Incidence of gestational diabetes mellitus (GDM) was reduced in women who received individualized counseling on diet, physical activity, and weight control during pregnancy, a Finnish study found. The intervention targeted women with previous GDM or a body mass index of 30 kg/m2 or greater. The rate of GDM between the 24th and 28th week of pregnancy was 14% in the treated women compared to 22% among a control group of similar patients who received standard care.
The study, referred to as the RADIEL trial, was published in the January Diabetes Care. The following commentary by Lorraine Lipscombe, MD, MSc, was published in the ACP Journal Club section of the Dec. 15, 2015, Annals of Internal Medicine.
The trial by Koivusalo and colleagues found that a lifestyle intervention during pregnancy reduced GDM in high-risk women (i.e., those who could benefit most). Previous trials of prenatal lifestyle interventions have mostly included women at moderate risk and had limited success, partly due to lack of meaningful behavior change. It is encouraging that GDM was reduced in the RADIEL trial despite a negligible effect on gestational weight gain and modest changes in diet and physical activity. However, the clinical importance of these findings is tempered by the lack of effect on macrosomia and cesarean sections.
Although RADIEL was carried out in a Finnish population, evidence suggests that lifestyle interventions achieve comparable adherence rates and reductions in diabetes in Finland and the USA. Adopting such a program as used in RADIEL would require additional staff and training; however, the burden imposed would be minimal for patients and the health care system, and greater health care resources would otherwise be needed to manage GDM.
Lifestyle interventions can lead to sustained diabetes prevention long after trials have ended. Thus, decreasing the risk for GDM may provide short-term benefits and may also translate into lower incidence of type 2 diabetes for both mothers and their offspring.