Perceived Barriers to Type 2 Diabetes Prevention for Low-Income Women With a History of Gestational Diabetes: A Qualitative Secondary Data Analysis

Purpose The purpose of this qualitative study was to examine perceived barriers to adoption of lifestyle changes for type 2 diabetes prevention among a diverse group of low-income women with a history of gestational diabetes mellitus (GDM). Methods A secondary data analysis of 10 semistructured focus group discussions was conducted. Participants were low-income African American, Hispanic, and Appalachian women ages 18 to 45 years who were diagnosed with GDM in the past 10 years. A qualitative content analysis was conducted to identify key themes that emerged within and between groups. Results Four key themes emerged on the role of knowledge, affordability, accessibility, and social support in type 2 diabetes prevention. Women discussed a lack of awareness of the benefits of breastfeeding and type 2 diabetes prevention, inaccessibility of resources in their local communities to help them engage in lifestyle change, and the desire for more culturally relevant education on healthful food options and proper portion sizes. Discussion Study findings suggests that to improve effectiveness of type 2 diabetes prevention efforts among low-income women with GDM history, health care providers and public health practitioners should avoid using “one-size-fits-all” approaches to lifestyle change and instead use tailored interventions that address the cultural and environmental factors that impact women’s ability to engage in recommended behavior change.

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Abstract MP32: Muscular Strength and Type 2 Diabetes Prevention

Circulation ◽

10.1161/circ.137.suppl_1.mp32 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Duck-chul Lee ◽

Angelique Brellenthin ◽

Xuemei Sui ◽

Steven Blair

Keyword(s):

Type 2 Diabetes ◽

Cardiorespiratory Fitness ◽

Diabetes Prevention ◽

Lower Risk ◽

Muscular Strength ◽

Incident Type ◽

Type 2 Diabetes Prevention ◽

Incident Type 2 Diabetes ◽

History Of

Introduction: There is little evidence on the effects of muscular strength, independent of cardiorespiratory fitness, on the development of type 2 diabetes. Hypothesis: We hypothesised that muscular strength, independent of cardiorespiratory fitness, has significant benefits in type 2 diabetes prevention. Methods: Participants were 5,578 men and women aged 18 to 100 years (mean age, 44) who received preventive medical examinations during 1980-2006 in the Aerobics Center Longitudinal Study. Participants were free of myocardial infarction, stroke, cancer, and diabetes at baseline. Total body muscular strength was quantified by combining 1 repetition maximum (1-RM) measures for leg and bench presses and categorized into three groups, lower (weak), middle, and upper (strong), based on the tertiles (thirds) of muscular strength. Cardiorespiratory fitness was measured by a maximal treadmill exercise test. Type 2 diabetes was defined as a fasting plasma glucose level of ≥126 mg/dl, a history of diabetes, or current insulin therapy. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident type 2 diabetes by muscular strength after adjusting for baseline age, sex, examination year, body mass index (BMI), current smoking, heavy alcohol drinking, parental history of diabetes, hypertension, hypercholesterolemia, glucose level, and maximum treadmill test time. Results: During an average follow-up of 8 years, 270 (4.8%) individuals developed type 2 diabetes. Compared with the individuals in the lower third of muscular strength, individuals in the middle third had a 30% lower risk of developing type 2 diabetes (HR: 0.70, 95% CI: 0.51-0.95), whereas no significant benefit was found in individuals in the upper third (HR: 1.16, 95% CI: 0.86-1.57) after adjusting for potential confounders and cardiorespiratory fitness. We found similar results in men and women, young (<50 years) and old (≥50 years), and normal (BMI <25 kg/m 2 ) and overweight/obese (BMI ≥25 kg/m 2 ) individuals. In the combined analysis of muscular strength and cardiorespiratory fitness, we also found similar results that individuals in the middle third of muscular strength showed lower risks of developing type 2 diabetes in both low (lower 50%) and high (upper 50%) cardiorespiratory fitness, compared with individuals in the lower third of muscular strength and low cardiorespiratory fitness. Conclusions: We found that a moderate level of muscular strength, independent of cardiorespiratory fitness, is associated with a lower risk of developing type 2 diabetes. Additional studies on the dose-response relationship of muscular strength and incident type 2 diabetes are warranted.

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Development of a type 2 diabetes prevention curriculum for Latinas with a history of gestational diabetes

The FASEB Journal ◽

10.1096/fasebj.20.4.a551-b ◽

2006 ◽

Vol 20 (4) ◽

Author(s):

Tara Denise Young ◽

Luz Elvia Vera Becerra ◽

Francene Steinberg

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Diabetes Prevention ◽

Type 2 Diabetes Prevention ◽

Prevention Curriculum ◽

History Of

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Type 2 Diabetes Prevention Toolkit for Health-Care Professionals

Case Medical Research ◽

10.31525/ct1-nct04126291 ◽

2019 ◽

Author(s):

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

Health Care Professionals ◽

Diabetes Prevention ◽

Type 2 Diabetes Prevention

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Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy—the PVS-PREDIAPS strategy—to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial

Implementation Science ◽

10.1186/s13012-021-01127-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alvaro Sanchez ◽

◽

Susana Pablo ◽

Arturo Garcia-Alvarez ◽

Silvia Dominguez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Diabetes Prevention ◽

Implementation Strategy ◽

Type Ii ◽

Collaborative Process ◽

Type 2 Diabetes Prevention ◽

Cluster Randomized ◽

Implementation Trial

Abstract Background The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. Methods A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. Results After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). Discussion Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.

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