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Ukke GG, Boyle JA, Reja A, Lee WK, Chen M, Ko MSM, Alycia C, Kwon J, Lim S. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity. Nutrients 2023; 15:4666. [PMID: 37960319 PMCID: PMC10649749 DOI: 10.3390/nu15214666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. OBJECTIVE This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. METHODS MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. RESULTS All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). CONCLUSION There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.
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Affiliation(s)
- Gebresilasea Gendisha Ukke
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Jacqueline A. Boyle
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Ahmed Reja
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Wai Kit Lee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia;
| | - Michelle Shi Min Ko
- MD Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore;
| | - Chelsea Alycia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Jane Kwon
- Diabetes Victoria, Suite G01/15-31 Pelham St, Carlton, VIC 3053, Australia;
| | - Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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A pilot study examining the impact of a brief health education intervention on food choices and exercise in a Latinx college student sample. Appetite 2022; 173:105979. [PMID: 35245642 DOI: 10.1016/j.appet.2022.105979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022]
Abstract
Healthy eating and physical activity (PA) necessitate interventions designed to increase these behaviors. Self-Determination Theory (SDT) posits addressing psychological needs to promote intrinsic motivation, while the Transtheoretical Model (TTM) posits progression through stages of change consistent with contemplating processes of change. Previous findings suggest the efficacy of combining these approaches to understand, initiate, and maintain behavior. This study assessed a pilot intervention to increase healthy eating and PA based on components derived from SDT and TTM. Latinx college students (N = 267) were randomized to either the Fit U intervention or the self-monitoring only group. The Fit U intervention augmented self-monitoring with personalized, culturally-tailored motivational enhancement feedback and goal setting. Inferential analyses used hierarchical regression models to predict total calorie intake, fruit and vegetable (FV) intake, eating behavior, PA, and perceived competence for diet and exercise. Logistic regression models were used to examine changes in motivation to engage in a healthy diet and PA at post-test. Findings suggest those in Fit U reported lower calorie intake (β = 0.143, p = .023), improvement in healthy eating (β = -0.157, p < .001), increased perceived competence for diet (β = -0.145, p = .007) and exercise (β = -0.167, p = .003), and progression through the stages of change for exercise (OR = 0.297, p = .003). Findings suggest the efficacy of personalized, culturally-tailored motivational enhancement and goal setting beyond simply self-monitoring on healthy eating and PA outcomes in Latinx college students. Future directions include assessing the impact of Fit U on a larger scale and including long term follow-up assessments to assess the sustainability of eating and PA changes and their impact on superordinate outcomes such as weight loss.
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Weight Loss Interventions for Hispanic Women in the United States: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:8714873. [PMID: 34457010 PMCID: PMC8397533 DOI: 10.1155/2021/8714873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
Background Obesity rates in Hispanic women residing in the United States (U.S.) are disproportionately high, increasing the risk of obesity-related disease and mortality. The effectiveness of interventions targeting weight loss in this population remains largely unknown. Purpose The purpose of this review was to systematically evaluate the evidence related to the effectiveness of weight loss interventions conducted among U.S. Hispanic women and provide guidance for future research. Methods Bibliographic databases (n = 10, from each database's inception to July 2, 2019) were searched using the PRISMA guidelines for systematic reviews. Randomized controlled trials (RCTs) and quasi-experimental studies with weight change outcomes were included. Results were described in a narrative synthesis. Results 5,423 articles were assessed for eligibility based on inclusion criteria; 15 studies were included in the final review. Nine trials were RCTs and six were quasi-experimental studies; all but six were pilot studies. Most studies recruited overweight or obese women with no existing medical conditions and did not follow participants beyond the intervention. All trials were delivered in-person. Intervention strategies and content and weight change outcomes were highly variable. Conclusions RCTs with statistically powered sample sizes are needed to robustly test the effects of weight loss interventions in this population.
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Smith-Miller CA, Berry DC, Miller CT. Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:44-55. [PMID: 33906459 DOI: 10.1177/15404153211011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.
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Affiliation(s)
- Cheryl A Smith-Miller
- UNC Medical Center, Nursing Quality and Research, Chapel Hill, NC, USA.,Office of Human Research Ethics, University of North Carolina-Chapel Hill, NC, USA.,School of Nursing, University of North Carolina-Chapel Hill, NC, USA
| | - Diane C Berry
- Co-Director Interventions for Preventing and Managing Chronic Illness (T32-NIH/NINR); Optimizing Outcomes in Women with Gestational Diabetes and their Infants (NIH/NIDDK); Diabetes Group Visits (Kate B. Reynolds), School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Cass T Miller
- Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
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Daneshmand SS, Stortz S, Morrisey R, Faksh A. Bridging Gaps and Understanding Disparities in Gestational Diabetes Mellitus to Improve Perinatal Outcomes. Diabetes Spectr 2019; 32:317-323. [PMID: 31798289 PMCID: PMC6858080 DOI: 10.2337/ds19-0013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IN BRIEF For a woman who is facing financial, cultural, psychological, or social challenges, discovering that she has gestational diabetes mellitus (GDM) represents a significant burden. By better understanding challenges underserved women with GDM face, multidisciplinary clinical teams can make essential changes in health care delivery to optimize outcomes not just during pregnancy, but also, equally importantly, beyond pregnancy to prevent long-term disease.
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Affiliation(s)
- Sean S. Daneshmand
- Division of Perinatology, Department of Obstetrics and Gynecology, Scripps Memorial Hospital La Jolla, San Diego, CA
| | - Sharon Stortz
- Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, CA
| | | | - Arij Faksh
- Division of Perinatology, Department of Obstetrics and Gynecology, Scripps Memorial Hospital La Jolla, San Diego, CA
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Abstract
PURPOSE OF REVIEW Gestational diabetes (GDM) is associated with adverse pregnancy and neonatal outcomes and increased maternal risk for subsequent type 2 diabetes. The best diagnostic strategy for GDM is debated and the role of oral antidiabetic medications (OAD) for treatment is unclear. In this paper, we review methods of GDM diagnosis, updates in GDM therapy, and interventions to reduce future type 2 diabetes in women with a history of GDM. RECENT FINDINGS A "one-step" screening protocol for GDM using 75-g, 2-h oral glucose tolerance testing at 24-28 weeks gestation is recommended by the International Association of the Diabetes and Pregnancy Study Groups, the American Diabetes Association, and the Endocrine Society. This strategy identifies a milder degree of hyperglycemia and thus increases GDM prevalence. Studies indicate that in these cases of mild hyperglycemia, treatment decreases pregnancy and neonatal complications. Insulin analogues including detemir, aspart, and lispro have been shown to be safe in pregnancy with a pregnancy category B classification. Growing literature suggests that sulfonylureas cross the placenta and are associated with increased incidence of macrosomia and neonatal hypoglycemia. Telephone or online diabetes prevention program (DPP)-based interventions for women with GDM have shown encouraging results in pilot studies. Insurance coverage remains a barrier. Additional studies are needed to determine the safety of OAD in pregnancy. Public policy supporting DPP could help improve patient access to these proven interventions.
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Affiliation(s)
- Laura T Dickens
- Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA.
| | - Celeste C Thomas
- Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA
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Maine A, Brown MJ, Dickson A, Truesdale M. Pilot feasibility study of the Walking Away from Diabetes programme for adults with intellectual disabilities in two further education colleges: Process evaluation findings. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1034-1046. [PMID: 30941841 DOI: 10.1111/jar.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/11/2019] [Accepted: 02/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND People with intellectual disabilities remain at high risk of developing type 2 diabetes (T2D) due to lifestyle-associated risk factors. Educational programmes have been adapted for people with intellectual disabilities targeting ongoing T2D self-management. However, there are no adapted programmes which aim to prevent T2D through reducing risk factors. The present study initiates addressing this gap. METHODS Further education (FE) colleges in Scotland were recruited for feasibility study using the Walking Away (WA) from Diabetes programme. Process evaluation assessed recruitment, retention, baseline physical activity levels, and acceptability and accessibility using focus groups. RESULTS Ninety six percent of invited students agreed to participate. WA was positively received, and some short-term impact was described. Suggestions for further adaptations regarding materials, delivery and content were provided, including delivery embedded within FE college curriculum. CONCLUSIONS Recruitment, retention and acceptability provide rationale for further research on T2D prevention in FE colleges.
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Affiliation(s)
- Andrew Maine
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Michael J Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Adele Dickson
- Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Maria Truesdale
- Edinburgh Napier University School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Maine A, Brown MJ, Dickson A, Truesdale M. An evaluation of mainstream type 2 diabetes educational programmes in relation to the needs of people with intellectual disabilities: A systematic review of the literature. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:256-279. [PMID: 30457200 DOI: 10.1111/jar.12544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Risk reduction and self-management programs for type 2 diabetes (T2D) are commonplace. However, little is known about their appropriateness for people with intellectual disabilities (ID). This review evaluates successful components and theoretical basis of interventions and preventions in relation to the needs of people with ID with or at risk of T2D. METHOD Characteristics of 23 randomised controlled trialled T2D educational programs were systematically assessed alongside the needs of people with ID, and evaluated in terms of study design and theoretical application. RESULTS Successful components of programs align to the needs of people with ID. Further adaptations are required to ensure accessibility of materials and social support to enable reflection on illness perceptions and self-efficacy, as underpinned by Self-regulation and Social-cognitive theories. CONCLUSIONS Support is provided for further trials of self-management and preventative adaptations under development. Impact may be enhanced through preventions aimed at younger groups in educational settings.
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Affiliation(s)
- Andrew Maine
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Michael J Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Adele Dickson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Truesdale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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