Effectiveness of system-based intervention in reducing incidence of type 2 diabetes and to improve the postnatal metabolic profiles in women with gestational diabetes mellitus: a randomized controlled study

Abstract

Aim: The objective of this study was to determine the effectiveness of system-based intervention in reducing the incidence of diabetes and to improve the postnatal metabolic profiles among women with gestational diabetes mellitus (GDM). Materials and methods: For women in the intervention arm (n = 130), they received one session of individualized health education at 36 gestational weeks, a booklet of diabetes prevention, five-session of postpartum booster educational program which were conducted including 1 session of dietary and exercise counseling by dietician and physiotherapist at 6 weeks postpartum. For women in the control group (n = 168), standard treatment whereby they had received group therapy on diet and physical activity modification by dietician and staff nurses during the antenatal period. Results: There were no significant differences in baseline characteristics between groups for most of the variables examined except for educational level which the control group had a higher education than the intervention group. The women assigned to systembased intervention have a significant difference to GDM women who were assigned to the control group for LDL and HDL but not in anthropometric measurements, blood pressure, glucose index, total cholesterol, and triglyceride. In addition, it was found that the incidence of Type 2 diabetes mellitus (T2DM) 2 years after delivery was 20% in the intervention arm compared to 17% in the control arm. Conclusion: The system-based intervention was not statistically superior to the control intervention as there is no difference in terms of incidence of T2DM between the intervention and control group. We, therefore, suggested that more intensive interventions are needed to prevent GDM from developing into T2DM.

Gestational diabetes mellitus, follow-up of future maternal risk of cardiovascular disease and the use of eHealth technologies—a scoping review

“…Details on the different trials are shown in Table 2 . In four of the included trials, the primary outcomes were partly or exclusively related to postpartum weight change [ 24 , 25 , 27 , 28 ], in three studies incidence of T2DM [ 26 , 30 , 32 ], and three studies reported other measures of glycemic status [ 28 , 29 , 31 , 33 , 34 ]. Glucose-related outcomes were additionally included among the secondary outcomes in two of the articles [ 25 , 27 ].…”

“…Three of the studies found significant effect of intervention on weight outcome [ 24 , 25 , 28 ]. Neither was there any consistent, significant effect on blood pressure, lipid profiles, or development of metabolic syndrome [ 24 , 26 , 29 – 31 ]…”

“… - One individual session, five group sessions, two telephone sessions consisting of diabetes risk assessment, diet and physical activity advice, stress management, etc. - Control group: usual care (not specified) - Follow-up: 12 months - Primary: fasting blood glucose, weight, and waist circumference at 12 months - Secondary: changes in lifestyle parameters, depression scores, and CVD risk factors - A 1 kg weight difference between the groups at 12 months was the only significant finding - Lee et al [ 26 ] - 2022 - Malaysia - RCT - 2013 World Health Organization criteria - Evaluate a system-based, postpartum intervention for women with GDM, aiming to reduce the incidence of diabetes and improve postnatal metabolic profiles - 298 women with previous GDM - Int. : 130.…”

“…Eleven trials assessing follow-up regarding cardiovascular risk (excluding those with a primarily eHealth technology-based intervention, see the "The use of eHealth technologies" section) were deemed to meet the criteria of the review [24][25][26][27][28][29][30][31][32][33][34], of which seven were RCTs [26][27][28][30][31][32][33], two cluster RCTs [24,25], one randomized clinical with two interventions and no control group [34], and one an interventional cohort trial [29]. Details on the different trials are shown in Table 2.…”

Insufficient sleep disrupts glucose metabolism during pregnancy by inhibiting PGC-1α

“…Maternal hyperglycemia accelerates intrauterine growth and increases the risk of macrosomia or the fetus being born large for gestational age (3), which may increase the risk of preeclampsia, neonatal hypoglycemia, shoulder dystocia, late stillbirth, or the need for caesarean section or neonatal intensive care (4)(5)(6). Moreover, maternal hyperglycemia can cause abnormal carbohydrate metabolism beyond the second generation (7)(8)(9). It has been shown that GDM modifies neurodevelopmental processes resulting in learning disability, attention deficit, and motor impairment in…”