TeleMAGDA, a telephone-based lifestyle-modification program for postpartum women with a prior history of gestational diabetes : A change in microsystem level

Abstract

Diabetes is a growing public health concern in Australia and worldwide. Prevention of type 2 diabetes mellitus (T2DM) was the single initiative under the National Chronic Disease Strategy to be signed off by the Council of Australian Governments in April 2007. T2DM is currently the second highest contributor to the Australian burden of disease and is projected to pose an economic burden of A$7 billion by 2023. With appropriate lifestyle change, T2DM can be a preventable disease, and healthy lifestyle programs can reduce progression to T2DM in high-risk populations. Gestational diabetes mellitus (GDM) – diabetes in pregnancy – is a strong predictor for developing T2DM for women. More than 10% of all pregnancies in Australia are complicated by GDM, and up to 50% of women with GDM develop T2DM within five years after their babies are born. Women with previous GDM represent an enormous opportunity for the health system to intervene and promote health in both the mothers and their families. The Mothers after Gestational Diabetes in Australia (MAGDA) study, funded by the National Health and Medical Research Council, examined the effectiveness and cost effectiveness of a face-to-face, group-based, lifestyle-modification program specifically tailored for post-partum women with previous gestational diabetes. Amongst the key findings of MAGDA were that group-based programs are not suited to mothers with young infants, who have difficulty attending a face-to-face delivered program, and that such programs do not address the barriers to engagement. In order to give post-partum women more individual control of the lifestyle-modification program, the TeleMAGDA trial was run in which the group sessions were replaced by individual sessions delivered by telephone.