Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/111570
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Type: Journal article
Title: Mothers after Gestational Diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program
Author: O Reilly, S.
Dunbar, J.
Versace, V.
Janus, E.
Best, J.
Carter, R.
Oats, J.
Skinner, T.
Ackland, M.
Phillips, P.
Ebeling, P.
Reynolds, J.
Shih, S.
Hagger, V.
Coates, M.
Wildey, C.
Citation: PLoS Medicine, 2016; 13(7):e1002092-1-e1002092-21
Publisher: Public Library Science
Issue Date: 2016
ISSN: 1549-1277
1549-1676
Statement of
Responsibility: 
Sharleen L. O, Reilly, James A. Dunbar, Vincent Versace, Edward Janus, James D. Best, Rob Carter, Jeremy J. N. Oats, Timothy Skinner, Michael Ackland, Paddy A. Phillips, Peter R. Ebeling, John Reynolds, Sophy T. F. Shih, Virginia Hagger, Michael Coates, Carol Wildey, MAGDA Study Group
Abstract: Background: Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. Methods and Findings: In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: −0.23 kg body weight in intervention group (95% CI −0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference −0.95 kg, 95% CI −1.87, −0.04; group by treatment interaction p = 0.04); −2.24 cm waist measurement in intervention group (95% CI −3.01, −1.42) compared with −1.74 cm in usual care group (95% CI −2.52, −0.96) (change difference −0.50 cm, 95% CI −1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference −0.05 mmol/l, 95% CI −0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. Conclusions: Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention.
Keywords: Diabetes Mellitus, Type 2
Rights: © 2016 O’Reilly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
RMID: 0030081927
DOI: 10.1371/journal.pmed.1002092
Grant ID: http://purl.org/au-research/grants/nhmrc/533956
Appears in Collections:Obstetrics and Gynaecology publications

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