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Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 6/2018

01-06-2018

The Impact of a Cultural Lifestyle Intervention on Metabolic Parameters After Gestational Diabetes Mellitus A Randomized Controlled Trial

Authors: Dana Zilberman-Kravits, Naomi Meyerstein, Yones Abu-Rabia, Arnon Wiznitzer, Ilana Harman-Boehm

Published in: Maternal and Child Health Journal | Issue 6/2018

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Abstract

Objectives

The prevalence of type 2 diabetes in Israel is increasing in all ethnic groups but most markedly in the Bedouin population. We aimed to assess the effects of a lifestyle change intervention on risk markers for type 2 diabetes after gestational diabetes mellitus (GDM).

Methods

One hundred eighty Jewish and Bedouin post-GDM women were randomly assigned to a lifestyle intervention group (IG) or a control group (CG) starting 3–4 months after delivery. The IG participated in healthy lifestyle sessions led by a dietician and a sports instructor for 24 months after delivery. The IG participants had three individual 45-min counseling sessions and four 90-min group meetings (10 women each). The dietary and exercise recommendations were culturally adapted. The primary outcome of the study was HOMA-IR. We monitored clinical and chemical biomarkers 1 and 2 years after delivery.

Results

After 1 and 2 years of intervention, the metabolic measures improved substantially. The intervention reduced the insulin, glucose and HOMA-IR levels in the IG compared with those in the CG (p < 0.001).

Conclusions

This novel culturally tailored lifestyle intervention program significantly improved the metabolic and morphometric indices measured 1 and 2 years after delivery. These results highlight and underscore the importance of effective lifestyle change education following GDM.
Literature
Abou-Rbiah, Y., & Weitzman, S. (2002). Diabetes among bedouins in the negev: The transition from a rare to a highly prevalent condition. The Israel Medical Association Journal: IMAJ, 4(9), 687–689.PubMed
American Diabetes Association. (2014). Standards of medical care in diabetes-2014. Diabetes Care, 37(Suppl 1), S14-80.
Aroda, V. R., Christophi, C. A., Edelstein, S. L., Zhang, P., Herman, W. H., & Barrett-Connor, E., et al. (2015). The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: The diabetes prevention program outcomes study 10-year follow-up. The Journal of Clinical Endocrinology and Metabolism, 100(4), 1646–1653. https://​doi.​org/​10.​1210/​jc.​2014-3761.CrossRefPubMedPubMedCentral
Bazzano, L. A., Hu, T., Reynolds, K., Yao, L., Bunol, C., Liu, Y., et al. (2014). Effects of low-carbohydrate and low-fat diets: A randomized trial. Annals of Internal Medicine, 161(5), 309–318.CrossRefPubMedPubMedCentral
Bonora, E., Targher, G., Alberiche, M., Bonadonna, R. C., Saggiani, F., Zenere, M. B., et al. (2000). Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: Studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care, 23(1), 57–63.CrossRefPubMed
Buchanan, T. A. (2001). Pancreatic B-cell defects in gestational diabetes: Implications for the pathogenesis and prevention of type 2 diabetes. The Journal of Clinical Endocrinology and Metabolism, 86(3), 989–993.CrossRefPubMed
Chodick, G., Elchalal, U., Sella, T., Heymann, A. D., Porath, A., Kokia, E., & Shalev, V. (2010). The risk of overt diabetes mellitus among women with gestational diabetes: A population-based study. Diabetic Medicine:. A Journal of the British Diabetic Association, 27(7), 779–785.CrossRef
Fletcher, B., Gulanick, M., & Lamendola, C. (2002). Risk factors for type 2 diabetes mellitus. The Journal of Cardiovascular Nursing, 16(2), 17–23.CrossRefPubMed
Foster, G. D., Wyatt, H. R., Hill, J. O., Makris, A. P., Rosenbaum, D. L., Brill, C., et al. (2010). Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: A randomized trial. Annals of Internal Medicine, 153(3), 147–157.CrossRefPubMedPubMedCentral
American Diabetes Association. (2004). Gestational diabetes mellitus. Diabetes Care, 27(suppl 1), s88–s90.
Harlev, A., & Wiznitzer, A. (2010). New insights on glucose pathophysiology in gestational diabetes and insulin resistance. Current Diabetes Reports, 10(3), 242–247.CrossRefPubMed
Kalter-Leibovici, O., Chetrit, A., Lubin, F., Atamna, A., Alpert, G., Ziv, A., et al. (2012). Adult-onset diabetes among Arabs and Jews in Israel: A population-based study. Diabetic Medicine. A Journal of the British Diabetic Association, 29(6), 748–754.CrossRefPubMed
Kessous, R., Shoham-Vardi, I., Pariente, G., Sherf, M., & Sheiner, E. (2013). An association between gestational diabetes mellitus and long-term maternal cardiovascular morbidity. Heart, 99(15), 1118–1121.CrossRefPubMed
Kim, C., Berger, D. K., & Chamany, S. (2007). Recurrence of gestational diabetes mellitus: A systematic review. Diabetes Care, 30(5), 1314–1319.CrossRefPubMed
Kim, C., McEwen, L. N., Piette, J. D., Goewey, J., Ferrara, A., & Walker, E. A. (2007). Risk perception for diabetes among women with histories of gestational diabetes mellitus. Diabetes Care, 30(9), 2281–2286.CrossRefPubMed
Kim, C., Newton, K. M., & Knopp, R. H. (2002). Gestational diabetes and the incidence of type 2 diabetes: A systematic review. Diabetes Care, 25(10), 1862–1868.CrossRefPubMed
Kim, C., Tabaei, B. P., Burke, R., McEwen, L. N., Lash, R. W., Johnson, S. L., et al. (2006). Missed opportunities for type 2 diabetes mellitus screening among women with a history of gestational diabetes mellitus. American Journal of Public Health, 96(9), 1643–1648.CrossRefPubMedPubMedCentral
Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., & Walker, E. A., et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6), 393–403.CrossRef
Lindstrom, J., Ilanne-Parikka, P., Peltonen, M., Aunola, S., Eriksson, J. G., & Hemio, K., et al. (2006). Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow-up of the finnish diabetes prevention study. Lancet, 368(9548), 1673–1679.CrossRefPubMed
Negami, M., Takahashi, E., Otsuka, H., & Moriyama, K. (2012). Prediction of homeostasis model assessment of insulin resistance in japanese subjects. The Tokai Journal of Experimental and Clinical Medicine, 37(4), 102–106.PubMed
Osgood, N. D., Dyck, R. F., & Grassmann, W. K. (2011). The inter- and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes. American Journal of Public Health, 101(1), 173–179.CrossRefPubMedPubMedCentral
Pols, M. A., Peeters, P. H., Ocke, M. C., Slimani, N., Bueno-de-Mesquita, H. B., & Collette, H. J. (1997). Estimation of reproducibility and relative validity of the questions included in the EPIC physical activity questionnaire. International Journal of Epidemiology, 26(Suppl 1), S181-9.PubMed
Ratner, R. E., Christophi, C. A., Metzger, B. E., Dabelea, D., Bennett, P. H., & Pi-Sunyer, X., et al. (2008). Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions. The Journal of Clinical Endocrinology and Metabolism, 93(12), 4774–4779.CrossRefPubMedPubMedCentral
Reece, E. A., Leguizamon, G., & Wiznitzer, A. (2009). Gestational diabetes: The need for a common ground. Lancet, 373(9677), 1789–1797.CrossRefPubMed
Rosner, B. (1995). Fundamentals of biostatistics (4th edn, p. 221). Belmont, CA: Duxbury Press.
Saaristo, T., Moilanen, L., Korpi-Hyovalti, E., Vanhala, M., Saltevo, J., Niskanen, L.,.. . Keinanen-Kiukaanniemi, S. (2010). Lifestyle intervention for prevention of type 2 diabetes in primary health care: One-year follow-up of the finish national diabetes prevention program (FIN-D2D). Diabetes Care, 33(10), 2146–2151.CrossRefPubMedPubMedCentral
Shahar, D., Fraser, D., Shai, I., & Vardi, H. (2003). Development of a food frequency questionnaire (FFQ) for an elderly population based on a population survey. The Journal of Nutrition, 133(11), 3625–3629.CrossRefPubMed
Shahar, D., Shai, I., Vardi, H., Brener-Azrad, A., & Fraser, D. (2003). Development of a semi-quantitative food frequency questionnaire (FFQ) to assess dietary intake of multiethnic populations. European Journal of Epidemiology, 18(9), 855–861.CrossRefPubMed
Shai, I., Rosner, B. A., Shahar, D. R., Vardi, H., Azrad, A. B., Kanfi, A.,.. . DEARR study (2005). Dietary evaluation and attenuation of relative risk: Multiple comparisons between blood and urinary biomarkers, food frequency, and 24-hour recall questionnaires: The DEARR study. The Journal of Nutrition, 135(3), 573–579.CrossRefPubMed
Shai, I., Shahar, D. R., Vardi, H., & Fraser, D. (2004). Selection of food items for inclusion in a newly developed food-frequency questionnaire. Public Health Nutrition, 7(6), 745–749.CrossRefPubMed
Shai, I., Vardi, H., Shahar, D. R., Azrad, A. B., & Fraser, D. (2003). Adaptation of international nutrition databases and data-entry system tools to a specific population. Public Health Nutrition, 6(4), 401–406.CrossRefPubMed
Siddiqui, F., Kurbasic, A., Lindblad, U., Nilsson, P. M., & Bennet, L. (2017). Effects of a culturally adapted lifestyle intervention on cardio-metabolic outcomes: A randomized controlled trial in iraqi immigrants to sweden at high risk for type 2 diabetes. Metabolism: Clinical and Experimental, 66, 1–13.CrossRef
Stern, E., Raz, I., & Weitzman, S. (1999). Prevalence of diabetes mellitus among workers in Israel: A nation-wide study. Acta Diabetologica, 36(4), 169–172.CrossRefPubMed
Symons Downs, D., & Ulbrecht, J. S. (2006). Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus. Diabetes Care, 29(2), 236–240.CrossRefPubMed
Tamir, O., Peleg, R., Dreiher, J., Abu-Hammad, T., Rabia, Y. A., Rashid, M. A., et al. (2007). Cardiovascular risk factors in the bedouin population: Management and compliance. The Israel. Medical Association Journal: IMAJ, 9(9), 652–655.
Torgerson, J. S., Hauptman, J., Boldrin, M. N., & Sjostrom, L. (2004). XENical in the prevention of diabetes in obese subjects (XENDOS) study: A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care, 27(1), 155–161.CrossRefPubMed
Turner, R. C. (1998). The U.K. prospective diabetes study. A Review. Diabetes Care, 21(Suppl 3), C35-8.PubMed
Verma, A., Boney, C. M., Tucker, R., & Vohr, B. R. (2002). Insulin resistance syndrome in women with prior history of gestational diabetes mellitus. The Journal of Clinical Endocrinology and Metabolism, 87(7), 3227–3235.CrossRefPubMed
Wiznitzer, A., Mayer, A., Novack, V., Sheiner, E., Gilutz, H., Malhotra, A., & Novack, L. (2009). Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: A population-based study. American Journal of Obstetrics and Gynecology, 201(5), 482.e1–482.e8.CrossRef
Metadata
Title
The Impact of a Cultural Lifestyle Intervention on Metabolic Parameters After Gestational Diabetes Mellitus A Randomized Controlled Trial
Authors
Dana Zilberman-Kravits
Naomi Meyerstein
Yones Abu-Rabia
Arnon Wiznitzer
Ilana Harman-Boehm
Publication date
01-06-2018
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 6/2018
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-018-2450-0

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