Current published evidence suggests that lifestyle interventions can help reduce the risk of type 2 diabetes (T2D) in women with previous gestational diabetes (GDM), according to a review published in Diabetes, obesity and metabolism.
However, the authors emphasized that the findings of this review should be interpreted with caution due to documented publication bias.
Lifestyle interventions such as dietary changes and physical activity have been shown to reduce the likelihood of progression to T2D in high-risk patients such as those with prediabetes. Another high-risk population is women with previous GDM, who are 7 times more likely to develop T2D compared to women without GDM.
“This risk of developing T2DM is greatest during the first decade after the pregnancy in which GDM is diagnosed,” the authors said. “Accordingly, women with recent GDM could benefit from an intervention to reduce the risk of progression to T2DM.”
To assess this, the authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 1 January 1950 and 14 December 2022. The review included 3,745 women in 13 eligible trials that compared a lifestyle intervention with standard care in women with previous GDM.
Eligible studies included RCTs conducted in women with previous GDM, studies comparing lifestyle interventions – including any intensive dietary recommendations, physical activity recommendations or both – with standard care, and studies reporting incidence of T2D during follow-up.
Studies were excluded if the lifestyle interventions lasted less than 3 months, if there was no control group, and if they were retrospective or observational.
According to a pooled analysis of these 13 studies, a lifestyle intervention was associated with a 24% reduction in T2D incidence compared with standard care (relative risk [RR]0.76; 95% CI, 0.63-0.93).
A sensitivity analysis including 6 studies that applied similarly intensive lifestyle modification as the study intervention demonstrated a positive effect of lifestyle on diabetes prevention (RR, 0.54; 95% CI, 0.38-0.78; I2 34.2%) .
Meta-regression analyzes also showed the duration of the lifestyle intervention (P = 0.81) and baseline body mass index (P = 0.90) had no effect on the reduced incidence of T2D. The pooled analysis also highlighted evidence of publication bias in the funnel plot and Egger’s test (P = 0.048). The authors added that the trim-and-fill calculation, which adjusted the estimates for this publication bias, did not affect the results of the meta-analysis.
“However, there are nuances that need to be recognized in the interpretation of these data, including the modest degree of risk reduction and limitations inherent in studies to date involving this literature,” the authors noted. “In this context, a measured interpretation of these findings suggests that lifestyle intervention alone may not be sufficient in practice to effectively prevent diabetes in this high-risk patient population.”
Retnakaran M, Viana LV, Kramer CK. Lifestyle interventions for the prevention of type 2 diabetes in women with previous gestational diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. Published online January 3, 2023. doi:10.1111/dom.14966