Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.

BACKGROUND: One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes. The COM-B model (incorporating Capability, Opportunity, and Motivational behavioral barriers and enablers) and the Behavior Change Wheel (BCW) framework, convey a theoretically based approach for intervention development. We combined a health literacy-tailored health IT tool for reaching ethnic minority patients with diabetes with a BCW-based approach to develop a health coaching intervention targeted to postpartum Latina women with recent gestational diabetes. Current evidence, four focus groups (n = 22 participants), and input from a Regional Consortium of health care providers, diabetes experts, and health literacy practitioners informed the intervention development. Thematic analysis of focus group data used the COM-B model to determine content. Relevant cultural, theoretical, and technological components that underpin the design and development of the intervention were selected using the BCW framework. RESULTS: STAR MAMA delivers DPP content in Spanish and English using health communication strategies to: (1) validate the emotions and experiences postpartum women struggle with; (2) encourage integration of prevention strategies into family life through mothers becoming intergenerational custodians of health; and (3) increase social and material supports through referral to social networks, health coaches, and community resources. Feasibility, acceptability, and health-related outcomes (weight loss, physical activity, consumption of healthy foods, breastfeeding, and glucose screening) will be evaluated at 9 months postpartum using a randomized controlled trial design. CONCLUSIONS: STAR MAMA provides a DPP-based intervention that integrates theory-based design steps. Through systematic use of behavioral theory to inform intervention development, STAR MAMA may represent a strategy to develop health IT intervention tools to meet the needs of diverse populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT02240420.

The risk of a persistent glucose metabolism impairment after gestational diabetes mellitus is increased in patients with polycystic ovary syndrome.

OBJECTIVE: To test the hypothesis that the risk of persistent glucose impairment after gestational diabetes mellitus (GDM) is increased in patients with polycystic ovary syndrome (PCOS). RESEARCH DESIGN AND METHODS: The prospective case-control study included 42 pregnant patients with PCOS and GDM and 84 pregnant control patients with GDM but without clinical and biochemical hyperandrogenism, polycystic ovaries, and oligo-anovulation. The case and control subjects were matched one to two for age and BMI. The glycemic profiles were studied in all subjects 6 weeks, 12 weeks, and 18 months after delivery. The incidence and the relative risk (RR) were calculated for overall persistence of an abnormal glycemic pattern and for each specific alteration, i.e., impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus (DM). RESULTS: At 18 months after delivery, the incidences of IFG, IGT, and IFG-IGT were significantly (P < 0.05) higher in the cases than in the controls. At the 18-month follow-up, the RR for the composite outcome of glucose metabolism impairment in PCOS women was 3.45 (95% CI 1.82-6.58). CONCLUSIONS: Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM.

Self-efficacy, social support, and associations with physical activity and body mass index among women with histories of gestational diabetes mellitus.

PURPOSE: To examine the associations between 2 potential facilitators of healthy behaviors (self-efficacy and social support), and both physical activity and body mass index (BMI) among women with histories of gestational diabetes mellitus (GDM). METHODS: Two hundred and twenty-eight women with histories of GDM who were enrolled in a managed care plan were surveyed. A cross-sectional analysis was used to assess the association between women's social support from family and friends for physical activity and self-efficacy for physical activity with women's physical activity levels. The association between women's social support from family and friends for healthy diet and self-efficacy for not overeating and their dietary habits also were examined. Finally, the association between all of these psychosocial constructs and body mass index (BMI) were assessed before and after adjustment for covariates. RESULTS: Participants reported low to moderate social support and self-efficacy scores, suboptimal performance of physical activity, suboptimal dietary scores, and high BMIs. Self-efficacy and social support from family and friends for physical activity were associated with physical activity. Social support from family and friends for a healthy diet was associated with better dietary scores, and the association between self-efficacy for not overeating and healthy diet bordered on significance. No significant associations existed between psychosocial constructs and BMI. CONCLUSIONS: Psychosocial constructs such as social support and self-efficacy are associated with physical activity and dietary habits. However, associations with BMI are weak. Further exploration of constructs associated with BMI may be needed to design effective weight-loss interventions in this population.

Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy.

AIM: To investigate whether modular out-patient group education for flexible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes-associated neonatal complications in pregestational diabetes. RESEARCH DESIGN AND METHODS: Outcome analysis of the modular out-patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases first after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54). CONTROLS: (a) diabetic pregnancies: historical controls; (b) non-diabetic pregnancies: retrospective case-controlled study; (c) population-based data of all Austrian newborns registered within the respective time period. RESULTS: HbA1c of 113 +/- 18% of mean value (= 100%) of non-diabetic, non-pregnant population (103 +/- 14% during the last pregnancy trimester), and self-monitored blood glucose of 5.6 +/- 0.7 mmol/l (5.3 +/- 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 +/- 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 +/- 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population-based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non-diabetic women, a lowering of diabetes-related neonatal complication rates to general population levels. CONCLUSIONS: Structured, comprehensive, modular out-patient group education promoting self-choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.

Diabetes mellitus gestacional

La gestación ha sido considerada ®diabetogénica¼ debido a los cambios metabólicos que conducen a una marcada resistencia a la insulina. Esta alteración se asocia con un aumento de la morbilidad perinatal, en parte por la macrosomía que produce, y que si no es tratada también puede aumentar un poco la mortalidad perinatal. Se estima que el 47 por ciento de las mujeres que padecen diabetes mellitus gestacional, desarrolla una diabetes mellitus no insulino dependiente después de cinco años. Se recomienda el tamizaje para la diabetes gestacional en todas las pacientes embarazadas. La prueba de tamizaje se realiza con una carga de 50g de glucosa oral entre semanas 24 y 28 de la gestación. Las pacientes con resultados positivos en esta prueba usualmente deben ser sometidas a una prueba de tolerancia a la glucosa de 3 horas para definir el diagnóstico. Se describe la fisiopatología de este trastorno y se analizan los principales factores de riesgo asociados. Por último, se dan las recomendadas en la conferencia internacional de trabajo en diabetes gestacional para el tamizaje y diagnóstico.