JMIR Publications

ABSTRACT

Background:

Women who have had gestational diabetes are at an eight-fold increased risk of developing type 2 diabetes, but positive lifestyle change can prevent or delay progression to type 2 diabetes. Technology based interventions offer a possible solution to help to overcome the challenges that women face in making lifestyle changes in the postpartum period.

Objective:

To assess whether technology-based diabetes prevention interventions are effective in improving outcomes related to the onset of type 2 diabetes among women with a previous diagnosis of gestational diabetes.

Methods:

The protocol for the systematic review was registered with the international prospective register of systematic reviews (PROSPERO; CRD42024324019). MEDLINE, CENTRAL, CINAHL, EMBASE, PsycINFO and MIDRIS were searched in March 2024 using a combination of database subject headings and free text. Titles and abstracts of all articles were independently screened by two authors, as were full text articles that were retrieved. Experimental or non-experimental studies were eligible if they examined the use of a technology-based diabetes prevention intervention for women with previous gestational diabetes and assessed either anthropometric outcomes, glycaemic control, health behaviour or psychological outcomes. Risk of bias was assessed by one reviewer using National Institute for Clinical Excellence checklist. Data were summarised narratively, and results were pooled, where possible, using a random effects model analysing the between group differences in each outcome at follow up.

Results:

This systematic review identified 15 studies reported in 17 papers including a total of 1,257 participants. Two out of 12 studies assessing weight and one out of five studies assessing glycaemic control reported significant differences favouring the intervention. One study assessed type 2 diabetes prevalence and found no significant differences between the intervention and control group. Pooled analysis of nine studies revealed a significantly greater weight loss among those receiving technology-based interventions with a mean difference of -0.72kg (0.78 to -0.66). Interventions delivered using technology and with a longer follow up resulted in increased weight loss compared to those using both technology-based and telemedicine approaches and studies with a longer follow up. Meta-analysis showed no significant differences in fasting glucose, two-hour glucose, HbA1c or HOMA-IR.

Conclusions:

Limitations of the evidence included in the review were the small sample sizes and lack of power calculations. Interventions were often poorly described making it difficult to code and identify potentially effective ingredients and most lacked an explicit theoretical basis to explain and understand how they might work. The findings of this meta-analysis suggests that that there is potential for technology-based interventions to support women in reducing their risk of type 2 diabetes following GDM but trials with larger samples and longer follow up are required to allow firm conclusions to be drawn.