Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview

Abstract

This systematic overview summarizes the relevant evidence from multiple systematic reviews of the benefits of nonpharmacological interventions for preventing type 2 diabetes mellitus (T2MD) in women diagnosed with gestational diabetes mellitus (GDM). A comprehensive search using the Cochrane Library, CINAHL, EMBASE and MEDLINE via Ovid SP, and PubMed databases was completed on 18 November 2015. Any systematic reviews that evaluated randomized controlled trials (RCTs) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion. The authors independently performed critical appraisals and quality assessments of the included reviews using the AMSTAR tool, and extracted data were converted to coherent values for tabular summarization. Six eligible reviews of diet and/or exercise, breastfeeding, and reminder interventions were identified; however, the methodologies of the reviews varied greatly, and the majority of the evidence suggested unclear bias. We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression, but these interventions were found to be effective at reducing glycemic load. Combined diet, exercise, and breastfeeding interventions proved to be effective at returning women to their postpartum weight. Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM. Overall, there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM, and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM, such as glycemic load or anthropometric changes.

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Acknowledgements

This research was supported by Research Promotion and Practical Use for Women’s Health from Japan’s Agency for Medical Research and Development, AMED; grant number: 16gk02100012h0001. The authors thank the information specialist Mr. Farhad Shokraneh for helping with search strategy development.

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Correspondence to Naoko Arata.

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Conflict of interest

Celine Miyazaki, Kanako Tanase-Nakao, Naoko Arata, Rintaro Mori, Maki Kawasaki, and Erika Ota declare no competing financial interests.

Ethics approval

This study respects the fundamental ethical principles consistent with the Declaration of Helsinki of The World Medical Association (WMA) 2013. This systematic overview only reviews published medical research studies that respected fundamental ethical principles, and it does not involve any animal or human subjects, including research on identifiable human material and data. The reporting of this study complies with the PRISMA checklist for systematic review and meta-analyses and was conducted only by individuals with the appropriate ethics and scientific education, training, and qualifications.

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Miyazaki, C., Tanase-Nakao, K., Arata, N. et al. Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview. Diabetol Int 8, 160–180 (2017). https://doi.org/10.1007/s13340-017-0316-0

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Keywords

  • Gestational diabetes mellitus
  • Non-drug intervention
  • Randomized controlled trial
  • Systematic overview
  • Type 2 diabetes mellitus