Advertisement

The Avoiding Diabetes After Pregnancy Trial in Moms Program: Feasibility of a Diabetes Prevention Program for Women With Recent Gestational Diabetes Mellitus

  • Author Footnotes
    1 Co-first authors, on behalf of the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) Study Group (Howard Berger, Denice Feig, Karen Fleming, Enza Gucciardi, Ilana Halperin, Paula Harvey, Geetha Mukerji, Joel Ray, Ravi Retnakaran, Diana Sherifali, Jacob A. Udell).
    Lorraine L. Lipscombe
    Correspondence
    Address for correspondence: Lorraine L. Lipscombe MD, MSc, Women’s College Hospital, Women’s College Research Institute, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
    Footnotes
    1 Co-first authors, on behalf of the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) Study Group (Howard Berger, Denice Feig, Karen Fleming, Enza Gucciardi, Ilana Halperin, Paula Harvey, Geetha Mukerji, Joel Ray, Ravi Retnakaran, Diana Sherifali, Jacob A. Udell).
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors, on behalf of the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) Study Group (Howard Berger, Denice Feig, Karen Fleming, Enza Gucciardi, Ilana Halperin, Paula Harvey, Geetha Mukerji, Joel Ray, Ravi Retnakaran, Diana Sherifali, Jacob A. Udell).
    Faith Delos-Reyes
    Footnotes
    1 Co-first authors, on behalf of the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) Study Group (Howard Berger, Denice Feig, Karen Fleming, Enza Gucciardi, Ilana Halperin, Paula Harvey, Geetha Mukerji, Joel Ray, Ravi Retnakaran, Diana Sherifali, Jacob A. Udell).
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Andrea J. Glenn
    Affiliations
    Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Stephanie de Sequeira
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Xinyun Liang
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Shannan Grant
    Affiliations
    Department of Applied Human Nutrition, Mount St Vincent’s University, Halifax, Nova Scotia, Canada

    Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, Nova Scotia, Canada
    Search for articles by this author
  • Kevin E. Thorpe
    Affiliations
    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
    Search for articles by this author
  • Jennifer A.D. Price
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

    Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors, on behalf of the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M) Study Group (Howard Berger, Denice Feig, Karen Fleming, Enza Gucciardi, Ilana Halperin, Paula Harvey, Geetha Mukerji, Joel Ray, Ravi Retnakaran, Diana Sherifali, Jacob A. Udell).
Published:September 25, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.08.019

      Abstract

      Objective

      Our aim in this study was to evaluate the feasibility of a home-based diabetes prevention program, delivered by interdisciplinary certified diabetes educators (CDEs), and customized for postpartum women with recent gestational diabetes mellitus (GDM).

      Methods

      This pilot randomized trial recruited women with GDM from 24 to 40 weeks gestation from 4 centres, and trained 10 CDEs in behaviour coaching, physical activity (PA) and low glycemic index education. Women were randomized after 3 months postpartum to standard care (1 visit) or 1 of 3 24-week coaching interventions (1 visit and 12 telephone calls): i) PA and diet, ii) PA only or iii) diet only. Feasibility outcomes included recruitment, retention, adherence and satisfaction.

      Results

      Of 1,342 eligible patients, 392 were actively invited (29.3%) and 227 (16.9%) consented. Of these, 149 (65.6%) were randomized postpartum, of whom 131 (87.9%) started the program and 105 (70.5%) attended the final assessment. Intervention arm participants completed a median 75% (interquartile range, 50% to 92%) of telephone calls. Visit and call duration were a mean 71.4 (standard deviation, 13.8) and 18.1 (standard deviation, 6.5) minutes, respectively. Participants reported excellent/very good satisfaction 73% of the time, and 87% would recommend the program to others.

      Conclusions

      A home-based diabetes prevention program customized for postpartum women with GDM can be feasibly delivered by CDEs, and it is associated with >70% retention, adherence and satisfaction.

      Résumé

      Objectif

      L’objectif dans notre étude était d'évaluer la faisabilité d'un programme de prévention du diabète réalisé à domicile, offert par des éducateurs interdisciplinaires agréés en diabète (EAD), et adapté aux femmes durant la période post-partum ayant récemment souffert de diabète sucré gestationnel (DSG).

      Méthodes

      Cet essai pilote randomisé a recruté dans 4 centres des femmes enceintes de 24 à 40 semaines atteintes de DSG et a formé 10 EAD à l'accompagnement comportemental, à l'activité physique (AP) et à la sensibilisation au faible indice glycémique. Les femmes ont été réparties aléatoirement 3 mois après l’accouchement pour suivre des soins standards (1 visite) ou suivre 1 de ces 3 interventions d’accompagnement de 24 semaines (1 visite et 12 appels téléphoniques) : i) AP et alimentation, ii) AP seulement ou iii) alimentation seulement. Les résultats de cette étude de faisabilité comprenaient l’évaluation du recrutement, du maintien dans le programme, de l'adhésion et du niveau de satisfaction.

      Résultats

      Des 1 342 patientes admissibles, 392 ont été activement sollicitées (29.3%) et 227 (16.9%) ont donné leur consentement. De ce nombre, 149 (65.6%) étaient des femmes en période post-partum sélectionnées aléatoirement, dont 131 (87.9%) ont commencé le programme et 105 (70.5%) ont participé à l'évaluation finale. Les participantes du groupe d'intervention ont répondu en moyenne à 75% des appels téléphoniques (écart interquartile, de 50% à 92%). La durée moyenne de la visite et de l'appel était respectivement de 71.4 minutes (écart-type, 13.8) et 18.1 minutes (écart-type, 6.5). Les participantes se sont dits extrêmement satisfaites/très satisfaites 73% du temps, et 87% recommanderaient le programme à d'autres personnes.

      Conclusions

      Un programme personnalisé de prévention du diabète à domicile pour les femmes post-partum atteintes de DSG peut facilement être proposé par les EAD, sachant qu’il est associé à un taux de rétention, d'adhésion et de satisfaction >70%.

      Keywords

      Mots clés

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Feig D.S.
        • Hwee J.
        • Shah B.R.
        • Booth G.L.
        • Bierman A.S.
        • Lipscombe L.L.
        Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: A large, population-based study in Ontario, Canada, 1996-2010.
        Diabetes Care. 2014; 37: 1590-1596
        • Feig D.S.
        • Berger H.
        • Donovan L.
        • et al.
        • Diabetes Canada Clinical Practice Guidelines Expert Committee
        Diabetes and pregnancy.
        Can J Diabetes. 2018; 42: S255-S282
        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.
        Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        • Feig D.S.
        • Zinman B.
        • Wang X.
        • Hux J.E.
        Risk of development of diabetes mellitus after diagnosis of gestational diabetes.
        CMAJ. 2008; 179: 229-234
        • Mukerji G.
        • Chiu M.
        • Shah B.R.
        Impact of gestational diabetes on the risk of diabetes following pregnancy among Chinese and South Asian women.
        Diabetologia. 2012; 55: 2148-2153
        • Xiang A.H.
        • Li B.H.
        • Black M.H.
        • et al.
        Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus.
        Diabetologia. 2011; 54: 3016-3021
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N Engl J Med. 2001; 344: 1343-1350
        • Ratner R.E.
        • Christophi C.A.
        • Metzger B.E.
        • et al.
        Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions.
        J Clin Endocrinol Metab. 2008; 93: 4774-4779
        • Gilinsky A.
        • Kirk A.
        • Hughes A.
        • Lindsay R.
        Lifestyle interventions for type 2 diabetes prevention in women with prior gestational diabetes: A systematic review and meta-analysis of behavioural, anthropometric and metabolic outcomes.
        Prev Med Rep. 2015; 2: 448-461
        • Goveia P.
        • Canon-Montanez W.
        • Santos D.P.
        • et al.
        Lifestyle intervention for the prevention of diabetes in women with previous gestational diabetes mellitus: A systematic review and meta-analysis.
        Front Endocrinol (Lausanne). 2018; 9: 583
        • Pedersen A.L.W.
        • Terkildsen Maindal H.
        • Juul L.
        How to prevent type 2 diabetes in women with previous gestational diabetes? A systematic review of behavioural interventions.
        Prim Care Diabetes. 2017; 11: 403-413
        • Smith B.J.
        • Cheung N.W.
        • Bauman A.E.
        • Zehle K.
        • McLean M.
        Postpartum physical activity and related psychosocial factors among women with recent gestational diabetes mellitus.
        Diabetes Care. 2005; 28: 2650-2654
        • Graco M.
        • Garrard J.
        • Jasper A.E.
        Participation in physical activity: Perceptions of women with a previous history of gestational diabetes mellitus.
        Health Promot J Austr. 2009; 20: 20‒5
        • Williamson D.F.
        • Madans J.
        • Pamuk E.
        • Flegal K.M.
        • Kendrick J.S.
        • Serdula M.K.
        A prospective study of childbearing and 10-year weight gain in US white women 25 to 45 years of age.
        Int J Obes Rel Metab Disord. 1994; 18: 561-569
        • Price J.
        • Landry M.
        • Rolfe D.
        • Delos-Reyes F.
        • Groff L.
        • Sternberg L.
        Women's cardiac rehabilitation: Improving access using principles of women's health.
        Can J Cardiovasc Nurs. 2005; 15: 32-41
        • Huffman M.
        Health coaching: A new and exciting technique to enhance patient self-management and improve outcomes.
        Home Healthc Nurse. 2007; 25 (quiz 5‒6): 271-274
        • Stanford School of Medicine
        Chronic disease self-management program 2014.
        (Accessed December 11, 2019)
        • Thompson D.
        • Berger H.
        • Feig D.
        • et al.
        • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
        Diabetes and pregnancy.
        Can J Diabetes. 2013; 37: S168-S183
        • Gale J.
        • Linder H.
        Health coaching model for CCPSM.
        (Accessed March 1, 2019)
        • Prochaska J.O.
        • Velicer W.F.
        The transtheoretical model of health behavior change.
        Am J Health Promot. 1997; 12: 38-48
        • Sutton K.
        • Logue E.
        • Jarjoura D.
        • Baughman K.
        • Smucker W.
        • Capers C.
        Assessing dietary and exercise stage of change to optimize weight loss interventions.
        Obes Res. 2003; 11: 641-652
        • Mukerji G.
        • McTavish S.
        • Glenn A.
        • et al.
        An innovative home-based cardiovascular lifestyle prevention program for women with recent gestational diabetes: A pilot feasibility study.
        Can J Diabetes. 2015; 39: 445-450
        • ClinicalTrials.gov
        Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M).
        National Library of Medicine, 2016 (2016. Updated March 21, 2019) (Accessed February 27, 2019)
        • Mottola M.F.
        • Davenport M.H.
        • Ruchat S.M.
        • et al.
        2019 Canadian guideline for physical activity throughout pregnancy.
        Br J Sports Med. 2018; 52: 1339-1346
        • Shields C.A.
        • Fowles J.R.
        • Dunbar P.
        • Barron B.
        • McQuaid S.
        • Dillman C.J.
        Increasing diabetes educators' confidence in physical activity and exercise counselling: The effectiveness of the "physical activity and exercise toolkit" training intervention.
        Can J Diabetes. 2013; 37: 381-387
        • Vincenti G.E.
        Edinburgh Postnatal Depression Scale.
        Br J Psychiatry. 1987; 151: 865
      1. Canadian physical activity guidelines.
        (Accessed February 11, 2019)
        • American College of Sports Medicine
        Franklin B.A. ACSM's Guidelines for Exercise Testing and Prescription. 6th edn. Lippincott, Williams & Wilkins, Philadelphia2000
        • Brand-Miller J.
        • Hayne S.
        • Petocz P.
        • Colagiuri S.
        Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials.
        Diabetes Care. 2003; 26: 2261-2267
        • Grant S.M.
        • Wolever T.M.
        • O'Connor D.L.
        • Nisenbaum R.
        • Josse R.G.
        Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia.
        Diabetes Res Clin Pract. 2011; 91: 15-22
        • Larsen T.M.
        • Dalskov S.M.
        • van Baak M.
        • et al.
        Diets with high or low protein content and glycemic index for weight-loss maintenance.
        N Engl J Med. 2010; 363: 2102-2113
        • Juanola-Falgarona M.
        • Salas-Salvado J.
        • Ibarrola-Jurado N.
        • et al.
        Effect of the glycemic index of the diet on weight loss, modulation of satiety, inflammation, and other metabolic risk factors: a randomized controlled trial.
        Am J Clin Nutr. 2014; 100: 27-35
        • Shyam S.
        • Arshad F.
        • Abdul Ghani R.
        • et al.
        Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: A six months randomized trial.
        Nutr J. 2013; 12: 68
      2. Wolever TMS. The glycaemic index: A physiological classification of dietary carbohydrate 2006.

        • Government of Canada
        Canada's food guide 2019.
        (Accessed February 24, 2019)
        • Diabetes Canada Clinical Practice Guidelines Expert Committee
        Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada.
        Can J Diabetes. 2018; 42: S1-S325
        • Aziz Z.
        • Absetz P.
        • Oldroyd J.
        • Pronk N.P.
        • Oldenburg B.
        A systematic review of real-world diabetes prevention programs: Learnings from the last 15 years.
        Implement Sci. 2015; 10: 172
        • Gulati M.
        • Black H.R.
        • Shaw L.J.
        • et al.
        The prognostic value of a nomogram for exercise capacity in women.
        N Engl J Med. 2005; 353: 468-475
        • O’Reilly S.L.
        • Dunbar J.A.
        • Versace V.
        • et al.
        Mothers after Gestational Diabetes in Australia (MAGDA): A randomised controlled trial of a postnatal diabetes prevention program.
        PLoS Med. 2016; 13: e1002092
        • Ferrara A.
        • Hedderson M.M.
        • Brown S.D.
        • et al.
        The comparative effectiveness of diabetes prevention strategies to reduce postpartum weight retention in women with gestational diabetes mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial.
        Diabetes Care. 2016; 39: 65-74
        • Aziz Z.
        • Absetz P.
        • Oldroyd J.
        • Pronk N.P.
        • Oldenburg B.
        A systematic review of real-world diabetes prevention programs: Learnings from the last 15 years.
        Implement Sci. 2015; 10: 172
        • Dasgupta K.
        • Terkildsen Maindal H.
        • Kragelund Nielsen K.
        • O'Reilly S.
        Achieving penetration and participation in diabetes after pregnancy prevention interventions following gestational diabetes: A health promotion challenge.
        Diabet Res Clin Pract. 2018; 145: 200-213
        • Kragelund Nielsen K.
        • Groth Grunnet L.
        • Terkildsen Maindal H.
        • et al.
        Prevention of Type 2 diabetes after gestational diabetes directed at the family context: A narrative review from the Danish Diabetes Academy symposium.
        Diabet Med. 2018; 35: 714-720
        • Dasgupta K.
        • Da Costa D.
        • Pillay S.
        • et al.
        Strategies to optimize participation in diabetes prevention programs following gestational diabetes: A focus group study.
        PLoS One. 2013; 8: e67878
        • Taylor R.S.
        • Dalal H.
        • Jolly K.
        • Moxham T.
        • Zawada A.
        Home-based versus centre-based cardiac rehabilitation.
        Cochrane Database Syst Rev. 2010; : CD007130
        • Dalal H.M.
        • Zawada A.
        • Jolly K.
        • Moxham T.
        • Taylor R.S.
        Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis.
        BMJ. 2010; 340: b5631
        • Eakin E.G.
        • Lawler S.P.
        • Vandelanotte C.
        • Owen N.
        Telephone interventions for physical activity and dietary behavior change: A systematic review.
        Am J Prev Med. 2007; 32: 419-434
        • Amorim A.R.
        • Linne Y.M.
        • Lourenco P.M.
        Diet or exercise, or both, for weight reduction in women after childbirth.
        Cochrane Database Syst Rev. 2007; : CD005627