1
|
Wang J, Mahe J, Huo Y, Huang W, Liu X, Zhao Y, Huang J, Shi F, Li Z, Jiang D, Li Y, Perceval G, Zhao L, Zhang L. Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis. J Med Internet Res 2024; 26:e58735. [PMID: 39190910 PMCID: PMC11387916 DOI: 10.2196/58735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.
Collapse
Affiliation(s)
- Jian Wang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Jinli Mahe
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yujia Huo
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Weiyuan Huang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Xinru Liu
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Feng Shi
- East China Aviation Personnel Medical Appraisal Center, Shanghai, China
| | - Zhihui Li
- Tsinghua Vanke School of Public Health, Tsinghua University, Shenzhen, China
| | - Dou Jiang
- School of Economics and Management, Southeast University, Nanjing, China
| | - Yilong Li
- School of Economics and Management, Southeast University, Nanjing, China
| | - Garon Perceval
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Lindu Zhao
- School of Economics and Management, Southeast University, Nanjing, China
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| |
Collapse
|
2
|
Ioannou E, Humphreys H, Homer C, Purvis A. Preventing Type 2 Diabetes after Gestational Diabetes: A Systematic Review Mapping Physical Activity Components using the Socio-Ecological Model. Matern Child Health J 2024; 28:1354-1379. [PMID: 38829517 PMCID: PMC11269493 DOI: 10.1007/s10995-024-03948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Gestational diabetes commonly occurs during pregnancy and increases lifetime risk of type 2 diabetes following pregnancy. Engaging in physical activity postnatally can reduce this subsequent risk. Interventions aiming to increase physical activity after gestational diabetes may not address the wide range of post-pregnancy barriers. A socio-ecological approach highlights the need to include multi-level factors such as social, community and organisational factors. The aim of the review was to map intervention components to prevent type 2 diabetes after gestational diabetes using the socio-ecological model as a framework and investigate how physical activity changes align with different intervention components utilised. METHODS Eligible studies included any study type within 5 years of a gestational diabetes diagnosis and targeted physical activity. A systematic search of MEDLINE, Cochrane Library, Web of Science, CINAHL Complete, and Scopus was conducted in October 2022. Results were categorised based on whether findings demonstrated no increases, non-statistically significant increases or statistically significant increases in physical activity. RESULTS Forty-eight studies were included (37 different interventions). Thirty-eight studies were assessed as "adequate" quality, only two studies were "good" quality, and the remaining were limited quality. Mixed physical activity outcomes were observed across components used at the intrapersonal level, with components across other levels of the socio-ecological model showing more increases in physical activity. Intervention components within the social and organisational levels, for example childcare provision, providing group-based sessions and offering remote delivery, were more often present in interventions with physical activity increases. CONCLUSIONS FOR PRACTICE Future interventions targeting physical activity after gestational diabetes should aim to include social and organisational-level components in their intervention design. This systematic review was registered in PROSPERO (ID: CRD42021272044).
Collapse
Affiliation(s)
- Elysa Ioannou
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Helen Humphreys
- Centre for Behavioural Science and Applied Psychology (CeBSAP), Sheffield Hallam University, Sheffield, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Alison Purvis
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
3
|
Dennison RA, Oliver-Williams C, Qi HLJ, Kotecha D, Seed L, Ward RJ, Griffin SJ. The effectiveness of pharmacological and lifestyle interventions to reduce the risk of diabetes and hyperglycaemia following gestational diabetes: A systematic review and meta-analysis. Diabet Med 2024; 41:e15316. [PMID: 38553834 DOI: 10.1111/dme.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 05/12/2024]
Abstract
AIMS To synthesize the available evidence to better understand the effectiveness of interventions to prevent or delay hyperglycaemia and Type 2 diabetes mellitus (T2DM) postnatally in women with current or previous gestational diabetes mellitus (GDM). METHODS We searched five databases up to December 2020 for primary peer-reviewed articles reporting postpartum glycaemic outcomes in women with (previous) GDM following pharmacological or lifestyle intervention. Outcomes were relative risk of T2DM or continuous measures of glycaemia, change or at follow-up. A minimum of two studies evaluating the same intervention-outcome combination were needed to conduct meta-analyses, otherwise studies were described narratively. Meta-regression was used to evaluate whether associations varied by additional variables. We assessed risk of bias using the Critical Appraisal Skills Programme checklist. PROSPERO record CRD42018102380. RESULTS We included 31 studies in the review with a total sample size of 8624 participants, and 26 studies in meta-analyses. Two-thirds of studies followed up participants at 1 year or less. Pharmacological interventions were associated with reduced risk of T2DM (0.80 [95% CI 0.64-1.00], n = 6 studies), as were lifestyle interventions albeit with a smaller effect size (0.88 [95% CI 0.76-1.01], n = 12 studies). Dietary and physical activity interventions were associated with a small reduction in fasting plasma glucose, particularly in longer interventions, but inconsistent effects were seen for other continuous outcomes. CONCLUSIONS Although possibly due to chance, interventions to reduce hyperglycaemia after GDM may be effective. Future research should improve understanding of how interventions affect glucose control and how to optimise interventions for this population.
Collapse
Affiliation(s)
- Rebecca A Dennison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Helen Lin Jia Qi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Deeya Kotecha
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Lydia Seed
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rebecca J Ward
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
4
|
Minschart C, Myngheer N, Maes T, De Block C, Van Pottelbergh I, Abrams P, Vinck W, Leuridan L, Driessens S, Mathieu C, Billen J, Matthys C, Laenen A, Bogaerts A, Benhalima K. Effectiveness of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of gestational diabetes (MELINDA): a 1-year, prospective, multicentre, randomised controlled trial. EClinicalMedicine 2024; 70:102523. [PMID: 38495521 PMCID: PMC10940944 DOI: 10.1016/j.eclinm.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Women with glucose intolerance after gestational diabetes mellitus (GDM) are at high risk to develop type 2 diabetes. Traditional lifestyle interventions in early postpartum have limited impact. We investigated the efficacy of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of GDM. Methods Prospective, double-arm, non-masked, multicentre randomised controlled trial (RCT) in which women with glucose intolerance, diagnosed 6-16 weeks after a GDM-complicated pregnancy, were assigned 1:1 to a one-year blended-care, telephone- and mobile-based lifestyle program (intervention) or usual care (control). Primary endpoint was the proportion of women able to achieve their weight goal (≥5% weight loss if prepregnancy BMI ≥ 25 kg/m2 or return to prepregnancy weight if prepregnancy BMI < 25 kg/m2) in the intention-to-treat sample. Key secondary outcomes were frequency of glucose intolerance, diabetes and metabolic syndrome, and lifestyle-related outcomes assessed with self-administered questionnaires. The study was registered in ClinicalTrials.gov (NCT03559621). Findings Between April 10th 2019 and May 13th 2022, 240 participants were assigned to the intervention (n = 121) or control group (n = 119), of which 167 (n = 82 in intervention and n = 85 in control group) completed the study. Primary outcome was achieved by 46.3% (56) of intervention participants compared to 43.3% (52) in the control group [odds ratio (OR) 1.13, 95% confidence interval (CI) 0.63-2.03, p = 0.680; risk ratio 1.07, 95% CI (0.78-1.48)]. Women in the intervention group developed significantly less often metabolic syndrome compared to the control group [7.3% (6) vs. 16.5% (14), OR 0.40, CI (0.22-0.72), p = 0.002], reported less sedentary behaviour and higher motivation for continuing healthy behaviours. In the intervention group, 84.1% (69) attended at least eight telephone sessions and 70.7% (58) used the app at least once weekly. Interpretation A blended, mobile-based lifestyle intervention was not effective in achieving weight goals, but reduced the risk to develop metabolic syndrome. Funding Research fund of University Hospitals Leuven, Novo Nordisk, Sanofi, AstraZeneca, Boehringer-Ingelheim, Lilly.
Collapse
Affiliation(s)
- Caro Minschart
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Nele Myngheer
- Department of Endocrinology, General Hospital Groeninge, Kortrijk 8500, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Hospital, Bonheiden 2820, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem 2650, Belgium
| | | | - Pascale Abrams
- Department of Endocrinology, ZAS Sint-Vincentius, Antwerp 2018, Belgium
- Department of Endocrinology, ZAS Sint-Augustinus, Wilrijk 2610, Belgium
| | - Wouter Vinck
- Department of Endocrinology, ZAS Sint-Augustinus, Wilrijk 2610, Belgium
| | - Liesbeth Leuridan
- Department of Endocrinology, General Hospital Klina, Brasschaat 2930, Belgium
| | - Sabien Driessens
- Department of Endocrinology, General Hospital Klina, Brasschaat 2930, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Jaak Billen
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven 3000, Belgium
| | - Christophe Matthys
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| | - Annouschka Laenen
- Centre of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven 3000, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Leuven 3000, Belgium
- Faculty of Health, University of Plymouth, Devon PL4 8AA, United Kingdom
| | - Katrien Benhalima
- Department of Endocrinology, University Hospitals Leuven, Leuven 3000, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven 3000, Belgium
| |
Collapse
|
5
|
Kemp BJ, Creighton RM, Cupples G, Kelly B, McAuley E, Fleck O, Wallace H, Graham U, McCance DR. Mothers' experiences of a lifestyle intervention for weight reduction 12 months after gestational diabetes mellitus: Qualitative findings from the PAIGE2 study. Midwifery 2024; 129:103911. [PMID: 38141456 DOI: 10.1016/j.midw.2023.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
The standardised pooled prevalence of gestational diabetes mellitus (GDM) globally is approximately 14 %, a reflection of increasing rates of obesity in women of childbearing age. Lifestyle interventions to reduce GDM and subsequent type 2 diabetes (T2D) have been deemed a research priority but are challenging to perform and have variable success rates. The PAIGE2 study was a pragmatic lifestyle randomised controlled trial for women with GDM and body mass index ≥25 kg/m2, which began during pregnancy and continued for one year postnatally. The primary outcome was weight loss 12 months postnatally compared with mothers receiving standard maternity care. Qualitative results are presented from end of study focus groups conducted amongst intervention mothers to gather feedback and determine acceptability of the PAIGE2 intervention. In total, 19 mothers participated in five virtual focus groups. Content analysis explored general study experience, longer term changes to lifestyle and suggested improvements of intervention components including monthly phone calls, motivational text messages, Fitbit experience, Slimming World, and study contact timings. Overall, most mothers found the individual PAIGE2 intervention components enjoyable, although opinions differed as to which were the most effective. Several mothers claimed the intervention helped them make long-term changes to their behaviours. A common suggested improvement was the establishment of a local group where mothers could share their experiences. In conclusion, most mothers deemed the intervention acceptable, and felt that with minor enhancements, it could be utilised as an effective tool to support weight loss after pregnancy and reduce future risk of obesity and T2D.
Collapse
Affiliation(s)
- Bridie J Kemp
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Rachel M Creighton
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Gina Cupples
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Bronagh Kelly
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Emma McAuley
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Olwen Fleck
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Helen Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, UK.
| |
Collapse
|
6
|
Ukke GG, Boyle JA, Reja A, Lee WK, Chen M, Ko MSM, Alycia C, Kwon J, Lim S. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity. Nutrients 2023; 15:4666. [PMID: 37960319 PMCID: PMC10649749 DOI: 10.3390/nu15214666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. OBJECTIVE This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. METHODS MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. RESULTS All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). CONCLUSION There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.
Collapse
Affiliation(s)
- Gebresilasea Gendisha Ukke
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Jacqueline A. Boyle
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Ahmed Reja
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Wai Kit Lee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia;
| | - Michelle Shi Min Ko
- MD Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore;
| | - Chelsea Alycia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Jane Kwon
- Diabetes Victoria, Suite G01/15-31 Pelham St, Carlton, VIC 3053, Australia;
| | - Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| |
Collapse
|
7
|
Laursen SH, Boel L, Udsen FW, Secher PH, Andersen JD, Vestergaard P, Hejlesen OK, Hangaard S. Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Diabetes Sci Technol 2023; 17:1364-1375. [PMID: 35533131 PMCID: PMC10563542 DOI: 10.1177/19322968221094626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. METHODS PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate (I2 = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds -1.34 [95% CI: -2.61; -0.08]) that favored telemedicine (GRADE, low). CONCLUSIONS No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.
Collapse
Affiliation(s)
- Sisse H. Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- University College of Northern Denmark, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Lise Boel
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pernille H. Secher
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole K. Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| |
Collapse
|
8
|
Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| |
Collapse
|
9
|
Maugeri A, Barchitta M, Agodi A. How Wearable Sensors Can Support the Research on Foetal and Pregnancy Outcomes: A Scoping Review. J Pers Med 2023; 13:jpm13020218. [PMID: 36836452 PMCID: PMC9961108 DOI: 10.3390/jpm13020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
The application of innovative technologies, and in particular of wearable devices, can potentially transform the field of antenatal care with the aim of improving maternal and new-born health through a personalized approach. The present study undertakes a scoping review to systematically map the literature about the use wearable sensors in the research of foetal and pregnancy outcomes. Online databases were used to identify papers published between 2000-2022, from which we selected 30 studies: 9 on foetal outcomes and 21 on maternal outcomes. Included studies focused primarily on the use of wearable devices for monitoring foetal vital signs (e.g., foetal heart rate and movements) and maternal activity during pregnancy (e.g., sleep patterns and physical activity levels). There were many studies that focused on development and/or validation of wearable devices, even if often they included a limited number of pregnant women without pregnancy complications. Although their findings support the potential adoption of wearable devices for both antenatal care and research, there is still insufficient evidence to design effective interventions. Therefore, high quality research is needed to determine which and how wearable devices could support antenatal care.
Collapse
|
10
|
Cheung NW, Thiagalingam A, Smith BJ, Redfern J, Barry T, Mercorelli L, Chow CK. Text messages promoting healthy lifestyle and linked with activity monitors stimulate an immediate increase in physical activity among women after gestational diabetes. Diabetes Res Clin Pract 2022; 190:109991. [PMID: 35835256 DOI: 10.1016/j.diabres.2022.109991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/13/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the immediate effect of text messages promoting healthy lifestyle and supporting parenting on physical activity amongst women with recent gestational diabetes (GDM). METHODS Analysis of data from a pilot randomised controlled trial of a healthy lifestyle program for women with recent GDM. Intervention subjects received text messages providing motivation, reminders, information and feedback as well as an activity monitor. This sub-study examined step count in the 4 h after receipt of a text message, compared to the same time of day on other days among intervention subjects. RESULTS Data from 7326 days where step counts were recorded, from 31 women were analysed. The median steps in the 4 h following a text message was 1237 (IQR 18-2240) and it was 1063 (IQR 0-2038) over the same time period on comparison days where there was no message (p < 0.001). The effect was similar whether the messages pertained to physical activity or not. There was no attenuation of the response over 36-38 weeks. CONCLUSIONS Women with recent GDM increase their step count in the hours following positive and supportive text messages. This suggests that text messaging programs can facilitate healthy lifestyle and diabetes prevention in this population.
Collapse
Affiliation(s)
- N Wah Cheung
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Ben J Smith
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Tony Barry
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Louis Mercorelli
- Sydney Informatics Hub, University of Sydney, Darlington, NSW 2008, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| |
Collapse
|
11
|
Taylor R, Rollo ME, Baldwin JN, Hutchesson M, Aguiar EJ, Wynne K, Young A, Callister R, Collins CE. Evaluation of a Type 2 diabetes risk reduction online program for women with recent gestational diabetes: a randomised trial. Int J Behav Nutr Phys Act 2022; 19:35. [PMID: 35346229 PMCID: PMC8962548 DOI: 10.1186/s12966-022-01275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate the preliminary efficacy, feasibility and acceptability of the 3-month Body Balance Beyond (BBB) online program among Australian women with overweight/obesity and recent gestational diabetes mellitus. Methods Women were randomised into either: 1) High Personalisation (HP) (access to ‘BBB’ website, video coaching sessions, text message support); 2) Medium Personalisation (MP) (website and text message support); or 3) Low Personalisation (LP) (website only). Generalised linear mixed models were used to evaluate preliminary efficacy, weight, diet quality, physical activity levels, self-efficacy and quality of life (QoL) at baseline and 3-months. Feasibility was assessed by recruitment and retention metrics and acceptability determined via online process evaluation survey at 3-months. Results Eighty three women were randomised, with 76 completing the study. Self-efficacy scores showed significant improvements in confidence to resist eating in a variety of situations from baseline to 3-months in HP compared to MP and LP groups (P=.03). The difference in mean QoL scores favoured the HP compared to MP and LP groups (P=.03). Half of the women (HP n=17[81%], MP n=12[75%], LP n=9[56%]) lost weight at 3-months. No significant group-by-time effect were reported for other outcomes. Two-thirds of women in the HP group were satisfied with the program overall and 86% would recommend it to others, compared with 25% and 44% in the MP group, and 14% and 36% in the LP group, respectively. Conclusions Video coaching sessions were associated with improvements in QoL scores and self-efficacy, however further refinement of the BBB website and text messages support could improve program acceptability. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000162112, registered 5 February 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01275-3.
Collapse
|
12
|
Horgan R, Pierce-Williams R, Saccone G, Berghella V. Reminder Systems to Increase Compliance With Glucose Logging in Gestational Diabetes: A Systematic Review & Meta-analysis. Am J Obstet Gynecol MFM 2022; 4:100586. [PMID: 35124298 DOI: 10.1016/j.ajogmf.2022.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to evaluate the effectiveness of reminder systems in improving patient compliance with blood glucose monitoring in gestational diabetes in a meta-analysis of randomized controlled trials. DATA SOURCES Scopus, PubMed, CINAHL and the Cochrane Library were searched from inception through October 2021. STUDY ELIGIBILITY CRITERIA Randomized control trials (RCTs) that examined reminder-based systems (i.e. technology assisted or phone based) to prompt pregnant patients with gestational diabetes to monitor glucose levels (compliance) versus traditional management without reminder systems were included. Studies were excluded if they examined only qualitative outcomes, examined patients with pre-existing diabetes or those in which the control group included another intervention rather than standard care. STUDY APPRAISAL AND SYNTHESIS METHOD Primary outcome was patient compliance, defined as the number of glucose values provided by the patient divided by the number of instructed glucose values. Secondary outcomes were maternal mean blood glucose values, 2 hour glucose tolerance test results postpartum, cesarean section rate, neonatal intensive care admission and rates of large for gestational age or macrosomia. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI). RESULTS Seven RCTs including 863 patients were included in our review. Reminder systems were associated with a statistically significant increase in patient compliance in blood glucose monitoring (83.5% versus 68.2%, MD 15.87%, 95% CI 10.94 to 20.8). Reminder systems were associated with a significant decrease mean blood glucose values (Mean difference -5.63, 95% CI -8.1 to -3.15) and in the rate of delivery by cesarean section (RR 0.66, 95% CI 0.49 to 0.88). Other outcomes including neonatal intensive care unit admissions, fetal macrosomia, large for gestational age infants, and two-hour glucose tolerance tests results postpartum were not significant between the two groups. CONCLUSION The use of reminder systems for patients with gestational diabetes increases patient compliance with blood glucose monitoring, decreases mean blood glucose values and is associated with a decreased risk of cesarean section.
Collapse
Affiliation(s)
- Rebecca Horgan
- Department of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, VA.
| | - Rebecca Pierce-Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
13
|
Larsen RT, Wagner V, Korfitsen CB, Keller C, Juhl CB, Langberg H, Christensen J. Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376:e068047. [PMID: 35082116 PMCID: PMC8791066 DOI: 10.1136/bmj-2021-068047] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN Systematic review and meta-analysis. STUDY SELECTION The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS 121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias. STUDY REGISTRATION PROSPERO CRD42018102719.
Collapse
Affiliation(s)
- Rasmus Tolstrup Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Brain Injury Rehabilitation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christoffer Bruun Korfitsen
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region, Frederiksberg, Denmark
- Danish Health Authority, Copenhagen, Denmark
| | - Camilla Keller
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Henning Langberg
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
| |
Collapse
|
14
|
MacPherson MM, Merry KJ, Locke SR, Jung ME. mHealth prompts within diabetes prevention programs: a scoping review. Mhealth 2022; 8:20. [PMID: 35449504 PMCID: PMC9014231 DOI: 10.21037/mhealth-21-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) prompts (e.g., text messaging, push notifications) are a commonly used technique within behaviour change interventions to prompt or cue a specific behaviour. Such prompts are being increasingly integrated into diabetes prevention programs (DPPs). While mHealth prompts provide a convenient and cost-effective way to reinforce behaviour change, no reviews to date have examined mHealth prompt use within DPPs. This scoping review aims to: (I) understand how mHealth prompts are being used within behaviour change interventions for individuals at risk for developing type 2 diabetes (T2D); and (II) provide recommendations for future mHealth prompt research, design, and application. METHODS The scoping review methodology outlined by Arksey and O'Malley were followed. Medline, CINAHL, PsycInfo, Web of Science, and SportDiscus were searched. The search strategy combined keywords relating to T2D risk and mHealth prompts in conjunction with database-controlled vocabulary when available (e.g., MeSH for Medline). RESULTS Of the 4,325 publications screened, 44 publications (based on 33 studies) met the inclusion criteria and were included for data extraction. Text messaging was the most widely used mHealth prompt (73%) followed by push notifications (21%). Only 30% of studies discussed the theoretical basis for prompt content and time of day messages were sent, and only 27% provided justification for prompt timing and frequency. Fourteen studies assessed participant satisfaction with mHealth prompts of which only two reported dissatisfaction due to either prompting frequency (hourly) or message content (solely focused on weight). Nine studies assessed behavioural outcomes including weight loss, physical activity, and diabetes incidence, and found mixed effects overall. CONCLUSIONS While mHealth prompts were well-received by participants, there are mixed effects on the influence of mHealth prompts on behavioural outcomes and diabetes incidence. More thorough reporting of prompt content development and delivery is needed, and more experimental research is needed to identify optimal content, delivery characteristics, and impact on behavioural and clinical outcomes.
Collapse
Affiliation(s)
- Megan M. MacPherson
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| | - Kohle J. Merry
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Sean R. Locke
- Department of Kinesiology, Brock University, St. Catherines, Canada
| | - Mary E. Jung
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| |
Collapse
|
15
|
Chen M, Moran LJ, Harrison CL, Ukke GG, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Lim S. Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis. Obes Rev 2022; 23:e13340. [PMID: 34528393 DOI: 10.1111/obr.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.
Collapse
Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Christie J Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
16
|
Huang S, Magny-Normilus C, McMahon E, Whittemore R. Systematic Review of Lifestyle Interventions for Gestational Diabetes Mellitus in Pregnancy and the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2021; 51:115-125. [PMID: 34843670 DOI: 10.1016/j.jogn.2021.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine the characteristics and effectiveness of lifestyle interventions for gestational diabetes mellitus (GDM) in pregnancy and the postpartum period to prevent Type 2 diabetes. DATA SOURCES We conducted searches in seven databases, including Ovid MEDLINE, CINAHL, Ovid Embase, Cochrane Central, Web of Science, Ovid PsycInfo, and ProQuest Dissertations and Theses for articles published from inception to January 2021. STUDY SELECTION We included articles on controlled intervention studies in which researchers evaluated a lifestyle intervention provided during pregnancy and the postpartum period for women with or at risk for GDM that were published in English. DATA EXTRACTION Twelve articles that were reports of seven studies met the inclusion criteria. In some cases, more than one article was selected from the same study. For example, articles reported different outcomes from the same study. We extracted data with the use of a data collection form and compared and synthesized data on study design, purpose, sample, intervention characteristics, recruitment and retention, and outcomes. DATA SYNTHESIS All seven studies focused on weight management and/or healthy lifestyle behaviors (diet and physical activity). Outcomes included glucose regulation, weight, lifestyle behaviors, and knowledge. The interventions varied in duration/dosage, strategies, and modes of delivery. In four studies, researchers reported interventions that had significant effects on improving glucose regulation and/or weight change. Some characteristics from the four effective interventions included goal setting, individualized care, and good retention rates. In the other three studies, limitations included low rates of participant retention, lack of personalized interventions, and limited population diversity or lack of culturally sensitive care. CONCLUSION Lifestyle interventions provided during and after pregnancy to reduce the risk associated with GDM have the potential to improve outcomes. Health care counseling to promote healthy lifestyle behaviors related to the prevention of Type 2 diabetes is needed at different stages of maternity care for women with GDM. Additional high-quality studies are needed to address the limitations of current studies.
Collapse
|
17
|
Chen M, Ukke GG, Moran LJ, Sood S, Bennett CJ, Bahri Khomami M, Absetz P, Teede H, Harrison CL, Lim S. The Effect of Lifestyle Intervention on Diabetes Prevention by Ethnicity: A Systematic Review of Intervention Characteristics Using the TIDieR Framework. Nutrients 2021; 13:4118. [PMID: 34836372 PMCID: PMC8624360 DOI: 10.3390/nu13114118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for Intervention Description and Replication (TIDieR) framework. MEDLINE, EMBASE and other databases were searched for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American and African groups. Forty-five studies (18,789 participants) were included in the systematic review and 41 studies in meta-analysis. Meta-analysis showed a high number of intervention sessions was significantly associated with a greater reduction in diabetes incidence (P = 0.043) and weight (P = 0.015), while other intervention characteristics including intervention provider and delivery format did not alter the outcomes (all P > 0.05). Additionally, narrative synthesis showed long-term interventions (≥12 months) were associated with significant diabetes risk reduction for all ethnic groups, while short-term interventions (<12 months) were more effective in weight loss in most ethnic groups. There may be ethnic preferences for the optimal number of intervention sessions.
Collapse
Affiliation(s)
- Mingling Chen
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Gebresilasea Gendisha Ukke
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Surbhi Sood
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Christie J. Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC 3168, Australia;
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland;
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
- Diabetes and Endocrine Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
- Diabetes and Endocrine Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia; (M.C.); (G.G.U.); (L.J.M.); (S.S.); (M.B.K.); (H.T.); (C.L.H.)
| |
Collapse
|
18
|
Marschner S, Chow C, Thiagalingam A, Simmons D, McClean M, Pasupathy D, Smith BJ, Flood V, Padmanabhan S, Melov S, Ching C, Cheung NW. Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2). BMJ Open 2021; 11:e054756. [PMID: 34535488 PMCID: PMC8451310 DOI: 10.1136/bmjopen-2021-054756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet. METHODS AND ANALYSIS This multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome. ETHICS AND DISSEMINATION Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12620000615987; Pre-results.
Collapse
Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Penrith South, New South Wales, Australia
- Macarthur Diabetes School, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Mark McClean
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Dharmintra Pasupathy
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Smith
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Suja Padmanabhan
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Melov
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cellina Ching
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - N Wah Cheung
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
19
|
MacPherson M, Cranston K, Johnston C, Locke S, Jung ME. Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study. JMIR Form Res 2021; 5:e28163. [PMID: 34448713 PMCID: PMC8433931 DOI: 10.2196/28163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.
Collapse
Affiliation(s)
- Megan MacPherson
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Kaela Cranston
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Cara Johnston
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Sean Locke
- Department of Kinesiology, Brock University, St Catharines, ON, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| |
Collapse
|
20
|
Stith BJ, Buls SM, Keim SA, Thung SF, Klebanoff MA, Landon MB, Gabbe SG, Gandhi KK, Oza-Frank R. Moms in motion: weight loss intervention for postpartum mothers after gestational diabetes: a randomized controlled trial. BMC Pregnancy Childbirth 2021; 21:461. [PMID: 34187391 PMCID: PMC8240610 DOI: 10.1186/s12884-021-03886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Up to 50 % of women with gestational diabetes mellitus (GDM) will receive a diagnosis of type 2 diabetes mellitus (T2DM) within a decade after pregnancy. While excess postpartum weight retention exacerbates T2DM risk, lifestyle changes and behavior modifications can promote healthy postpartum weight loss and contribute to T2DM prevention efforts. However, some women have difficulty prioritizing self-care during this life stage. Efficacious interventions that women can balance with motherhood to reduce T2DM risk remain a goal. The objective of the Moms in Motion study is to evaluate the efficacy of a simple, novel, activity-boosting intervention using ankle weights worn with daily activities during a 6-month postpartum intervention among women with GDM. We hypothesize that women randomized to the 6-month intensity-modifying intervention will (1) demonstrate greater weight loss and (2) greater improvement in body composition and biomarker profile versus controls. Methods This study will be a parallel two-arm randomized controlled trial (n = 160). Women will be allocated 1:1 to an ankle weight intervention group or a standard-of-care control group. The intervention uses ankle weights (1.1 kg) worn on each ankle during routine daily activities (e.g., cleaning, childcare). Primary outcomes include pre- and post-assessments of weight from Visit 2 to Visit 3. Secondary outcomes include body composition, glycemia (2-h, 75 g oral glucose tolerance test), and fasting insulin. Exploratory outcomes include energy expenditure, diet, and psychosocial well-being. Discussion Beyond the expected significance of this study in its direct health impacts from weight loss, it will contribute to exploring (1) the mechanism(s) by which the intervention is successful (mediating effects of energy expenditure and diet on weight loss) and (2) the effects of the intervention on body composition and biomarkers associated with insulin resistance and metabolic health. Additionally, we expect the findings to be meaningful regarding the intervention’s effectiveness on engaging women with GDM in the postpartum period to reduce T2DM risk. Trial registration The ClinicalTrials.gov Identifier, is NCT03664089. The trial registration date is September 10, 2018. The trial sponsor is Dr. Sarah A. Keim.
Collapse
Affiliation(s)
- Briana J Stith
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Samantha M Buls
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Stephen F Thung
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA
| | - Mark A Klebanoff
- Department of Pediatrics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mark B Landon
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA
| | - Steven G Gabbe
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA
| | - Kajal K Gandhi
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Reena Oza-Frank
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA. .,Ohio Department of Health, 246 N High Street, Columbus, OH, 43215, USA.
| |
Collapse
|
21
|
Halligan J, Whelan ME, Roberts N, Farmer AJ. Reducing weight and BMI following gestational diabetes: a systematic review and meta-analysis of digital and telemedicine interventions. BMJ Open Diabetes Res Care 2021; 9:9/1/e002077. [PMID: 33853849 PMCID: PMC8054068 DOI: 10.1136/bmjdrc-2020-002077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 11/04/2022] Open
Abstract
Women with past gestational diabetes mellitus (GDM) are at risk of subsequent type 2 diabetes and adverse cardiovascular events. Digital and telemedicine interventions targeting weight loss and reductions in body mass index (BMI) may help reduce risk for women with GDM. The aim was to compare the effectiveness of digital or telemedicine intervention with usual care. Randomized controlled trials (RCTs) were identified in Embase, Medline, CINAHL, PsycINFO and the Cochrane Library. Included trials recruited women with prior GDM but without pre-existing diabetes, and tested a digital or telemedicine intervention with or without an in-person component. Data extraction was carried out independently by two authors. The search yielded 898 citations. Eighteen articles reporting 15 trials were included, of which 8 tested digital interventions. Reported outcomes included weight, BMI, fasting plasma glucose and waist circumference. None of the included trials reported type 2 diabetes incidence or cardiovascular risk. Data were pooled using a random-effects model. The point estimate favored the intervention but was non-significant for both BMI (-0.90 kg/m2, 95% CI -1.89 to 0.09; p=0.08) and weight (-1.83 kg, 95% CI -4.08 to 0.42, p=0.11). Trials evaluating digital and telemedicine interventions identified clinically relevant, but non-significant improvements in BMI and weight compared with control. No trials assessed type 2 diabetes occurrence as an outcome. More well-designed RCTs with adequate power and long-term follow-up are needed to identify the impact of these interventions on type 2 diabetes occurrence.
Collapse
Affiliation(s)
- Julia Halligan
- St Hilda's College, Oxford University, Oxford, Oxfordshire, UK
| | - Maxine E Whelan
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Oxford University, Oxford, Oxfordshire, UK
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| |
Collapse
|
22
|
Lim S, Chen M, Makama M, O'Reilly S. Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs. Semin Reprod Med 2021; 38:377-383. [PMID: 33511581 DOI: 10.1055/s-0040-1722315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.
Collapse
Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Sharleen O'Reilly
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
23
|
Barrett S, Begg S, O'Halloran P, Howlett O, Lawrence J, Kingsley M. The effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital settings: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:7. [PMID: 33413512 PMCID: PMC7791684 DOI: 10.1186/s12966-020-01076-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this systematic review and meta-analysis was to investigate whether behaviour change interventions promote changes in physical activity and anthropometrics (body mass, body mass index and waist circumference) in ambulatory hospital populations. Methods Randomised controlled trials were collected from five bibliographic databases (MEDLINE, Embase, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO). Meta-analyses were conducted using change scores from baseline to determine mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. Results A total of 29 studies met the eligibility criteria and 21 were included in meta-analyses. Behaviour change interventions significantly increased physical activity (SMD: 1.30; 95% CI: 0.53 to 2.07, p < 0.01), and resulted in significant reductions in body mass (MD: -2.74; 95% CI: − 4.42 to − 1.07, p < 0.01), body mass index (MD: -0.99; 95% CI: − 1.48 to − 0.50, p < 0.01) and waist circumference (MD: -2.21; 95% CI: − 4.01 to − 0.42, p = 0.02). The GRADE assessment indicated that the evidence is very uncertain about the effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital patients. Conclusions Behaviour change interventions initiated in the ambulatory hospital setting significantly increased physical activity and significantly reduced body mass, body mass index and waist circumference. Increased clarity in interventions definitions and assessments of treatment fidelity are factors that need attention in future research. PROSPERO registration number: CRD42020172140.
Collapse
Affiliation(s)
- Stephen Barrett
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.,Health Promotion Department, Bendigo Health Care Group, PO Box 126, Bendigo, Victoria, 3552, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3068, Australia
| | - Owen Howlett
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.,Research and Innovation, Bendigo Health Care Group, PO Box 126, Bendigo, Victoria, 3552, Australia
| | - Jack Lawrence
- Gurri Wanyarra Welllbing Centre, Bendigo, Victoria, 3550, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia. .,Department of Exercise Sciences, University of Auckland, Newmarket, 1023, New Zealand.
| |
Collapse
|
24
|
Ringeval M, Wagner G, Denford J, Paré G, Kitsiou S. Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e23954. [PMID: 33044175 PMCID: PMC7589007 DOI: 10.2196/23954] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Unhealthy behaviors, such as physical inactivity, sedentary lifestyle, and unhealthful eating, remain highly prevalent, posing formidable challenges in efforts to improve cardiovascular health. While traditional interventions to promote healthy lifestyles are both costly and effective, wearable trackers, especially Fitbit devices, can provide a low-cost alternative that may effectively help large numbers of individuals become more physically fit and thereby maintain a good health status. OBJECTIVE The objectives of this meta-analysis are (1) to assess the effectiveness of interventions that incorporate a Fitbit device for healthy lifestyle outcomes (eg, steps, moderate-to-vigorous physical activity, and weight) and (2) to identify which additional intervention components or study characteristics are the most effective at improving healthy lifestyle outcomes. METHODS A systematic review was conducted, searching the following databases from 2007 to 2019: MEDLINE, EMBASE, CINAHL, and CENTRAL (Cochrane). Studies were included if (1) they were randomized controlled trials, (2) the intervention involved the use of a Fitbit device, and (3) the reported outcomes were related to healthy lifestyles. The main outcome measures were related to physical activity, sedentary behavior, and weight. All the studies were assessed for risk of bias using Cochrane criteria. A random-effects meta-analysis was conducted to estimate the treatment effect of interventions that included a Fitbit device compared with a control group. We also conducted subgroup analysis and fuzzy-set qualitative comparative analysis (fsQCA) to further disentangle the effects of intervention components. RESULTS Our final sample comprised 41 articles reporting the results of 37 studies. For Fitbit-based interventions, we found a statistically significant increase in daily step count (mean difference [MD] 950.54, 95% CI 475.89-1425.18; P<.001) and moderate-to-vigorous physical activity (MD 6.16, 95% CI 2.80-9.51; P<.001), a significant decrease in weight (MD -1.48, 95% CI -2.81 to -0.14; P=.03), and a nonsignificant decrease in objectively assessed and self-reported sedentary behavior (MD -10.62, 95% CI -35.50 to 14.27; P=.40 and standardized MD -0.11, 95% CI -0.48 to 0.26; P=.56, respectively). In general, the included studies were at low risk for bias, except for performance bias. Subgroup analysis and fsQCA demonstrated that, in addition to the effects of the Fitbit devices, setting activity goals was the most important intervention component. CONCLUSIONS The use of Fitbit devices in interventions has the potential to promote healthy lifestyles in terms of physical activity and weight. Fitbit devices may be useful to health professionals for patient monitoring and support. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019145450; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145450.
Collapse
Affiliation(s)
- Mickael Ringeval
- École des Sciences de la Gestion, Université du Québec à Montréal, Montreal, QC, Canada
| | - Gerit Wagner
- Research Chair in Digital Health, HEC Montreal, Montreal, QC, Canada
| | - James Denford
- Department of Management, Faculty of Social Sciences and Humanities, Royal Military College of Canada, Kingston, ON, Canada
| | - Guy Paré
- Research Chair in Digital Health, HEC Montreal, Montreal, QC, Canada
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
25
|
Cajita MI, Kline CE, Burke LE, Bigini EG, Imes CC. Feasible but Not Yet Efficacious: A Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep. CURR EPIDEMIOL REP 2020; 7:25-38. [PMID: 33365227 DOI: 10.1007/s40471-020-00229-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose of Review The present review aimed to explore the range and characteristics of interventions that utilize WAM and descriptively summarize the efficacy of these interventions. Recent Findings A total of 65 articles (61 studies) were included in this review. Most of the WAM-based interventions (n=58) were designed to improve physical activity (PA). Interventions targeting sedentary behavior (SB) were much less common (n=12), and even less frequent were WAM-based sleep interventions (n=3). Most studies tested the feasibility of WAM-based interventions; hence, efficacy of these interventions in improving PA, SB, and/or sleep could not be conclusively determined. Nonetheless, WAM-based interventions showed considerable potential in increasing PA and decreasing SB. Summary WAM-based PA interventions exhibited preliminary efficacy in increasing PA. Although not as many interventions were focused on SB, current interventions also showed potential in decreasing sedentary time. Meanwhile, more evidence is needed to determine the utility of WAM in improving sleep. Major challenges with including WAM as part of interventions are reduced engagement in using the devices over time and the rapid changes in technology resulting in devices becoming obsolete soon after completion of an efficacy trial.
Collapse
Affiliation(s)
- Maan Isabella Cajita
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL, USA
| | - Christopher E Kline
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh, PA, USA
| | - Lora E Burke
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Evelyn G Bigini
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | | |
Collapse
|
26
|
Simmons D. GDM and Nutrition-Answered and Unanswered Questions-There's More Work to Do! Nutrients 2019; 11:nu11081940. [PMID: 31426514 PMCID: PMC6722957 DOI: 10.3390/nu11081940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is the commonest medical pregnancy complication, and a growing problem around the world as the obesity epidemic continues. Ways to prevent GDM are urgently required, the management of GDM still poses many unanswered questions, and the postpartum prevention of the progression of GDM to type 2 diabetes remains a challenge. With GDM, the impact of any intervention on the offspring is always a major concern. Nutritional interventions come to the fore as one of our few levers in reducing the short-term pregnancy risk and long-term cardiometabolic risks to both mother and child. This special issue reports on the relationship between several nutrients and foods and the development and management of GDM, behavioural strategies to enhance lifestyle choices, the issues raised by prior bariatric surgery and ways to screen for GDM. The work identifies further unanswered questions over nutritional strategies to reduce the impact of GDM.
Collapse
Affiliation(s)
- David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW 2560, Australia.
| |
Collapse
|