Diabetes Research and Clinical Practice - Volume 120 - Supplement 1 - October 2016

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Conclusion: Our results indicate the healthy behaviors modi-
fication, an essential component in diabetes management,
can be effectively strengthened by multidisciplinary care in
the accredited diabetesmanagement program. Without health
education and dietetic consultation, the usual medical care
provided by physicians alone is hard to optimize diabetes care,
especially in bettering glycemic control, normalizing trigly-
ceride level and changing healthy lifestyle.
OL08-5
Intervention outcomes from a randomised controlled trial of
diabetes prevention: Mothers after Gestational Diabetes in
Australia Diabetes Prevention Program (MAGDA-DPP)
Sophy TF SHIH1, Sharleen O’REILLY2, Vincent VERSACE3,
Edward JANUS 4, Timothy SKINNER5, John REYNOLDS6,
Carol WILDEY 1, Rob CARTER1, James BEST7, Jeremy OATS8,
Michael ACKLAND9 , Paddy PHILLIPS10, James DUNBAR1,
On Behalf of the MAGDA Study Group1. 1Centre for Population
Health Research, Faculty of Health, Deakin University, 2Institute of
Physical Activity and Nutrition Research, Deakin University, 3Greater
Green Triangle Department of Rural Health, Flinders University and
Deakin University, 4Department of Medicine, University of Melbourne
and Western Health, Sunshine Hospital, St Albans, Victoria, 5School
of Psychological and Clinical Sciences, Charles Darwin University,
6 Alfred Health and Faculty of Medicine, Nursing and Health Sciences,
Monash University, Australia; 7Lee Kong Chian School of Medicine,
Imperial College London and Nanyang Technological University,
Singapore; 8Melbourne School of Population and Global Health,
University of Melbourne, 9Department of Epidemiology and
Preventive Medicine, Monash University, 10Department of Medicine,
Flinders University and SA Health, Australia
Incidence of gestational diabetes mellitus (GDM) and type 2
diabetes (T2DM) is increasing worldwide posing an immense
burden to healthcare systems. Women with GDM diagnosis
have a life-time risk exceeding 70% of developing T2DM. The
Mothers after Gestational Diabetes in Australia (MAGDA) study
was a randomised controlled trial aiming to assess the
effectiveness of a group-based lifestyle modification program
for women with GDM diagnosis in their first postnatal year. A
total of 573 womenwere randomised to either the intervention
group (n = 284) receiving a structured diabetes prevention
program or the control group (n = 289) receiving usual care.
The diabetes prevention intervention comprised of 1 individ-
ual and 5 group face-to-face sessions delivered by trained
healthcare professionals followed by 2 additional follow-up
telephone calls.
The primary outcomewas changes in diabetes risk determined
by weight, waist and fasting plasma glucose (FPG). The
secondary outcomes included changes in behavioural goals,
depression score, and cardiovascular disease risk factors.
These outcomes were assessed at baseline and 12 months for
all participating women and additionally at 3 months for the
intervention participants only. At baseline, 28% and 38% of
participants were overweight or obese respectively, while only
10% participants had impaired glucose tolerance (IGT) and 2%
impaired fasting glucose (IFG). Results of intention to treat (ITT)
analysis show, at 12 months, the intervention groups’ average
weight loss was 0.23 kg (95% CI −0.89, 0.43) compared with
weight gainof 0.72 kg (95%CI 0.09, 1.35) in theusual care control
group. The change difference between groups over 12 months
was statistically significant, with 0.95 kg weight loss in the
intervention group (95% CI −1.87, −0.14, group by treatment
intervention p = 0.04). At three months, the intervention group
had lost 0.92 kg (p = 0.001) compared to the baseline levels.
Other significant outcomes at three months were reduction in
waist circumference, total cholesterol, high-density lipoprotein
cholesterol (HDL-C) and low-density lipoprotein cholesterol
(LDL-C) (all p < 0.001) in the intervention group. Reduction in
waist circumference, total cholesterol and LDL-C were main-
tainedat 12months, but not the reduction inweight andHDL-C.
The MAGDA-DPP study demonstrates a modest effect of the
intervention in women with prior GDM diagnosis. Although
1kg weight difference is likely to be significant for reducing
diabetes risk, the engagement effort required during the first
postnatal year is not sustainable in routine health services. It is
recommended to implement annual diabetes screening until
post-GDM women develop IGT or IFG, before offering an
intervention.
OL08-6
Program engagement in a randomised controlled trial for
diabetes prevention: Mothers after Gestational Diabetes in
Australia Diabetes Prevention Program (MAGDA-DPP)
Sophy TF SHIH1, Carol WILDEY1, Vincent VERSACE2,
Sharleen O’REILLY3, Rob CARTER1, Edward JANUS4,
Timothy SKINNER5, James DUNBAR1,
On Behalf of the MAGDA Study Group1. 1Centre for Population
Health Research, Faculty of Health, Deakin University,2Greater Green
Triangle Department of Rural Health, Flinders University and Deakin
University, 3Institute of Physical Activity and Nutrition Research,
Deakin University, 4Department of Medicine, University of Melbourne
and Western Health, Sunshine Hospital, St Albans, Victoria, 5School
of Psychological and Clinical Sciences, Charles Darwin University,
Australia
Women with gestational diabetes (GDM) are at sevenfold
increased risk of developing type 2 diabetes compared with
women without GDM. The Mothers after Gestational Diabetes
in Australia (MAGDA) study was a multicentre randomized
controlled trial assessing the effectiveness of a structured
diabetes prevention program (DPP) for women with previous
GDM in their first postnatal year.
The MAGDA-DPP intervention comprised 1 individual and 5
group sessions delivered by trained healthcare professionals,
with 2 follow-up telephone calls. Women aged over 18 years
diagnosed with GDM in their most recent pregnancy were
recruited using multiple strategies: (i) an antenatal clinic
appointment approach (4 metropolitan hospitals); (ii) a
postnatal private obstetrician invitation letter; and (iii) a
postnatal invitation letter through the National Gestational
Diabetes Register (NGDR) to selected postcodes.
NGDR-recruited participants were older (p < 0.001) and the
babies of women recruited antenatally were younger than the
other recruitment methods (p < 0.001). On average, recruiters
spent 22 minutes per woman assessing interest and eligibil-
ity. ANOVA results showed no difference in recruitment
efforts (number of contacts, time and staff cost) across
different recruitment strategies. Recruitment success rates
did differ; with the NGDR being the most successful strategy
(149/191, 74%), followed by postnatal invitation (36/77, 47%)
and antenatal approach (402/1972, 20%) (p < 0.001). Among
women randomized to the intervention (n = 284), 66% (n =
188) completed ≥1 session. More specifically, 13% had only an
individual session (IS) (n = 37), 53% completed the individual
session plus ≥1 group session(s) (GS) (program minimum
standard, n = 149), with only 10% completing all 6 sessions
(n = 28). 34% of women randomised had no exposure (n = 96),
despite an average of 4 contact attempts made by facilitators.
On average, group facilitators spent 18 minutes per inter-
vention participant arranging and reminding women about
intervention sessions. Of those participants achieving the
program minimum standard, the average attendance was
3 sessions, with facilitators averaging 20 minutes with 10
contacts to achieve this. ANOVA tests showed no difference
in retention efforts between intervention participants
recruited by different strategies. Program attendance by
women recruited through antenatal approach, however, was
significantly lower than other recruitment methods [IS only
(p = 0.04), IS plus ≥1 GS (p = 0.01), and IS plus ≥3 GS
(p < 0.001)].
Oral Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S40–S64 S59