Effects of a Lifestyle Intervention to Prevent Deterioration in Glycemic Status Among South Asian Women With Recent Gestational Diabetes

Abstract

IMPORTANCEWomen with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. OBJECTIVE To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. DESIGN, SETTING, AND PARTICIPANTS This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled

The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries

“…Study characteristics and descriptions of the interventions and main findings of eligible studies are summarised quantitatively in Table 1 , and qualitatively reviewed in the appendix (pp 14-23). The majority of the eligible studies were published in the last decade, 2012-2022, (90%), and conducted in lower-middle (56%) 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 or upper-middle-income (44%) 23 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 countries. No eligible study was found in low-income countries.…”

“…No eligible study was found in low-income countries. By continent, the vast majority of studies (84%) were performed in Asia (15 in India, 25 , 27 , 28 , 29 , 32 , 33 , 35 , 36 , 41 , 42 , 44 , 46 , 47 , 48 , 50 12 in China, 53 , 54 , 55 , 56 , 57 , 58 , 60 , 61 , 63 , 66 , 67 , 68 five in Iran, 31 , 37 , 40 , 43 , 45 two in Thailand, 51 , 65 Vietnam, 30 , 49 Bangladesh, 24 , 32 and Sri Lanka, 26 , 32 and one in Jordan, 69 Pakistan, 39 and Mongolia 38 ), followed (14%) by America (three in Brasil, 52 , 64 , 70 two in Colombia, 23 , 62 and one in Cuba 59 ), and only one study (2%) in Africa (Egypt 34 ). To define at-risk populations, most studies selected participants with impaired glucose/prediabetes (52%) or presenting a combination of cardiometabolic risks (34%).…”

“…No intervention components related to financial incentives were identified. As per eligibility criteria, all interventions were evaluated using an RCT design with 74% of studies using individually randomisation 23 , 26 , 27 , 28 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 50 , 52 , 53 , 54 , 55 , 56 , 59 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 and 26% clustered randomisation. 24 , 25 , 30 , 31 , 45 , 46 , 48 , 49 , 51 , 57 , 58 , 60 When appraising the risk of bias using RCT-specific tools, 54% of studies were ranked as having medium risk, 23 , 26 , 28 , 29 , 33 , 35 , 36 , 37 , 39 , 42 , 43 , 45 , 46 , ...…”

“…As an alternative approach, we reviewed the characteristics of the interventions reporting the outcome of T2D incidence that were ranked as low risk of bias and had the greatest weights in the meta-analysis. This approach revealed that an 3-month yoga-based lifestyle intervention reduced the incidence of T2D by 64% 25 while a 12-month lifestyle intervention focused on preventing weight gain after GDM 32 and an 18-month mHealth intervention, encouraging a healthy lifestyle and awareness of T2D, 24 did not have an effect on reducing the onset of T2D. This qualitative analysis exemplifies the heterogeneity in the design of effective interventions and points to the need for contextualised intervention components and overall strategies.…”

Optimising mothers’ health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention

“…These included limited opportunity to attend face-to-face group sessions, a poor understanding of the program plan, or limited motivation; support from the intervention (staff and peers), partners and family enhanced retention [ 25 ]. However, the recently published LIVING randomised trial of a 12-month lifestyle intervention following gestational diabetes did not halt worsening of glycaemic status in the 1601 randomised participants, [ 26 ] so lifestyle intervention impact following medical pregnancy complications such as HDP and gestational diabetes is far from assured.…”