Table 2.
Randomized Trials of Lifestyle Interventions to Reduce Risk of Type 2 Diabetes among Women with Gestational Diabetes Mellitus (GDM); Findings.
| Author (year) | Name | Impact on Type 2 Diabetes |
Impact on Biomarkers of Insulin Resistance |
Impact on Weight | Impact on PA | Impact on Diet | Impact on Breastfeeding |
|---|---|---|---|---|---|---|---|
| Cheung et al.; 2011 | NA | NA | BMI (kg/m2): 28 (95% CI: 23.9, 34.3) vs. 25.5 (95% CI: 22.5, 28.7), p=0.14 |
Steps (% achieving goal): 30.8 vs. 17.6 p=0.34; PA (% achieving goal): 70.0 vs. 57.9, p=0.51 |
NA | ||
| Ferrara et al.; 2011 | DEBI (Diet, Exercise and Breastfeeding Intervention) |
NA | NA | Weight (% achieving goal): 37.5% vs. 21.4%, p=0.07 |
PA (difference in mean change in min/wk.): 25.3, p=0.91 |
Fat (% difference in mean change) −3.6, p=0.002 |
Breastfeeding (difference in % partially or exclusively breastfeeding): 15%, p=0.09 |
| Hu et al.; 2012 | Tianjin Gestational Diabetes Mellitus Prevention Program (TGDMPP) |
NA | FG (change in mmol/l): −0.09±.52 vs. −0.09±0.6, p=0.97; Insulin (change in pmol/l): −11.8±27.4 vs. −3.2±31.2, p=0.004 |
Weight change: − 1.4±3.44 kg vs − 0.21±3.52 kg (0.3%), p=0.001; BMI change: −0.50±1.41 kg/m2 vs. −0.09±1.37 kg/m2, p=0.004 |
LTPA (% increased): 59.4% vs. 26.9%, p<0.001 |
Fat (% decrease): 77.1 vs. 68.9, p=0.064; Fiber (% increase) 59.5 vs. 47.4, p=0.012 |
NA |
| Kim et al.; 2012 | NA | FG (change in mmol/l): − 0.046 vs. 0.038, p=0.65; 2 hr. glucose on 75g OGTT (change in mmol/l): −0.48 vs. −0.42, p=0.91 |
Weight (change in kg): − 0.14 kg vs. −1.5 kg, p=0.13 |
PA (% moderate-intensity): 58 vs. 47, p=0.51 |
NA | NA | |
| McIntyre et al.; 2012 | NA | FG (change in mmol/L): 0.25+.56 vs. 0.12+0.42, NS; Insulin (change in µU/mL): 1.49+4.23 vs. 0.06+3.89, NS |
Change in weight (kg): 0.97+3.7 vs. 0.22+4.2 NS |
PA (median [range] increase in planned PA mins./wk.): 60 (0–540) vs. 0 (0–580); p=0.234; walking: NS |
NA | NA | |
| Ratner et al.; 2008 | Diabetes Prevention Project (DPP) |
Diabetes: 53% risk reduction vs. placebo, p=0.002 |
NA | Weight (change in kg): − 5.13±0.43 vs. approx. 0 in placebo at 6 mos.; − 1.6±0.80 vs. approx. 0 in placebo at 3 yrs. |
PA (change in h/wk.): 1.5 h/wk. vs. NA in yr. 1; <0.5 vs NA in yr. 3. |
NA | NA |
| Reinhardt et al.; 2012 | NA | NA | BMI (difference in change in kg/m2): −1.5 (95% CI: −2.8, −0.1); Weight (difference in change in kg): −4.0 (95% CI: −7.6, −0.5) |
LTPA (change in min/day): 11 (95% CI: 1, 22) |
Total fat (change in g/day): −19 (95%CI: −37, − 1); GL (unit change) −26 (95% CI −48, −4) |
NA | |
| Shyam et al.; 2013 | NA | Glucose: 2hr post 75g OGTT (median mmol/l, IQR): −0.2 (2.8) vs. 0.8 (2.0), p=0.025; Insulin (<2 µU/L): 61.5% vs. 52.6%, p=0.228 |
Weight (% achieving goal): 33% vs. 8%, p=0.01 |
PA (median METmin/ wk., IQR): 933 (1403) vs. 965 (857), p=0.908 |
Fat (g): 58±18 vs. 53±16, p=0.695 for difference in change; Fiber (g): 17±4 vs. 13±4, p=0.02 for difference in change; GI: 57±5 vs. 64±6, p=0.033 for difference in change |
||
| Wein et al.; 1999 | Diabetes (annual IR): 6.1% vs. 7.3% (IRR=0.83, 95% CI: 0.47, 1.48) |
NA | NA | NA | NA |
RCT = randomized clinical trial; FU = follow-up; GDM= gestational diabetes mellitus; IGT= impaired glucose tolerance; PA=physical activity; FG=fasting glucose; GI = glycemic index; PA = physical activity,