1118 Characteristics of patients with gestational diabetes that follow up postpartum for type 2 diabetes testing

Objective. To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM).Design. A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n=24) or wait control (n=26) and postintervention qualitative interviews with participants.Main Outcome Measures. Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up.Results. At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance.Conclusions. Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.

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Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women

Journal of Diabetes Research ◽

10.1155/2020/3076463 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 6

Author(s):

Zhuyu Li ◽

Yunjiu Cheng ◽

Dongyu Wang ◽

Haitian Chen ◽

Hanqing Chen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Type 2 Diabetes Mellitus ◽

Gestational Diabetes ◽

Sample Size ◽

Incidence Rate ◽

Meta Analysis

Objective. The reported incidence of type 2 diabetes mellitus (T2DM) after gestational diabetes (GDM) varies widely. The purpose of this meta-analysis was to define the incidence rate of T2DM among women with a history of GDM and to examine what might modulate the rate. Research Design and Methods. We searched PubMed and Embase for terms related to T2DM after GDM up to January 2019. Large cohort studies with sample size ≥300 and follow-up duration of at least one year were included. Data from selected studies were extracted, and meta-analysis was performed using the random-effects model. Subgroups analyses were based on the sample size of gestational diabetes, geographic region, maternal age, body-mass index, diagnostic criteria, and duration of follow-up. Results. Twenty-eight studies involving 170,139 women with GDM and 34,627 incident cases of T2DM were identified. The pooled incidence of T2DM after GDM was 26.20 (95% CI, 23.31 to 29.10) per 1000 person-years. Women from Asia and those with older age and higher body mass index seem to experience higher risk of developing T2DM. The incidence rate of T2DM was lowest when applying IADPSG (7.16 per 1000 person-years) to diagnose GDM. The risk of developing T2DM after GDM increased linearly with the duration of follow-up. The increments per year of follow-up were estimated at 9.6‰. The estimated risks for T2DM were 19.72% at 10 years, 29.36% at 20 years, 39.00% at 30 years, 48.64% at 40 years, and 58.27% at 50 years, respectively. Conclusions. The findings of very high incidence of T2DM after GDM add an important insight into the trajectory of the development of T2DM in the long-term postpartum periods, which could provide evidence for consultant and might motivate more women with GDM to screen for T2DM. This trial is registered with PROSPERO identifier CRD42019128980.

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A comparison of follow-up rates of women with gestational diabetes before and after the updated National Institute for Health and Care Excellence guidance advocating routine follow-up, and the association with neighbourhood deprivation

British Journal of Diabetes ◽

10.15277/bjd.2019.202 ◽

2019 ◽

Vol 19 (1) ◽

pp. 14-18 ◽

Cited By ~ 1

Author(s):

Sebastian Walsh ◽

Mahmoud Mahmoud ◽

Htwe Htun ◽

Sheena Hodgett ◽

David Barton

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Fasting Glucose ◽

Neighbourhood Deprivation ◽

Small Areas ◽

Significant Difference ◽

Before And After ◽

Nice Guidance

Background: Gestational diabetes mellitus (GDM) occurs in one in every 23 UK pregnancies. GDM identifies the mother as high-risk for development of type 2 diabetes. The National Institute for Health and Care Excellence (NICE) published updated guidance in February 2015 recommending routine follow-up of women with GDM.Aims: This cohort study compared follow-up rates of women with GDM before and after the updated guidance. We also investigated for an association between follow-up rates and deprivation.Methods: Participants were identified from the database of the GDM service of two English hospitals and were organised into two cohorts: ‘pre-guidance’ (2012–2015) and ‘post-guidance’ (2015–2016). Using the recommendations of the NICE guidance as the follow-up standard, we used the hospitals’ computer system to compare follow-up rates of the two cohorts. The English Indices of Deprivation split the country into 32,844 small areas and rank them in order of deprivation such that 1 is the most deprived area and 32,844 is the least deprived. We compared the patients’ postcodes against the English Indices of Deprivation to investigate the relative levels of neighbourhood deprivation of those followed up compared with those not followed up. The Z statistic was used to test for statistical significance.Results: 535 participants were included (pre-guidance n=306, post-guidance n=229). Baseline average age (pre-guidance 32.2 years, post-guidance 32.5 years), body mass index (30.7 kg/m2, 30.9 kg/m2) and fasting glucose (4.9 mmol/L, 4.8 mmol/L) were all comparable between cohorts. The follow-up rate improved from 60.5% in the pre-guidance group to 69.9% in the post-guidance group. The median deprivation rank of those followed up was 14,565 compared with 13,393 in those not followed up. This difference was not found to be significant.Conclusion: A higher proportion of women with GDM were followed up with screening for type 2 diabetes after the updated NICE guidance in 2015 recommended routine follow-up. Across the study, over a third of women were not followed up. There was no statistically significant difference in the deprivation levels of those women followed up compared with those not followed up.

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Periodontitis and type 2 diabetes among women with previous gestational diabetes: epidemiological and immunological aspects in a follow-up of three years

Journal of Applied Oral Science ◽

10.1590/1678-77572016-0367 ◽

2017 ◽

Vol 25 (2) ◽

pp. 130-139

Author(s):

Rafael Paschoal ESTEVES LIMA ◽

Luis Otávio Miranda COTA ◽

Tarcília Aparecida SILVA ◽

Sheila Cavalca CORTELLI ◽

José Roberto CORTELLI ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Previous Gestational Diabetes

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Health care professionals’ perspectives on screening and management of gestational diabetes mellitus in public hospitals of South India – a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-06077-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Biswamitra Sahu ◽

Giridhara R. Babu ◽

Kaveri Siddappa Gurav ◽

Maithili Karthik ◽

Deepa Ravi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Health Care ◽

Gestational Diabetes ◽

Health Care Providers ◽

Public Hospitals ◽

Effective Management ◽

Care Providers

Abstract Background Women developing Gestational Diabetes Mellitus (GDM) are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM are essential in preventing progression to type 2 diabetes mellitus. We aimed to explore the perspectives of healthcare providers regarding the barriers from the health system context that restrict the timely screening and effective management of GDM. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India’s major city (Bengaluru). The interviews were conducted in the preferred language of the participants (Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using the grounded theory approach by NVivo 12 plus. The findings are put into perspective using the socio-ecological model. Results Health care providers identified delayed visits to public hospitals and stress on household-level responsibilities as barriers at the individual level for GDM screening. Also, migration of pregnant women to their natal homes during first pregnancy is a cultural barrier in addition to health system barriers such as unmet nurse training needs, long waiting hours, uneven power dynamics, lack of follow-up, resource scarcity, and lack of supportive oversight. The barriers for GDM management included non-reporting women to follow - up visits, irregular self-monitoring of drug and blood sugar, trained staff shortage, ineffective tracking, and lack of standardized protocol. Conclusion There is a pressing need to develop and improve existing GDM Screening and Management services to tackle the growing burden of GDM in public hospitals of India.

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Migrant Middle Eastern women with gestational diabetes seven years after delivery – positive long-term development of beliefs about health and illness shown in follow-up interviews

Primary Health Care Research & Development ◽

10.1017/s1463423621000232 ◽

2021 ◽

Vol 22 ◽

Author(s):

Katarina Hjelm ◽

Karin Bard ◽

Jan Apelqvist

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Qualitative Content Analysis ◽

Self Care ◽

Adverse Outcomes ◽

Migrant Women ◽

Health Lifestyle

Abstract Aim: No previous studies have been found focusing on the long-term development of beliefs about health, illness and healthcare in migrant women with gestational diabetes mellitus (GDM). The aim of this study was to explore this and the influence on health-related behaviour (i.e. self-care and care seeking) in migrant women from the Middle East living in Sweden seven years after delivery. Background: GDM is increasing, particularly in migrant women. The risk of adverse outcomes of GDM for health can be improved by interventions reducing blood glucose and lifestyle modifications which medicalise the woman’s pregnancy due to intensive follow-up and demanding self-care. The reactions might have an enduring impact on the women’s long-term psychological and physical health and adoption of preventive health behaviours. Method: Qualitative exploratory study. Semi-structured follow-up interviews 7 years after delivery with women previously interviewed in gestational weeks 34–38 and 3 and 14 months after delivery. Data analysed with qualitative content analysis. Findings: Health meant freedom from illness, feeling well and living long to be able to care for the children. The present situation was described either positively, changing to a healthier lifestyle, or negatively, with worries about being affected by type 2 diabetes. Beliefs changed among the majority of women, leading to a healthier lifestyle, and they looked positively back at the time when diagnosed and their reactions to it. With few exceptions, they were confident of being aware of future health risks and felt responsible for their own and their children’s health/lifestyle. None except those diagnosed with type 2 diabetes had been in contact with healthcare since the last follow-up a year after delivery. Yet, they still would like and need a healthcare model delivering more information, particularly on developing a healthy lifestyle for children, and with regular check-ups also after the first year after delivery.

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Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care

British Journal of General Practice ◽

10.3399/bjgp18x695297 ◽

2018 ◽

Vol 68 (669) ◽

pp. e260-e267 ◽

Cited By ~ 7

Author(s):

Brian McMillan ◽

Katherine Easton ◽

Elizabeth Goyder ◽

Brigitte Delaney ◽

Priya Madhuvrata ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Qualitative Study ◽

Gestational Diabetes ◽

Secondary Care ◽

Future Research ◽

Increased Risk ◽

Risk Of Progression

BackgroundDespite the seven-fold increased risk of type 2 diabetes mellitus (T2DM) among females previously diagnosed with gestational diabetes (GD), annual rates of follow-up in primary care are low. There is a need to consider how to reduce the incidence of progression to T2DM among this high-risk group.AimTo examine the views of females diagnosed with GD to ascertain how to improve primary care support postnatally, and the potential role of technology in reducing the risk of progression to T2DM.Design and settingA qualitative study of a purposive sample of 27 postnatal females leaving secondary care with a recent diagnosis of GD.MethodSemi-structured interviews were conducted with 27 females, who had been previously diagnosed with GD, at around 6–12 weeks postnatally. Interviews were audiotaped, transcribed, and analysed thematically.ResultsFacilitators and barriers to engaging in a healthy postnatal lifestyle were identified, the most dominant being competing demands on time. Although females were generally satisfied with the secondary care they received antenatally, they felt abandoned postnatally and were uncertain what to expect from their GP in terms of follow-up and support. Females felt postnatal care could be improved by greater clarity regarding this, and enhanced by peer support, multidisciplinary input, and subsidised facilities. Technology was seen as a potential adjunct by providing information, enabling flexible and personalised self-management, and facilitating social support.ConclusionA more tailored approach for females previously diagnosed with GD may help reduce the risk of progression to T2DM. A need for future research to test the efficacy of using technology as an adjunct to current care was identified.

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Gestational Diabetes Mellitus: Perspectives on Lifestyle Changes during Pregnancy and Post-partum, Physical Activity and the Prevention of Future Type 2 Diabetes

Australian Journal of Primary Health ◽

10.1071/py08040 ◽

2008 ◽

Vol 14 (3) ◽

pp. 85 ◽

Cited By ~ 12

Author(s):

Frances Doran

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Post Partum ◽

Oral Glucose ◽

The Impact

This paper reports on a mixed methods study which sought to explore the role of physical activity in relation to the management of gestational diabetes mellitus (GDM); the impact of a diagnosis of GDM on a woman?s life; follow-up support and factors that both hinder and support women to engage in physical activity post-partum in order to reduce their risk of developing future type 2 diabetes. Thirty-eight women who had a pregnancy complicated by GDM completed surveys. In-depth interviews were then conducted with a subset of eight women who completed these surveys, to further explore their experiences. Women reported making changes to their lifestyle to improve diet and engage in physical activity during pregnancy. These changes were harder to sustain after the baby was born. In this study few women underwent the recommended six-weekly oral glucose tolerance testing, and post-partum follow-up support was virtually non-existent. There is a clear role for health promotion across a number of sectors to support sustained behaviour change in this high-risk group of women. Factors are identified that could enhance follow-up support, particularly for lifestyle change.

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Type 1 and type 2 diabetes after gestational diabetes: a 23 year cohort study

Diabetologia ◽

10.1007/s00125-020-05215-3 ◽

2020 ◽

Vol 63 (10) ◽

pp. 2123-2128 ◽

Cited By ~ 1

Author(s):

Anna-Maaria Auvinen ◽

Kaisu Luiro ◽

Jari Jokelainen ◽

Ilkka Järvelä ◽

Mikael Knip ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Cohort Study ◽

Gestational Diabetes ◽

Fasting Glucose ◽

University Hospital ◽

Characteristic Analysis

Abstract Aims/hypothesis The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study. Methods We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984–1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, ≥4.8 mmol/l; 1 h, ≥10.0 mmol/l; and 2 h, ≥8.7 mmol/l. Two follow-up questionnaires were sent (in 1995–1996 and 2012–2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7–28.8) years. Results Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]). Conclusions/interpretation All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.

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Progression from gestational diabetes to type 2 diabetes in one region of Scotland: an observational follow-up study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-015-0457-8 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 15

Author(s):

Claire E Eades ◽

Maggie Styles ◽

Graham P Leese ◽

Helen Cheyne ◽

Josie MM Evans

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Follow Up Study

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