IINDIAGO (Integrated INtervention for DIAbetes rIsk after GestatiOnal diabetes)

Background

In South Africa, the prevalence of gestational diabetes mellitus (GDM) is high at over 15%. Women with GDM are a high risk group for developing type 2 diabetes (T2D) and represent an important and unique target group for intervention. GDM is also reported to increase long term CVD risk while GDM offspring are susceptible to impaired glucose tolerance and obesity. Recognition of the effects of GDM on both the mother and infant, has led to calls from national and international organisations, to intervene more effectively with women with prior GDM and their offspring. IINDIAGO is an integrated health system intervention aimed at reducing type 2 diabetes risk in disadvantaged women after gestational diabetes in South Africa.

Aims

To develop and evaluate a novel health system intervention to reduce the subsequent risk of developing T2D among women with recent gestational diabetes and to identify opportunities and barriers to subsequent scale-up and sustainability within routine, community-based primary health care services.

Project plan

Assess the feasibility and acceptability of the proposed intervention among both women and healthcare providers and managers, through formative research and evaluation. The formative research, as well as the on-going process evaluation during the trial, will use qualitative methodologies and be based on conceptual and methodological frameworks from health systems and implementation research and will be informed by applied social science models.
Develop and implement a novel health system intervention package for women with recent gestational diabetes, that links existing public hospital-based antenatal care with postnatal community-based care at well baby clinics and which incorporates postpartum screening and evidence-based brief behaviour change counselling on the lifestyle risk factors for diabetes.
Evaluate the risk for diabetes and its risk factors at baseline and at 12 months post-partum.
Assess the process of implementation, including the possible system facilitators and barriers to integrating the intervention into routine, community-based primary healthcare services should the pilot prove successful.
Assess the cost-effectiveness of the proposed intervention package.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage.

GACD have also published an end-of-programme report, providing a comprehensive summary of the programme and outcomes. More information about the Diabetes report is available here.

Principal investigators

Naomi Levitt University of Cape Town, South Africa
Christina Zarowsky Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada

Team members

Lara Fairall University of Cape Town, South Africa
Vicki Lambert University of Cape Town, South Africa
Katherine Murphy University of Cape Town, South Africa
Krisela Steyn University of Cape Town, South Africa
Mark Tomlinson Stellenbosch University, South Africa
Shane Norris University of the Witwatersrand, South Africa
Carl Lombard South African Medical Research Council, South Africa