title: Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program.
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.
  
  
  RESULTS
  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.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12610000338066.
authors.affiliation: Institute of Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia.
authors.forename: Sharleen L
authors.initials: SL
authors.lastname: O'Reilly
authors.affiliation: Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
authors.forename: James A
authors.identifier: http://orcid.org/0000-0003-0866-4365
authors.initials: JA
authors.lastname: Dunbar
authors.affiliation: School of Medicine, Deakin University, Warrnambool, Victoria, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Versace
authors.affiliation: Department of Medicine, Melbourne Medical School-Western Precinct, University of Melbourne, St Albans, Victoria, Australia.|General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria, Australia.
authors.forename: Edward
authors.identifier: http://orcid.org/0000-0003-0213-4515
authors.initials: E
authors.lastname: Janus
authors.affiliation: Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore.
authors.forename: James D
authors.initials: JD
authors.lastname: Best
authors.affiliation: Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Carter
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Jeremy J N
authors.initials: JJ
authors.lastname: Oats
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia.
authors.forename: Timothy
authors.identifier: http://orcid.org/0000-0002-0018-6963
authors.initials: T
authors.lastname: Skinner
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ackland
authors.affiliation: Department of Medicine, Flinders University, Bedford Park, South Australia, Australia.|SA Health, Adelaide, South Australia, Australia.
authors.forename: Paddy A
authors.identifier: http://orcid.org/0000-0002-9985-7631
authors.initials: PA
authors.lastname: Phillips
authors.affiliation: Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Ebeling
authors.affiliation: Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-8825-8625
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
authors.forename: Sophy T F
authors.initials: ST
authors.lastname: Shih
authors.affiliation: Diabetes Australia Victoria, Melbourne, Victoria, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hagger
authors.affiliation: School of Medicine, Deakin University, Warrnambool, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Coates
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Wildey
mesh_terms: D000328:Adult; D001315:Australia; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000517:prevention & control*; D005260:Female; D006801:Humans; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D055105:Waist Circumference