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Meta-Analysis
. 2023 Nov 3;15(21):4666.
doi: 10.3390/nu15214666.

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

Gebresilasea Gendisha Ukke  1 , Jacqueline A Boyle  1 , Ahmed Reja  2 , Wai Kit Lee  3 , Mingling Chen  4 , Michelle Shi Min Ko  5 , Chelsea Alycia  3 , Jane Kwon  6 , Siew Lim  1
Affiliations
Meta-Analysis

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

Gebresilasea Gendisha Ukke et al. Nutrients. .

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.

Keywords: diabetes gestational; diabetes mellites type 2; equity; lifestyle intervention; meta-analysis; progress.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of this study; in the collection, analysis, or interpretation of the data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA diagram of included studies.
Figure 2
Figure 2
The effect of a lifestyle intervention on bodyweight (by country) according to the World Bank classification (HIC: high-income countries, MIC: middle-income countries) [29,32,33,35,38,44,49,50,51,52,53,54,58,60,61,63,64,65,68,69,71,75,76,77,80].
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