Women with a history of GDM had 48% increased risk of developing diabetes…
From previous studies it is known that women with gestational diabetes are at a higher risk for the development of type 2 diabetes. Previous results from the Diabetes Prevention Program (DPP) showed that Intensive Lifestyle Intervention (ILS) and metformin were able to prevent or delay diabetes in women with a history of Gestational Diabetes Mellitus (GDM).
The objective of this study was to evaluate the impact of ILS and metformin intervention over a period of 10 years in women with and without a history of GDM. The subjects were pulled from the DPP and Diabetes Prevention Program Outcomes Study. The study was a randomized controlled clinical trial with an observational follow-up, and was conducted at a total of 27 clinical centers. There were 350 women with a history of GDM and 1416 women with previous live births but no history of GDM who participated in the study. All participants were evaluated and had an elevated body mass index, fasting glucose and impaired glucose tolerance at study entry. There were 3 arms in the study, the placebo group, ILS group, and metformin group. The outcome measure was diabetes mellitus.
Baseline characteristics were described using percentages for categorical variables and means SD for continuous variables. Comparisons between groups were performed using the x2 test of independence for categorical variables and the Student’s t test for continuous variables. Cox proportional hazards models were used to assess the effect of the treatment on the development of diabetes before and after adjusting for covariates. Mixed-effects models were used to estimate the mean differences over time in body weight within the different treatment groups in women with and without a history of GDM, and adjusted for the baseline values.
After being adjusted for age at randomization using a Cox proportional hazards model, the study showed that women with a history of GDM had a 48% increased risk of developing diabetes compared with women without a history of GDM in the placebo group (P <0.05). When compared with placebo, both ILS and metformin were shown to be effective at reducing the progression to diabetes in women with a history of GDM, with ILS providing a 35.2% risk reduction and metformin a 40.4% risk reduction. In women without a history of GDM, ILS was effective at reducing the risk of progression to diabetes by 29.7% compared with the placebo. When women without a history of GDM, were treated with metformin it produced a non-significant risk reduction of only 3.3% compared with the placebo.
These results determined that overall women with a history of GDM are at an increased risk of developing diabetes. When looking at women with a history of GDM in the DPP/Diabetes Prevention Program Outcomes Study, both lifestyle intervention and metformin were highly effective at reducing progression to diabetes during a 10-year follow-up period. When looking at women without a history of GDM, lifestyle intervention was effective at reducing progression to diabetes but not metformin.
- Intensive Lifestyle Intervention seemed to produce very similar outcomes when looking at this population.
- Women who cannot tolerate the GI side effects of metformin after proper titration may benefit from Intensive Lifestyle Interventions.
- Previous analyses showed no significant effects of metformin on the development of metabolic syndrome in women while showing a significant impact in men.
V. R. Aroda. “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”. J Clin Endocrinol Metab. Dec 22, 2014.