Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM) A dietary exchange of common bread for tailored bread of low glycaemic index and rich in dietary fibre improved insulin economy in young women with impaired glucose tolerance Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Randomized crossover study of 40% vs. 55% carbohydrate weight loss strategies in women with previous gestational diabetes mellitus and non-diabetic women of 130-200% ideal body weight. A Trial of Simple versus Intensified Dietary Modification for Prevention of Progression to Diabetes Mellitus in Women with Impaired Glucose Tolerance
Background Gestational Diabetes Mellitus ( GDM ) increases risks for type 2 diabetes and weight management is recommended to reduce the risk . Conventional dietary recommendations ( energy-restricted , low fat ) have limited success in women with previous GDM . The effect of lowering Glycaemic Index ( GI ) in managing glycaemic variables and body weight in women post-GDM is unknown . Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education , in the management of glucose tolerance and body weight in Asian women with previous GDM . MethodS eventy seven Asian , non-diabetic women with previous GDM , between 20- 40y were r and omised into Conventional healthy dietary recommendation ( CHDR )  and  low GI  ( LGI ) groups . CHDR received conventional dietary recommendations only ( energy restricted , low in fat and refined sugars , high-fibre ) . LGI group received advice on lowering GI in addition . Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test ( 2HPP ) were measured at baseline and 6 months after intervention . Anthropometry and dietary intake were assessed at baseline , three and six months after intervention . The study is registered at the Malaysian National Medical Research Register ( NMRR ) with Research ID : 5183 . Results After 6 months , significant reductions in body weight , BMI and waist-to-hip ratio were observed only in LGI group ( P<0.05 ) . Mean BMI changes were significantly different between groups ( LGI vs. CHDR : -0.6 vs. 0 kg/m2 , P= 0.03 ) . More subjects achieved weight loss ≥5 % in LGI compared to CHDR group ( 33 % vs. 8 % , P=0.01 ) . Changes in 2HPP were significantly different between groups ( LGI vs. CHDR : median ( IQR ) : -0.2(2.8 ) vs. + 0.8 ( 2.0 ) mmol/L , P=0.025 ) . Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group ( −1.9±0.42 vs. + 1.31±1.4 mmol/L , P<0.001 ) . After 6 months , LGI group diets showed significantly lower GI ( 57±5 vs. 64±6 , P<0.001 ) , GL ( 122±33 vs. 142±35 , P=0.04 ) and higher fibre content ( 17±4 vs.13±4 g , P<0.001 ) . Caloric intakes were comparable between groups . Conclusion In women post-GDM , lowering GI of healthy diets result ed in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription Background Gestational diabetes mellitus ( GDM ) is a risk factor for the development of type 2 diabetes . Lifestyle intervention can prevent progression to type 2 diabetes in high risk population s. We design ed a r and omised controlled trial ( RCT ) to evaluate the effectiveness of an established lifestyle intervention compared to st and ard care for delaying diabetes onset in European women with recent GDM . Recruitment into the RCT was more challenging than anticipated with only 89 of 410 ( 22 % ) women agreeing to participate . This paper identifies factors that could enhance participation of the target population in future interventions . Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined , and secondly that it would be possible to predict participation on the bases of those risk factors . To test our hypothesis , we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3 - 5 years following GDM , reducing the sample to 43 participants and 73 decliners . We considered established diabetes risk factors : smoking , daily fruit and vegetable intake , participation in exercise , family history of diabetes , glucose values and BMI scores on post-partum re-screens , use of insulin during pregnancy , and age at delivery . We also analysed narrative data from 156 decliners to further underst and barriers to and facilitators of participation . Results Two factors differentiated participants and decliners : age at delivery ( with women older than 34 years being more likely to participate ) and insulin use during pregnancy ( with women requiring the use of insulin in pregnancy less likely to participate ) . Binary logistic regression confirmed that insulin use negatively affected the odds of participation . The most significant barriers to participation included the accessibility , affordability and practicality of the intervention . Conclusions Women with recent GDM face multiple barriers to lifestyle change . Intervention design ers should consider : ( i ) the practicalities of participation for this population , ( ii ) research design s that capitalise on motivational differences between participants , ( iii ) alleviating concerns about long-term diabetes management . We hope this work will support future research ers in developing interventions that are more relevant , effective and successful in recruiting the desired population .Trial registration Current Controlled Trials IS RCT Objective : To study the possibility of improving blood lipids , glucose tolerance and insulin sensitivity in women with impaired glucose tolerance and a history of gestational diabetes by merely changing the glycaemic index ( GI ) and dietary fibre ( DF ) content of their bread . Design : R and omized crossover study where test subjects were given either low GI/high DF or high GI/low DF bread products during two consecutive 3-week periods , separated by a 3-week washout period . An intravenous glucose tolerance test followed by a euglycaemic – hyperinsulinaemic clamp was performed on days 1 and 21 in both the high- and low-GI periods , to assess insulin secretion and insulin sensitivity . Blood sample s were also collected on days 1 and 21 for analysis of fasting levels of glucose , insulin , HDL-cholesterol and triacylglycerols ( TG ) . Setting : Lund University , Sweden . Subjects : Seven women with impaired glucose tolerance . Results : The study shows that a modest dietary modification , confined to a lowering of the GI character and increasing cereal DF of the bread products , improved insulin economy as judged from the fact that all women lowered their insulin responses to the intravenous glucose challenge on average by 35 % ( 0–60 min ) , in the absence of effect on glycaemia . No changes were found in fasting levels of glucose , insulin , HDL-cholesterol or TG . Conclusion : It is concluded that a combination of low GI and a high content of cereal DF has a beneficial effect on insulin economy in women at risk of developing type II diabetes . This is in accordance with epidemiological data , suggesting that a low dietary GI and /or increased intake of whole grain prevent against development of type II diabetes . Sponsorship : Supported by grants from Cerealia Research Foundation BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin OBJECTIVE The optimum diet composition for weight loss in obese women with or without previous gestational diabetes mellitus remains to be determined . Weight loss may be especially important for the latter group in terms of preventing future gestational as well as non-insulin dependent diabetes mellitus . We studied 40 % vs. 55 % carbohydrate calorically restricted diets to compare weight loss and metabolic response . METHODS We performed a prospect i ve , 12-week , blinded , r and omized crossover study of 25 obese women ; 13 of whom had previous gestational diabetes . Each woman was allocated to a treatment regimen for 6 weeks and then " crossed over " to the alternative regimen for an additional 6 weeks . Calories were provided in the form of nutritional supplement bars except for the evening meal that comprised 1/3 of the caloric needs . All subjects were seen and weighed weekly . Metabolic variables including glucose tolerance , glycated proteins , lipids , and percent body fat were measured at the beginning , crossover , and end of the study . RESULTS Women with previous gestational diabetes mellitus were comparable to obese women without a history of previous gestational diabetes except that the former had higher maximum levels of glucose on a glucose tolerance test and higher fasting insulin levels consistent with greater insulin resistance . Weight loss was comparable for all groups during the first 6 weeks but attenuated in all groups during the second 6 weeks of the trial regardless of diabetes history or treatment group allocation . Women with or without a previous history of gestational diabetes had higher triglycerides while on a 55 % carbohydrate diet than while on a 40 % carbohydrate diet . CONCLUSIONS A weight loss regimen consisting of 40 % carbohydrate results in lower triglyceride levels than those achieved with a 55 % carbohydrate content diet in obese women . Thus , the hypocaloric diet with the higher fat content produced the more favorable lipid profile in all obese women Summary : Women with impaired glucose tolerance are at high risk of developing noninsulin dependent diabetes mellitus ( NIDDM ) . The Mercy Hospital for Women has a long‐term follow‐up programme for women with gestational diabetes , which identifies many women with impaired glucose tolerance . Two hundred of these women were entered into a r and omized controlled trial of intensive versus routine dietary advice . Seven women were lost to follow‐up . The annual incidence rates of diabetes mellitus for the 2 groups were 6.1 % ( intervention ) and 7.3 % ( control ) , an incident rate ratio of 0.83 , 95 % confidence interval 0.47–1.48 , p = 0.50 . Overall , there was a return to normal glucose tolerance in 44 % of patients . Multivariate analysis showed that body mass index , fasting and 2‐hour plasma glucose levels at trial entry were significantly associated with an increased risk of diabetes mellitus . Impaired glucose tolerance is an important condition that should be treated with advice about lifestyle modification ( diet and /or exercise ) . We consider that future trials in the management of women with previous gestational diabetes who have impaired glucose tolerance should investigate the effect of pharmacological intervention in addition to diet and /or exercise , the latter providing a therapy that it would be unethical to exclude on the evidence presently available
BACKGROUND Women with prior gestational diabetes ( GDM ) have an increased lifetime risk of developing type 2 diabetes mellitus ( T2DM ) .
There are no up-to- date systematic review s analyzing the relationship of diet with risk of developing T2DM following GDM .
OBJECTIVE To systematic ally review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history .