Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design

Lorraine L Lipscombe; Ananya Tina Banerjee; Sarah McTavish; Geetha Mukerji; Julia Lowe; Joel Ray; Marilyn Evans; Denice S Feig

doi:10.1016/j.diabres.2014.07.019

Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design

Diabetes Res Clin Pract. 2014 Oct;106(1):57-66. doi: 10.1016/j.diabres.2014.07.019. Epub 2014 Jul 26.

Authors

Lorraine L Lipscombe¹, Ananya Tina Banerjee², Sarah McTavish², Geetha Mukerji³, Julia Lowe⁴, Joel Ray⁵, Marilyn Evans⁶, Denice S Feig⁷

Affiliations

¹ Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6. Electronic address: [email protected].
² Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8.
³ Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8.
⁴ Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5.
⁵ Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology and Metabolism, St. Michael's Hospital, 61 Queen St. East, Toronto, ON, Canada, M5C 2T2; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8.
⁶ Faculty of Health Sciences, Western University, Arthur and Sonia Labatt Health Sciences Building, London, ON, Canada N6A 5B9.
⁷ Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology, Mount Sinai Hospital, 60 Murray Street, Toronto, ON, Canada, M5T 3L9; Department of Obstetrics and Gyencology, University of Toronto, 123 Edward Street, Toronto, ON, Canada, M5G 1E2.

PMID: 25154309
DOI: 10.1016/j.diabres.2014.07.019

Abstract

Aims: Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study.

Methods: The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change.

Conclusions: Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.

Keywords: Barriers; Diabetes prevention; Gestational diabetes mellitus; Stage of readiness for lifestyle change.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Canada
Diabetes Mellitus, Type 2 / etiology
Diabetes Mellitus, Type 2 / prevention & control*
Diabetes, Gestational / etiology
Diabetes, Gestational / prevention & control*
Female
Health Promotion / methods
Humans
Life Style*
Patient Acceptance of Health Care*
Postpartum Period
Pregnancy
Prospective Studies
Research Design
Surveys and Questionnaires