Preventing type 2 diabetes: Public health implications for women with a history of gestational diabetes mellitus

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, GA, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 09/2008; 200(4):365.e1-8. DOI: 10.1016/j.ajog.2008.06.031
Source: PubMed


There is now strong evidence that lifestyle modification can prevent or delay the development of type 2 diabetes mellitus in high-risk individuals. Women with gestational diabetes mellitus are at increased risk for type 2 diabetes and so are candidates for prevention programs. We review literature on type 2 diabetes risk in women with gestational diabetes, examine current recommendations for postpartum and long-term follow-up, and summarize findings from a 2007 expert-panel meeting. We found data to support that women with gestational diabetes have an increase in risk of type 2 diabetes comparable in magnitude with that of individuals with impaired glucose tolerance and/or impaired fasting glucose and that prevention interventions likely are effective in this population. Current recommendations from leading organizations on follow-up of women after delivery are conflicting and compliance is poor. Clinicians and public health workers face numerous challenges in developing intervention strategies for this population. Translation research will be critical in addressing this important public health issue.

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    • "There is consensus that prevention of type 2 diabetes should be prioritized through lifestyle interventions (National Institute of Health and Care Excellence, 2008; Buchanan et al., 2012; England et al., 2009). The recent diagnostic criteria for classification of GDM proposed by the International Association of Diabetes in Pregnancy Study Group (IADPSG) (Coustan et al., 2010) offers opportunity for early lifestyle intervention and future prevention of Type 2 diabetes and other disease over the lifespan. "
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    ABSTRACT: Purpose: To systematically review lifestyle interventions for women with prior Gestational Diabetes Mellitus (GDM) to report study characteristics, intervention design and study quality and explore changes in 1) diet, physical activity and sedentary behaviour; 2) anthropometric outcomes and; 3) glycaemic control and diabetes risk. Methods: Databases (Web of Science, CCRCT, EMBASE and Science DIRECT) were searched (1980 to April 2014) using keywords for controlled or pre-post design trials of lifestyle intervention targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Selected studies were narratively synthesized with anthropometric and glycaemic outcomes synthesized using meta-analysis. Results: Three of 13 included studies were rated as low bias risk. Recruitment rates were poor but study retention good. Six of 11 studies reporting on physical activity reported favourable intervention effects. All six studies reporting on diet reported favourable intervention effects. In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD = - 1.06 kg (95% CI = -1.68, -0.44)). Lifestyle interventions did not change fasting blood glucose (WMD = -0.05. mmol/L, 95% CI = -0.21, 0.11) or type 2 diabetes risk. Conclusions: Lack of methodologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM. Recruitment into trials is challenging.
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    • "There is still no consensus on screening method or establishing globally applicable threshold criteria (Yogev et al., 2009). Universal guidelines for preconception management and postpartum treatment of GDM for the early detection and prevention of type 2 diabetes also have yet to be proposed (Boinpally and Jovanovic, 2009; England et al., 2009; Kim, 2009; Metzger et al., 2007). "

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