Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program

Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. Methods and Findings: In this study, 573 women wer...

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Main Authors: O’Reilly, Sharleen L., Dunbar, James A., Versace, Vincent, Janus, Edward, Best, James D., Carter, Rob, Oats, Jeremy J. N., Skinner, Timothy, Ackland, Michael, Phillips, Paddy A., Ebeling, Peter R., Reynolds, John, Shih, Sophy T. F., Hagger, Virginia, Coates, Michael, Wildey, Carol
Other Authors: Wareham, Nicholas J
Format: Article
Language:English
Published: 2018
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Online Access:https://hdl.handle.net/10356/88477
http://hdl.handle.net/10220/46921
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spelling sg-ntu-dr.10356-884772022-02-16T16:28:09Z Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program O’Reilly, Sharleen L. Dunbar, James A. Versace, Vincent Janus, Edward Best, James D. Carter, Rob Oats, Jeremy J. N. Skinner, Timothy Ackland, Michael Phillips, Paddy A. Ebeling, Peter R. Reynolds, John Shih, Sophy T. F. Hagger, Virginia Coates, Michael Wildey, Carol Wareham, Nicholas J Lee Kong Chian School of Medicine (LKCMedicine) DRNTU::Science::Medicine Cardiovascular Disease Gestational Diabetes Mellitus Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. Methods and Findings: In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: −0.23 kg body weight in intervention group (95% CI −0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference −0.95 kg, 95% CI −1.87, −0.04; group by treatment interaction p = 0.04); −2.24 cm waist measurement in intervention group (95% CI −3.01, −1.42) compared with −1.74 cm in usual care group (95% CI −2.52, −0.96) (change difference −0.50 cm, 95% CI −1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference −0.05 mmol/l, 95% CI −0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. Conclusions: Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention. Published version 2018-12-12T04:59:50Z 2019-12-06T17:04:09Z 2018-12-12T04:59:50Z 2019-12-06T17:04:09Z 2016 Journal Article O’Reilly, S. L., Dunbar, J. A., Versace, V., Janus, E., Best, J. D., Carter, R., Oats, J. J. N., et al. (2016). Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program. PLOS Medicine, 13(7), e1002092-. doi:10.1371/journal.pmed.1002092 1549-1277 https://hdl.handle.net/10356/88477 http://hdl.handle.net/10220/46921 10.1371/journal.pmed.1002092 27459502 en PLOS Medicine © 2016 O’Reilly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 21 p. application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic DRNTU::Science::Medicine
Cardiovascular Disease
Gestational Diabetes Mellitus
spellingShingle DRNTU::Science::Medicine
Cardiovascular Disease
Gestational Diabetes Mellitus
O’Reilly, Sharleen L.
Dunbar, James A.
Versace, Vincent
Janus, Edward
Best, James D.
Carter, Rob
Oats, Jeremy J. N.
Skinner, Timothy
Ackland, Michael
Phillips, Paddy A.
Ebeling, Peter R.
Reynolds, John
Shih, Sophy T. F.
Hagger, Virginia
Coates, Michael
Wildey, Carol
Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
description Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. Methods and Findings: In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: −0.23 kg body weight in intervention group (95% CI −0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference −0.95 kg, 95% CI −1.87, −0.04; group by treatment interaction p = 0.04); −2.24 cm waist measurement in intervention group (95% CI −3.01, −1.42) compared with −1.74 cm in usual care group (95% CI −2.52, −0.96) (change difference −0.50 cm, 95% CI −1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference −0.05 mmol/l, 95% CI −0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. Conclusions: Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention.
author2 Wareham, Nicholas J
author_facet Wareham, Nicholas J
O’Reilly, Sharleen L.
Dunbar, James A.
Versace, Vincent
Janus, Edward
Best, James D.
Carter, Rob
Oats, Jeremy J. N.
Skinner, Timothy
Ackland, Michael
Phillips, Paddy A.
Ebeling, Peter R.
Reynolds, John
Shih, Sophy T. F.
Hagger, Virginia
Coates, Michael
Wildey, Carol
format Article
author O’Reilly, Sharleen L.
Dunbar, James A.
Versace, Vincent
Janus, Edward
Best, James D.
Carter, Rob
Oats, Jeremy J. N.
Skinner, Timothy
Ackland, Michael
Phillips, Paddy A.
Ebeling, Peter R.
Reynolds, John
Shih, Sophy T. F.
Hagger, Virginia
Coates, Michael
Wildey, Carol
author_sort O’Reilly, Sharleen L.
title Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
title_short Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
title_full Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
title_fullStr Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
title_full_unstemmed Mothers after gestational diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
title_sort mothers after gestational diabetes in australia (magda): a randomised controlled trial of a postnatal diabetes prevention program
publishDate 2018
url https://hdl.handle.net/10356/88477
http://hdl.handle.net/10220/46921
_version_ 1725985648180985856