Living: A lifestyle intervention program for the prevention of type 2 diabetes mellitus among South Asian women with gestational diabetes mellitus

Background

Gestational diabetes mellitus (GDM) complicates more than 10% of pregnancies among women In South Asia. Existing data suggest that as many as 40% of individuals might develop type 2 diabetes mellitus (T2DM) within 5 years of delivery, indicating an extraordinarily high rate of conversion in a young adult population. Previous trials of intensive lifestyle modification among individuals with pre-diabetes, including one in India, have shown large and sustained reductions in the incidence of T2DM. Whether such interventions can be adapted, implemented and affordably brought to scale in South Asian populations with prior GDM was not known.

Aims

Primary research aim
To determine whether a resource- and culturally-appropriate lifestyle intervention program in South Asian countries, provided to women with gestational diabetes after delivery, will reduce the incidence of type 2 diabetes, in a manner that is affordable, acceptable and scalable.

Secondary research aim
To determine the effects of the intervention on intermediate biological outcomes and lifestyle behaviours, as well as the proportion of women with a change in glucose metabolism status.

Project plan

We have taken the learnings from previous diabetes prevention programs to develop a new lifestyle program that has a high probability of being feasible, acceptable and cost-effective in the South Asian context for women with prior GDM. We aimed to optimise this intervention using an iterative, systems-based and user-centred approach. The intervention was delivered by auxiliary nurse midwives or their equivalent in each participating hospital, representing a strategy of within-system task-shifting. We evaluated the intervention in a randomised controlled trial (1414 women from 24 centres) to determine whether it could reduce the incidence of T2DM at a median of 20 months follow-up. This project focused on generating new knowledge around implementation of a preventive strategy embedded within existing health systems, using mixed-methods evaluation to inform on cost-effectiveness, acceptability and scalability. It incorporated a science component (a program based on behaviour change theory that supports a multi-level approach to prevention by combining individually targeted strategies with social support), a social component (an innovative workforce strategy) and a sustainability component (a systems perspective for integration with existing health system infrastructure).

Impact

This project demonstrated that women with gestational diabetes (GDM) in urban areas of South Asia represent a high-risk group for the development of type 2 diabetes. The project identified several socioeconomic challenges to behaviour change in women with recent GDM, and pointed to potential solutions in policy, health care practice, and addressing sociocultural norms for improved community health. The project also improved access to 75 gram glucose packets for glucose tolerance testing amongst pregnant mothers.

Publications and output

GACD have also published an end-of-programme report providing a comprehensive summary of the programme and outcomes.

Principal investigators

Team members

Funding organisations

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