Lifestyle Intervention May Help Reduce T2D Risk in Women With Prior Gestational Diabetes

Current published evidence suggests lifestyle interventions can help reduce the risk of type 2 diabetes (T2D) in women with prior gestational diabetes (GDM), according to a review published in Diabetes, Obesity and Metabolism.

However, the authors emphasized this review’s findings should be interpreted with caution due to documented publication bias.

Lifestyle interventions such as dietary changes and physical activity have been shown to reduce likelihood of progression to T2D in patients at high-risk, such as those with pre-diabetes. Another high-risk population is women with prior GDM, who are 7 times more likely to develop T2D compared with women without GDM.

“This risk of developing T2DM is greatest within the first decade after the pregnancy in which GDM was diagnosed,” the authors said. “Accordingly, women with recent GDM could benefit from intervention to reduce their risk of progression to T2DM.”

To assess this, the authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between January 1, 1950, and December 14, 2022. The review included 3745 women across 13 eligible studies that compared lifestyle intervention with standard of care in women with prior GDM.

Eligible studies included RCTs conducted in women with prior GDM, studies comparing lifestyle interventions—including any intensive dietary advice, physical activity advice, or both—with standard of care, and studies reporting T2D incidence during follow-up.

Studies were excluded if lifestyle interventions lasted less than 3 months, if there was no control group, and if they were retrospective or observational in design.

According to a pooled analysis of these 13 studies, lifestyle intervention was linked to a 24% reduction in T2D incidence compared with standard of care (relative risk [RR], 0.76; 95% CI, 0.63-0.93).

A sensitivity analysis including 6 studies that applied similar intensive lifestyle modification as the study intervention demonstrated a positive impact of lifestyle on diabetes prevention (RR, 0.54; 95% CI, 0.38-0.78; I2 34.2%).

Meta-regression analyses also showed the duration of lifestyle intervention (P = .81) and baseline body mass index (P = .90) had no impact on reduced T2D incidence. The pooled analysis also highlighted evidence of publication bias on funnel plot and Egger Test (P = .048). The authors added that the trim-and-fill computation, which adjusted the estimates for this publication bias, did not affect the results of the meta-analysis.

“However, there are nuances to recognize in the interpretation of these data, including the modest degree of risk reduction and limitations inherent within the trials comprising this literature to date,” the authors noted. “In this context, measured interpretation of these findings suggests that lifestyle intervention alone may not be sufficient for effective diabetes prevention in this high-risk patient population in practice.”

Reference

Retnakaran M, Viana LV, Kramer CK. Lifestyle intervention for the prevention of type 2 diabetes in women with prior gestational diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. Published online January 3, 2023. doi:10.1111/dom.14966