Educational Attainment, Decision-Making Preferences, and Interest in Evidence-Based Diabetes Prevention among Women with a History of Gestational Diabetes Mellitus

Abstract

Background: The Diabetes Prevention Program (DPP) showed that lifestyle change or metformin is equally efficacious in preventing diabetes in women who have had gestational diabetes mellitus (GDM). Few studies have investigated the relationship between education and willingness to engage in either intervention and between education and preferred decision-making style. Methods: Within a large health system, we surveyed insured women 18–64 years old with a history of GDM, identified through the electronic health record. We estimated preference for decision-making style and interest in DPP lifestyle change and/or metformin by educational level, using multivariate logistic regression models controlling for age, race, and ethnicity. Results: Our sample ( n = 264) was 36% Latino, 29% Asian, 28% non-Latino white, and 5% African American, with a mean age of 37 years. In terms of education, 31% had a postgraduate degree, 41% were college graduates, and 29% did not graduate from college. In multivariate analyses, willingness to engage in either intervention did not vary by education. Women who did not graduate from college were more likely to leave medical decisions to their provider ( p = 0.004) compared to women with a college or postgraduate degree. However, regardless of education, over 80% of women preferred to make medical decisions themselves or jointly with their provider. Conclusions: Most women prefer to play an active role in their own medical decisions and have an interest in both evidence-based diabetes prevention strategies. This suggests that shared decision-making is appropriate for many women with a history of GDM and different levels of educational attainment.

Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the GEM cluster-randomized trial

“…We also had limited opportunity to examine education or income. While important social determinants of health [3], recent research among patients with GDM indicates that interest in behavioral intervention for diabetes prevention did not differ across levels of education [14]. Finally, evaluation respondents were more likely than nonrespondents to have completed more intervention sessions, and therefore may have more positively evaluated the intervention.…”

“…For patients with GDM, barriers to participation in postpartum diabetes prevention include time constraints, fatigue, and other demands of parenthood [13]. Yet recent research indicates strong interest in behavioral intervention for diabetes prevention [14], which can be further strengthened via theory-driven strategies [15]. In fact, a history of GDM has been linked with greater engagement in diabetes prevention activities [16].…”

Associations of education attainment with gestational diabetes mellitus and the mediating effects of obesity: A Mendelian randomization study

“…Howe et al [ 28 ] conducted a within-sibship MR study that revealed a strong association between higher EA and lower BMI. Furthermore, in an observational study, Panchal et al [ 29 ] found that individuals with lower EA (less than college graduates) had higher BMI than those with higher EA (college graduates and post-college degrees) [31.8 ± 6.4 vs. 29.6 ± 4.8 vs. 29.7 ± 5.2, p = 0.04]. These findings align with our study results, indicating a robust and significant causal association between obesity-related traits, such as BMI, BF%, WHR (indicative of central obesity), and the incidence of GDM.…”