Authors (including presenting author) :
Koo WK (1), Kan CYE (1), Choi CH (1), Wong FKG (1)
Affiliation :
(1) Diabetes and Endocrine Center, Queen Elizabeth Hospital
Introduction :
Individuals with a history of GDM have an increased lifetime maternal risk for diabetes estimated at 50–60%, and those with GDM have a 10-fold increased risk of developing type 2 diabetes compared with those without GDM (ADA, 2024). In the prospective Nurses’ Health Study II (NHS II), subsequent diabetes risk after a history of GDM was significantly lower in those who followed healthy eating patterns (Tobias et al, 2012).
Objectives :
By providing protocol driven structured educational intervention to GDM patients after delivery for 5 years in QEH:
1. To evaluate the real life adherence of preventive program
2. To evaluate the effectiveness in terms of DM & weight gain prevention, and insulin resistance (HOMA) improvement
Methodology :
Subjects
Chinese GDM women under endocrine pregnancy clinic in QEH who had normal or pre-diabetes in postnatal OGTT results were recruited from Sept 2018 to Apr 2021. Patients who diagnosed to have DM, unstable psychiatric or multiple diseases requiring treatment were excluded.
Intervention
Single arm without comparison group, once every year for 5 years
- Provide doctor and nurse consultation with structural education program, including
o Knowledge education
o Target development
o Lifestyle modification strategies
o Self-monitoring
o Motivation technique with blood result interpretation
- Blood monitoring including OGTT and HOMA
- Telephone visit (after 6 months of that year)
- Give summary of the program and rounded up at the end of 5th year
Result & Outcome :
Result:
- 90 women were recruited, 8 of them got pregnancy, 3 diagnosed to have other medical conditions. Among those 79 patients, 34 left the program (14 failed to contact, 19 quitted for personal reasons, 1 emigrated), 17 of them developed DM. For the remaining 28 patients, 14 attended less than 4 years (incomplete FU), and only 14 of them completed 4 to 5 years; among them 11 were able to achieve significant weight reduction.
- 17/45 (38%) developed DM within the FU period (excluded defaulters).
- 12 /17 (70%) diagnosed DM were overweight (BMI > 23), 10/17 (58) had further weight gain (2 to 14%) after recruitment.
- 11/14 (79%) who completed the program had significant weight loss and trend of insulin resistance improvement.
Limitation:
Single arm without control or confounding correction
Conclusion:
1. High default rate for the preventive program (34/90: 38%), innovative design like teleconferencing or coordination with NGO may be necessary.
2. Significant number of patients had significant weight loss and insulin resistance improvement after completion of the program.
