Effectiveness of self-care interventions for the prevention of type 2 diabetes among women with previous gestational diabetes: a systematic review and meta-analysis

Abstract

Objective: Gestational diabetes (GDM) is associated with an increased risk of developing type 2 diabetes later in life. Self-care interventions are known to prevent type 2 diabetes in high-risk populations. This systematic review aimed to investigate whether self-care interventions can prevent type 2 diabetes among women with previous GDM.

Data sources: A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, and PsycINFO was conducted on December 2, 2024.

Study eligibility criteria: Randomised, cluster-randomised, and non-randomised controlled trials that compared the effects of self-care interventions with standard/usual care or no intervention for preventing type 2 diabetes among women with previous GDM were included. The primary outcomes were the incidence of type 2 diabetes, the composite incidence of any type of diabetes, glycated hemoglobin, fasting blood glucose, blood glucose level 2 hours after the oral glucose tolerance test, and body weight.

Study appraisal and synthesis methods: Risk of bias for included studies was assessed using the Cochrane risk-of-bias tool (ROB2) or the Risk of Bias In Non-Randomized Studies of Interventions tool (ROBINS-I). Random effects models were employed for meta-analyses. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: The search identified 35 trials including 6624 women. Only one randomised trial (n=1601) reported the incidence of type 2 diabetes, indicating that the lifestyle intervention focusing on diet and physical activity may have little to no effect (hazard ratio 0.89 [95% confidence interval 0.65-1.22], low certainty of evidence). The effects of self-care interventions on the other primary outcomes-composite incidence of any type of diabetes (three trials), glycated hemoglobin (three trials), fasting blood glucose (11 trials), blood glucose level 2 hours after the oral glucose tolerance test (six trials), and body weight (18 trials) were uncertain (very low certainty of evidence). Downgrading of the certainty of evidence was predominantly due to high risk of bias, imprecision, and inconsistency.

Conclusion: Available evidence on the effect of self-care interventions for the prevention of type 2 diabetes among women with previous GDM is insufficient to draw strong conclusions, necessitating further research.

Keywords: behavioral interventions; gestational diabetes; lifestyle interventions; prevention; self-care interventions; type 2 diabetes.