Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program

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dc.contributor.author O'Reilly, Sharleen L
dc.contributor.author Dunbar, James A
dc.contributor.author Versace, Vincent L
dc.contributor.author Janus, Edward
dc.contributor.author Best, James D
dc.contributor.author Carter, Rob
dc.contributor.author Oats, Jeremy J N
dc.contributor.author Skinner, Timothy
dc.contributor.author Ackland, Michael
dc.contributor.author Phillips, Paddy Andrew
dc.contributor.author Ebeling, Peter R
dc.contributor.author Reynolds, John
dc.contributor.author Shih, Sophy T F
dc.contributor.author Hagger, Virginia
dc.contributor.author Coates, Michael
dc.contributor.author Wildey, Carol
dc.contributor.author Study Group, MAGDA
dc.date.accessioned 2016-11-07T00:01:36Z
dc.date.available 2016-11-07T00:01:36Z
dc.date.issued 2016
dc.description 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. en
dc.description.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. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12610000338066 en
dc.identifier.citation O’Reilly SL, Dunbar JA, Versace V, et al. Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program. Wareham NJ, ed. PLoS Medicine. 2016;13(7):e1002092. doi:10.1371/journal.pmed.1002092. en
dc.identifier.doi https://doi.org/10.1371/journal.pmed.1002092 en
dc.identifier.issn 1549-1277
dc.identifier.uri http://hdl.handle.net/2328/36589
dc.language.iso en
dc.oaire.license.condition.license CC-BY
dc.publisher Public Library of Science en
dc.rights Copyright © 2016 O’Reilly et al en
dc.rights.holder The Authors en
dc.title Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program en
dc.type Article en
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