A Community Intervention To Reduce the Risks of Developing Diabetes after Gestational Diabetes

Gestational diabetes (GDM) occurs more frequently in women of Mexican ancestry than in other ethnic and racial groups. Over 50% of women with GDM subsequently develop type 2 diabetes, and their children also are at high risk for the disease.

Thus, as one of its Community Engagement programs, the Scripps Translational Science Institute (STSI) turned to the Scripps Whittier Diabetes Institute (SWDI) to design a behavioral change intervention to prevent and reduce type 2 diabetes in low-income San Diego area women of Mexican ancestry who have a medical history of GDM.

To devise educational sessions, individual lifestyle coaching and behavior change maintenance activities that are culturally appropriate and acceptable, the researchers are adapting the approaches that have proven so successful in two other behavioral change programs: the national Diabetes Prevention Program (DPP) and Project Dulce®, established in 1997 by SWDI.

A major multi-center clinical research study sponsored by the National Institutes of Health, DPP showed that diabetes can be prevented by modest weight loss combined with increased physical activity. Although the DPP study no longer is active, Project Dulce continues to demonstrate the value and effectiveness of culturally appropriate community-based diabetes management, education and support programs that employ peer educators to motivate individuals to change their behaviors and maintain healthy lifestyles.

To adapt the many lessons of DPP and Project Dulce to the target population in San Diego, researchers have conducted developmental and formative research, including focus groups with members of the target population and their health care providers.

SWDI is also training members representative of the target population to serve as peer educators who will be in frequent contact with members of their community. Peer educators will serve as individual lifestyle coaches who will help recruit participants for the planned pilot study and will help implement the structured, multi-session core-curriculum that emphasizes on intensive behavioral self-management strategies for weight loss and regular physical activity.

The pilot study will evaluate the behavioral intervention that the researchers designed for the San Diego target population. Participating in the study will be 70 pregnant women ages 18 to 45 years with a medical history of GDM.

The results of the pilot will investigate the effectiveness of a culturally appropriate diabetes prevention program and may lay the groundwork for a prospective, randomized control trial to determine whether the intervention designed for the San Diego population will be relevant to other geographical and ethnic groups in the U.S.