Effectiveness of system-based intervention in reducing incidence of type 2 diabetes and to improve the postnatal metabolic profiles in women with gestational diabetes mellitus: a randomized controlled study

Abstract

Aim

The objective of this study was to determine the effectiveness of system-based intervention in reducing the incidence of diabetes and to improve the postnatal metabolic profiles among women with gestational diabetes mellitus (GDM).

Materials and methods

For women in the intervention arm (n = 130), they received one session of individualized health education at 36 gestational weeks, a booklet of diabetes prevention, five-session of postpartum booster educational program which were conducted including 1 session of dietary and exercise counseling by dietician and physiotherapist at 6 weeks postpartum. For women in the control group (n = 168), standard treatment whereby they had received group therapy on diet and physical activity modification by dietician and staff nurses during the antenatal period.

Results

There were no significant differences in baseline characteristics between groups for most of the variables examined except for educational level which the control group had a higher education than the intervention group. The women assigned to system-based intervention have a significant difference to GDM women who were assigned to the control group for LDL and HDL but not in anthropometric measurements, blood pressure, glucose index, total cholesterol, and triglyceride. In addition, it was found that the incidence of Type 2 diabetes mellitus (T2DM) 2 years after delivery was 20% in the intervention arm compared to 17% in the control arm.

Conclusion

The system-based intervention was not statistically superior to the control intervention as there is no difference in terms of incidence of T2DM between the intervention and control group. We, therefore, suggested that more intensive interventions are needed to prevent GDM from developing into T2DM.

系统干预对改善妊娠期糖尿病女性产后代谢状况和降低2型糖尿病发病率的效果：一项随机对照研究 摘要

目的：本研究旨在确定对于妊娠期糖尿病（gestational diabetes mellitus , GDM）女性, 基于系统干预对改善产后代谢状况和降低糖尿病发病率的效果。

材料和方法：对于干预组（n = 130）的女性, 她们在孕36周时接受一次个性化健康教育, 收到一本糖尿病预防手册, 进行五次产后强化教育, 包括在产后6周由营养师和理疗师进行一次饮食和运动咨询。对于对照组（n = 168）中的女性, 在产前接受营养师和护理人员针对饮食和体力活动调整的集体治疗。

结果：除对照组的受教育程度高于干预组外, 两组之间基线特征中的大多数情况没有差异。与对照组的GDM女性相比, 干预组的女性低密度脂蛋白和高密度脂蛋白有显著差异, 但在人体测量、血压、血糖指数、总胆固醇和甘油三酯无显著差异。此外, 研究发现, 干预组产后2年2型糖尿病（Type 2 diabetes mellitus, T2DM）的发病率为20%, 而对照组为17%。

结论：基于系统干预在统计学上并不优于对照干预, 因为干预组和对照组的2型糖尿病发病率没有差异。因此, 我们建议需要更强的干预措施来防止GDM发展为T2DM。

Keywords:

• Gestational diabetes mellitus
• clinical trial
• antenatal intervention
• postpartum intervention
• prevention of diabetes mellitus

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Institute of Health Malaysia (Project number: BP005000).