Article Text

Reducing weight and BMI following gestational diabetes: a systematic review and meta-analysis of digital and telemedicine interventions
  1. Julia Halligan1,
  2. Maxine E Whelan2,
  3. Nia Roberts3,
  4. Andrew J Farmer4
  1. 1St Hilda’s College, Oxford University, Oxford, Oxfordshire, UK
  2. 2Centre for Intelligent Healthcare, Coventry University, Coventry, UK
  3. 3Bodleian Health Care Libraries, Oxford University, Oxford, Oxfordshire, UK
  4. 4Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
  1. Correspondence to Dr Maxine E Whelan; ad5094{at}coventry.ac.uk

Abstract

Women with past gestational diabetes mellitus (GDM) are at risk of subsequent type 2 diabetes and adverse cardiovascular events. Digital and telemedicine interventions targeting weight loss and reductions in body mass index (BMI) may help reduce risk for women with GDM. The aim was to compare the effectiveness of digital or telemedicine intervention with usual care. Randomized controlled trials (RCTs) were identified in Embase, Medline, CINAHL, PsycINFO and the Cochrane Library. Included trials recruited women with prior GDM but without pre-existing diabetes, and tested a digital or telemedicine intervention with or without an in-person component. Data extraction was carried out independently by two authors. The search yielded 898 citations. Eighteen articles reporting 15 trials were included, of which 8 tested digital interventions. Reported outcomes included weight, BMI, fasting plasma glucose and waist circumference. None of the included trials reported type 2 diabetes incidence or cardiovascular risk. Data were pooled using a random-effects model. The point estimate favored the intervention but was non-significant for both BMI (−0.90 kg/m2, 95% CI −1.89 to 0.09; p=0.08) and weight (−1.83 kg, 95% CI −4.08 to 0.42, p=0.11). Trials evaluating digital and telemedicine interventions identified clinically relevant, but non-significant improvements in BMI and weight compared with control. No trials assessed type 2 diabetes occurrence as an outcome. More well-designed RCTs with adequate power and long-term follow-up are needed to identify the impact of these interventions on type 2 diabetes occurrence.

  • diabetes
  • gestational
  • telemedicine
  • meta-analysis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Contributors JH made substantial contributions to the conception of the work, acquisition, analysis and interpretation of data for the work, drafted the work, approved the final version to be published and agreed to be accountable for all aspects of the work. MEW made substantial contributions to the acquisition, analysis and interpretation of data for the work as well as revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work. NR made substantial contributions to the acquisition of data for the work as well as revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work. AJF made substantial contributions to the conception of the work and interpretation of data, revised the work critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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