would greatly benefit from a simplified and harmless alternative to the standard OGTT. Thus, we aimed to compare the diagnostic values of HbA1c and glycemias at interval time points during the 2-h OGTT for IGT and CFRD detection in APCF. To do so, we conducted a cross-sectional analysis of 194 APCF with normal fasting plasma glucose values (≤ 7.0 mmol · L(-1)) who underwent a 2-h OGTT. Receivers operating characteristic area under the curves (ROC-AUC) were analyzed to assess the diagnostic value of HbA1c and intermediate OGTT glycemias using 2-h OGTT glycemia as reference. For both IGT and CFRD diagnoses, ROC-AUC values obtained from glycemia at 90 min were significantly higher than HbA1c and remaining intermediate glycemias (p < 0.001). The best 90-min OGTT cut-off values for these diagnoses were >9.3 mmol · L(-1) (IGT) and ≥ 11.5 mmol · L(-1) (CFRD). A 90-min OGTT glycemia might be a simplified alternative to 2-h OGTT glycemia for earlier glucose tolerance abnormalities diagnosis in APCF. This finding should be confirmed in other APCF cohorts and its predictive value should be established prospectively.
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Affiliation(s)
- Adèle Coriati
- Institut de Recherches Cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7, Canada
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Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, Kozak S, Ryan E, Sermer M, Vinokuroff C. Diabetes and pregnancy. Can J Diabetes 2013; 37 Suppl 1:S168-83. [PMID: 24070943 DOI: 10.1016/j.jcjd.2013.01.044] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Zera CA, Nicklas JM, Levkoff SE, Seely EW. Diabetes risk perception in women with recent gestational diabetes: delivery to the postpartum visit. J Matern Fetal Neonatal Med 2012; 26:691-6. [PMID: 23131116 DOI: 10.3109/14767058.2012.746302] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Low perceived risk for type 2 diabetes (T2DM) may be a barrier to lifestyle change in women with recent gestational diabetes (GDM). We assessed perceived risk for T2DM at delivery and postpartum. METHODS We used a validated diabetes risk perception instrument to survey women with GDM at delivery and postpartum. We compared women with low perceived risk for T2DM at delivery to those with high perceived risk. RESULTS The majority (N = 43 of 70, 61%) perceived high risk at delivery. Women who perceived low risk were younger (30.7 ± 6.3 versus 35.0 ± 4.5 years, p = 0.003) than women who perceived high risk. Although knowledge of risk factors for T2DM was poor (mean 6.0 ± 1.9, of 11 points), 95% correctly identified GDM as a risk factor. Perceived risk was maintained in most (N = 51 of 58, 88%) who returned for their postpartum visit. Low perceived risk was not associated with loss to follow up, however correct identification of GDM as a risk factor was protective (OR 0.05, 95% CI 0.005, 0.56). CONCLUSIONS Risk perception is accurate in most women with GDM at delivery and postpartum. Further study is needed to translate perceived risk into preventive behaviors in women with recent GDM.
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Affiliation(s)
- Chloe A Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA .
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Morrison MK, Koh D, Lowe JM, Miller YD, Marshall AL, Colyvas K, Collins CE. Postpartum diet quality in Australian women following a gestational diabetes pregnancy. Eur J Clin Nutr 2012; 66:1160-5. [DOI: 10.1038/ejcn.2012.84] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Keely E. An opportunity not to be missed--how do we improve postpartum screening rates for women with gestational diabetes? Diabetes Metab Res Rev 2012; 28:312-6. [PMID: 22228674 DOI: 10.1002/dmrr.2274] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The ability to detect postpartum dysglycaemia, intervene and prevent type 2 diabetes in this high-risk population may be the most compelling reason to diagnose gestational diabetes. However, most studies show that less than 50% of women receive any glucose screening in the postpartum period and are thus denied this opportunity. Although many have advocated for simpler testing, the 75-g oral glucose tolerance test remains the gold standard as fasting glucose level will miss 30-40% of cases of type 2 diabetes and will not detect isolated impaired glucose tolerance. Haemoglobin A(1c) as a screening test has not been adequately studied. To improve postpartum screening rates, we need to increase awareness of the very high risk of type 2 diabetes, improve communication between providers, reduce fragmentation of care and introduce system factors that facilitate screening adherence.
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Affiliation(s)
- Erin Keely
- Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, Ottawa, ON, Canada.
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Kim C, Draska M, Hess ML, Wilson EJ, Richardson CR. A web-based pedometer programme in women with a recent history of gestational diabetes. Diabet Med 2012; 29:278-83. [PMID: 21838764 PMCID: PMC4139030 DOI: 10.1111/j.1464-5491.2011.03415.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIMS Women with remote histories of gestational diabetes mellitus can reduce their diabetes risk through lifestyle changes, but the effectiveness of interventions in women with more recent histories of gestational diabetes has not been reported. Therefore, we conducted a pilot study of a low-intensity web-based pedometer programme targeting glucose intolerance among women with recent gestational diabetes. METHODS Women with a gestational diabetes delivery within the past 3 years were randomized to a 13-week intervention consisting of a structured web-based pedometer programme which gave personalized steps-per-week goals, pedometers and education regarding lifestyle modification, or to a letter about diabetes risk reduction and screening after delivery for gestational diabetes (control condition). The main outcome measures were change in fasting plasma glucose and 2-h glucose levels on a 75-g oral glucose tolerance test between baseline and 13-week follow-up. Weight was a secondary outcome and behavioural constructs (self-efficacy, social support, risk perception) were also assessed. RESULTS Forty-nine women were enrolled. At 13-week follow-up, women randomized to the intervention did not have significant changes in behavioural constructs, physical activity or anthropometrics compared with women in the control group. Changes in fasting plasma glucose (-0.046 mmol/l vs. 0.038 mmol/l, P = 0.65), 2-h glucose values (-0.48 mmol/l vs. -0.42 mmol/l, P = 0.91) and weight (-0.14 kg vs. -1.5 kg, P = 0.13) were similar between the control and intervention groups, respectively. CONCLUSIONS Structured web-based education utilizing pedometers is feasible although uptake may be low. Such programmes may need to be supplemented with additional measures in order to be effective for reduction of diabetes risk.
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Affiliation(s)
- C Kim
- Department of Medicine, University of Michigan, Ann Arbor, USA.
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Clark HD, Keely E. Getting mothers with gestational diabetes to return for postpartum testing: what works and what does not. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/dmt.11.64] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE To assess a cluster of risk factors, including parameters of the metabolic syndrome, in women with gestational diabetes mellitus (GDM) early after delivery, that features the best prediction for developing diabetes. METHODS Women with GDM 3-6 months after delivery received a complete metabolic characterization at baseline as well as annually for up to 10 years of follow-up (N=110). We used parameters characterizing the metabolic syndrome as well as demographic variables at baseline to predict diabetes manifestation. RESULTS Metabolic disturbances and insulin treatment during pregnancy were significantly associated with overt diabetes. Waist circumference of 80 cm or higher failed to show a significant effect on later development of the disease; however, it was significant when 88 cm or more was used as a cutoff value. We identified impaired glucose tolerance (13 [56.5%]; hazard ratio 6.77, confidence interval [CI] 2.96-15.45, P<.001) as well as high-density lipoprotein (HDL) cholesterol less than 50 mg/dL (14 [60.9%]; hazard ratio 2.88, CI 1.24-6.67, P=.010) and age older than 35 years (12 [52.2%]; hazard ratio 3.06, CI 1.32-7.12, P=.006) as the best predictors with additive effects. Women with at least two risk factors had a higher risk to develop the disease as compared with those women who showed only one risk factor (hazard ratio 3.2, CI 1.4-7.7, P=.008). CONCLUSION Impaired glucose tolerance, HDL cholesterol less than 50 mg/dL, and age older than 35 years were identified as the best predictors of developing diabetes after GDM.
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MORRISON MK, COLLINS CE, LOWE JM. Dietetic practice in the management of gestational diabetes mellitus: A survey of Australian dietitians. Nutr Diet 2011. [DOI: 10.1111/j.1747-0080.2011.01537.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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