Effects of a Lifestyle Intervention in Young Women with GDM and Subsequent Diabetes.

The purpose of this study was to examine whether a 9-month intensive lifestyle intervention could lead to weight loss and improve cardiovascular risk factors among young women with both gestational diabetes mellitus (GDM) and newly diagnosed diabetes. A total of 83 young women, who had GDM and were subsequently diagnosed as type 2 diabetes at an average of 2.6 years after delivery, participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6-9 years postintervention. After the 9-month intervention, these women had a weight loss of 2.90 kg (-4.02% of initial weight), decreased waist circumference (-3.12 cm), body fat (-1.75%), diastolic blood pressure (-3.49 mmHg), fasting glucose (-0.98 mmol/L) and HbA1c (-0.72%). During the 6-9 years postintervention period, they still had lower weight (-3.71 kg; -4.62% of initial weight), decreased waist circumference (-4.56 cm) and body fat (-2.10%), but showed a slight increase in HbA1c (0.22%). The prevalence of using glucose-lowering agents increased from 2.4% at baseline to 34.6% after the 9-month lifestyle intervention, and to 48.4% at 6-9 years postintervention. A 9-month intensive lifestyle intervention can produce beneficial effects on body weight, HbA1c and other cardiovascular risk factors among young women with previous GDM who subsequently developed new diabetes.

ß-Cell function or insulin resistance was associated with the risk of type 2 diabetes among women with or without obesity and a history of gestational diabetes.

INTRODUCTION: To evaluate the single association of postpartum ß-cell dysfunction and insulin resistance (IR), as well as different combinations of postpartum ß-cell dysfunction, IR, obesity, and a history of gestational diabetes mellitus (GDM) with postpartum type 2 diabetes risk. RESEARCH DESIGN AND METHODS: The study included 1263 women with prior GDM and 705 women without GDM. Homeostatic model assessment was used to estimate homeostatic model assessment of ß-cell secretory function (HOMA-%ß) and homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: Multivariable-adjusted ORs of diabetes across quartiles of HOMA-%ß and HOMA-IR were 1.00, 1.46, 2.15, and 6.25 (ptrend <0.001), and 1.00, 2.11, 5.59, and 9.36 (ptrend <0.001), respectively. Women with IR only had the same diabetes risk as women with ß-cell dysfunction only. Obesity, together with IR or ß-cell dysfunction, had a stronger effect on diabetes risk. This stronger effect was also found for a history of GDM with IR or ß-cell dysfunction. Women with three risk factors, including obesity, a history of GDM and ß-cell dysfunction/IR, showed the highest ORs of diabetes. CONCLUSIONS: ß-cell dysfunction or IR was significantly associated with postpartum diabetes. IR and ß-cell dysfunction, together with obesity and a history of GDM, had the highest ORs of postpartum diabetes risk.

Within-trial cost-effectiveness of lifestyle intervention using a 3-tier shared care approach for pregnancy outcomes in Chinese women with gestational diabetes.

This study assessed within-trial cost-effectiveness of a shared care program (SC, n = 339) for pregnancy outcomes compared to usual care (UC, n = 361), as implemented in a randomized trial of Chinese women with gestational diabetes (GDM). SC consisted of an individualized dietary advice and physical activity counseling program. The UC was a one-time group education program. The effectiveness was measured by number needed to treat (NNT) to prevent one macrosomia/large for gestational age (LGA) infant. The cost-effectiveness was measured by incremental cost-effectiveness ratio in terms of cost (2012 Chinese Yuan/US dollar) per case of macrosomia and LGA prevented. The study took both a health care system and a societal perspective. This study found that the NNT was 16/14 for macrosomia/LGA. The incremental cost for treating a pregnant woman was ¥1,877 ($298) from a health care system perspective and ¥2,056 ($327) from a societal perspective. The cost of preventing a case of macrosomia/LGA from the two corresponding perspectives were ¥30,032/¥26,278 ($4,775/$4,178) and ¥32,896/¥28,784 ($5,230/$4,577), respectively. Considering the potential severe adverse health and economic consequences of a macrosomia/LGA infant, our findings suggest that implementing this lifestyle intervention for women with GDM is an efficient use of health care resources.

High risk of metabolic syndrome after delivery in pregnancies complicated by gestational diabetes.

AIMS: To investigate the risk of postpartum metabolic syndrome in women with GDM compared with those without GDM in a Chinese population. METHODS: Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM. Multivariate logistic regression was used to assess risks of postpartum metabolic syndrome between women with and without GDM. Postpartum metabolic syndrome was diagnosed by two commonly used criteria. RESULTS: During a mean 3.53 years of follow up, 256 cases of metabolic syndrome were identified by using the NCEP ATPIII criteria and 244 cases by using the IDF criteria. Multivariable-adjusted odds ratios of metabolic syndrome in women with GDM compared with those without GDM were 3.66 (95% confidence interval [CI] 2.02-6.63) for NCEP ATPIII criteria and 3.90 (95% CI 2.13-7.14) for IDF criteria. Women with GDM had higher multivariable-adjusted odds ratios of central obesity, hypertriglyceridemia, and high blood pressure than women without GDM. The multivariable-adjusted odds ratios of low HDL cholesterol and hyperglycemia were not significant between women with and without GDM, however, the multivariable-adjusted odds ratio of hyperglycemia became significant when we used the modified criteria. CONCLUSIONS: The present study indicated that women with prior GDM had significantly higher risks for postpartum metabolic syndrome, as well as its individual components.

Lactation intensity and duration to postpartum diabetes and prediabetes risk in women with gestational diabetes.

OBJECTIVE: To investigate the association of lactation intensity and duration with postpartum diabetes and prediabetes risks among Chinese women with a history of gestational diabetes (GDM). METHODS: We included 1260 women with a history of GDM who participated in the whole population's GDM universal screening survey by using the 1999 World Health Organization's criteria. Lactation intensity and lactation duration were collected by a standardized questionnaire. Postpartum diabetes and prediabetes risk were confirmed by an oral glucose tolerance test. RESULTS: During a mean postpartum period of 3.65 years, we identified 114 cases of diabetes and 417 cases of prediabetes. The multivariable-adjusted hazard ratios based on different lactation intensity (exclusive formula, mixed feeding, and exclusive lactation) were 1.00, 0.68, 0.45 for diabetes (Ptrend  = 0.008), and 1.00, 0.74, and 0.61 for prediabetes (Ptrend  = 0.006), respectively. The multivariable-adjusted hazard ratios associated with different lactation duration (none, 0-6 months, 6-12 months, 12-18 months, and ≥18 months) were 1.00, 0.66, 0.42, 0.66, and 0.25 for diabetes (Ptrend  = 0.013), and 1.00, 0.82, 0.62, 0.67, and 0.63 for prediabetes (Ptrend  = 0.021), respectively. A restricted cubic spline curve showed a graded inverse association of lactation duration with the risks of diabetes and prediabetes (Ptrend  < 0.001). CONCLUSIONS: Higher-lactation intensity and longer-lactation duration were significantly associated with lower risks of postpartum diabetes and prediabetes among Chinese women with a history of GDM.

Gestational diabetes with diabetes and prediabetes risks: a large observational study.

AIMS: To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy. SUBJECTS AND METHODS: Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization's criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. RESULTS: During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI: 23.6-246) for diabetes and 25.4 (95% CI: 18.2-35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 121 diabetes and 616 prediabetes cases were identified. Women with prior GDM had a 13.0-fold multivariable-adjusted risk (95% CI: 5.54-30.6) for diabetes and 2.15-fold risk (95% CI: 1.76-2.62) for prediabetes compared with women without GDM. The positive associations between GDM and the risks of postpartum diabetes and prediabetes were significant and persistent when stratified by younger and older than 30 years at delivery and normal weight and overweight participants. CONCLUSIONS: The present study indicated that women with prior GDM had significantly increased risks for postpartum diabetes and prediabetes, with the highest risk at the first 3-4 years after delivery, compared with those without GDM.

One-year weight losses in the Tianjin Gestational Diabetes Mellitus Prevention Programme: A randomized clinical trial.

AIMS: To report the weight loss findings after the first year of a lifestyle intervention trial among women with gestational diabetes mellitus (GDM). METHODS: A total of 1180 women with GDM were randomly assigned (1:1) to receive a 4-year lifestyle intervention (intervention group, n = 586) or standard care (control group, n = 594) between August 2009 and July 2011. Major elements of the intervention included 6 face-to-face sessions with study dieticians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. RESULTS: Among 79% of participants who completed the year 1 trial, mean weight loss was 0.82 kg (1.12% of initial weight) in the intervention group and 0.09 kg (0.03% of initial weight) in the control group (P = .001). In a prespecified subgroup analysis of people who completed the trial, weight loss was more pronounced in women who were overweight (body mass index ≥24 kg/m2 ) at baseline: mean weight loss 2.01 kg (2.87% of initial weight) in the intervention group and 0.44 kg (0.52% of initial weight) in the control group (P < .001). Compared with those in the control group, women in the intervention group had a greater decrease in waist circumference (1.76 cm vs 0.73 cm; P = .003) and body fat (0.50% vs 0.05% increase; P = .001). CONCLUSION: The 1-year lifestyle intervention led to significant weight losses after delivery in women who had GDM, and the effect was more pronounced in women who were overweight at baseline.

Uric acid and diabetes risk among Chinese women with a history of gestational diabetes mellitus.

AIMS: To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and prediabetes among women with prior gestational diabetes mellitus (GDM). METHODS: We performed a cross-sectional study of 1262 GDM women at 1-5 years after delivery using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Program. Logistic regression models were used to estimate the association of different levels of serum UA with the risks of type 2 diabetes and prediabetes. RESULTS: The multivariable-adjusted odds ratios (ORs) across quartiles of serum UA were 1.00, 1.23 (95% confidence interval [CI] 0.55-2.78), 2.05 (95% CI 0.96-4.39), and 3.17 (95% CI 1.54-6.55) (Ptrend < 0.001) for type 2 diabetes, and 1.00, 1.50 (95% CI 1.03-2.19), 2.28 (95% CI 1.58-3.30), and 2.88 (95% CI 1.99-4.17) (Ptrend < 0.001) for prediabetes, respectively. Restricted cubic splines models showed positive linear associations of serum UA as a continuous variable with the risks of type 2 diabetes and prediabetes. This positive association was significant when stratified by healthy weight and overweight participants. CONCLUSIONS: Serum UA levels have a graded positive association with the risks of type 2 diabetes and prediabetes among Chinese with a history of GDM.

C-peptide levels and the risk of diabetes and pre-diabetes among Chinese women with gestational diabetes.

AIMS: To examine the association of connecting peptide (C-peptide) and the risks of postpartum diabetes and pre-diabetes among women with prior gestational diabetes. METHODS: A cross-sectional study of 1263 women with prior gestational diabetes was carried out at 1-5years after delivery in Tianjin, China. Logistic regression was used to assess the associations of C-peptide and the risks of diabetes and pre-diabetes. RESULTS: The multivariable-adjusted odds ratios based on different levels of C-peptide (0-33%, 34-66%, 67-90%, and >90% as C-peptide cutpoints) were 1.00, 1.93 (95% confidence interval [CI] 0.85-4.39), 2.49 (95% CI 1.06-5.87), and 3.88 (95% CI 1.35-11.1) for diabetes (P for trend <0.0001), and 1.00, 1.66 (95% CI 1.18-2.36), 2.38 (95% CI 1.56-3.62) and 2.35 (95% CI 1.27-4.37) for pre-diabetes (P for trend <0.0001), respectively. Restricted cubic splines models showed a positive linear association of C-peptide as a continuous variable with the risks of type 2 diabetes and pre-diabetes. The positive association was significant when stratified by healthy weight and overweight participants. CONCLUSIONS: We found a positive association between serum C-peptide levels and the risks of diabetes and pre-diabetes among Chinese women with prior gestational diabetes. Our finding suggested that elevated C-peptide levels may be a predictor of diabetes and pre-diabetes.

Gestational hypertension and chronic hypertension on the risk of diabetes among gestational diabetes women.

AIMS: We aimed to examine the association of gestational hypertension and chronic hypertension at the inter-conception examination with type 2 diabetes risk among women with a history of gestational diabetes. METHODS: We conducted a population-based study among 1261 women who had a history of gestational diabetes at 1-5years after delivery in Tianjin, China. Logistic regression or Cox regression was used to assess the associations of gestational hypertension and chronic hypertension at the inter-conception examination with pre-diabetes and type 2 diabetes risks. RESULTS: Gestational diabetic women who had a history of gestational hypertension but did not use antihypertensive drugs during pregnancy had a 3.94-fold higher risk (95% CI: 1.94-8.02) of developing type 2 diabetes compared with those who were normotensive in index pregnancy. Compared with gestational diabetic women who had normal blood pressure at the inter-conception examination, hypertensive women at the inter-conception examination were 3.38 times (95% CI: 1.66-6.87) and 2.97 times (95% CI: 1.75-5.05) more likely to develop diabetes and prediabetes, respectively. The odds ratios of type 2 diabetes and prediabetes associated with each 5mmHg increase in systolic blood pressure were 1.25 (95% CI: 1.03-1.51) and 1.20 (95% CI: 1.06-1.35). Each 5mmHg increase in diastolic blood pressure contributed to a 1.49-fold higher risk (95% CI: 1.18-1.88) for type 2 diabetes and a 1.42-fold higher risk (95% CI: 1.22-1.65) for prediabetes. CONCLUSIONS: For women with prior gestational diabetes, gestational hypertension and chronic hypertension at the inter-conception examination were risk factors for type 2 diabetes.

Physical activity, sedentary behaviors and risk of gestational diabetes mellitus: a population-based cross-sectional study in Tianjin, China.

OBJECTIVE: Physical activity in a nonpregnant state or before pregnancy reduces the risk of type 2 diabetes and is also associated with reduced risk of gestational diabetes mellitus (GDM). However, it is uncertain whether physical activity during pregnancy reduces the risk of GDM. DESIGN AND METHODS: Using an established universal screening system in Tianjin, China, we prospectively recruited 11 450 pregnant women within the 12th gestational week from 2010 to 2012. These women underwent a 50-g 1-h glucose challenge test (GCT) at 24-28 weeks of gestation and a 75-g 2-h oral glucose tolerance test if GCT glucose ≥7.8mmol/L. GDM was defined according to the International Association of Diabetes and Pregnancy Study Group's criteria. Self-reported physical activity in the last month was collected at GCT time using a validated questionnaire. RESULTS: GDM developed in 7.3% (n=840) of the women. Women with GDM were less likely to be engaged in moderate-to-high physical activity during pregnancy than those without (79.8% vs 81.6%, P=0.191). Moderate-to-high physical activity during pregnancy was associated with decreased risk of GDM (multivariable odds ratio (OR): 0.81, 95% confidence interval (CI): 0.67-0.97). Sitting at home for 2-4h per day and >4h per day were associated with significantly increased risk of GDM (multivariable OR of sitting time for 2-4h vs <2h: 1.59, 95% CI: 1.18-2.15; OR of sitting time for >4h vs <2h: 1.73, 95% CI: 1.22-2.43). CONCLUSIONS: Increased physical activity during pregnancy was associated with reduced GDM risk, whereas sedentary lifestyle was associated with increased GDM risk among Chinese pregnant women.

Fasting and 2-hour plasma glucose, and HbA1c in pregnancy and the postpartum risk of diabetes among Chinese women with gestational diabetes.

AIMS: Very few studies have assessed the association of fasting and 2h glucose, and HbA1c during pregnancy with postpartum diabetes risk among women with prior gestational diabetes mellitus (GDM). We assessed the association of fasting glucose, 2h glucose and HbA1c at 26-30 gestational weeks with postpartum diabetes risk among women with prior GDM. METHODS: A cohort study in 1263 GDM women at 1-5 years after delivery was performed. Cox proportional hazards regression models were used to evaluate the association of fasting and 2h plasma glucose, and HbA1c at 26-30 gestational weeks with the risk of diabetes at postpartum. RESULTS: The multivariable-adjusted (age, pre-pregnancy body mass index, weight gain during pregnancy, current body mass index, family history of diabetes, marital status, education, family income, smoking status, passive smoking, leisure-time physical activity, alcohol drinking, and intake of energy, saturated fat, and dietary fiber) hazard ratios of postpartum diabetes were 1.61 (95% confidence interval [CI]: 1.36-1.91) for each 1 mmol/l increase in fasting glucose during pregnancy, 1.63 (95% CI: 1.45-1.84) for each 1 mmol/l increase in 2h glucose during pregnancy, 2.11 (95% CI: 1.50-2.97) for each 1 unit (%) increase in HbA1c during pregnancy. When fasting glucose, 2h glucose and HbA1c during pregnancy were entered multivariable-adjusted model simultaneously, 2h glucose and HbA1c but not fasting glucose remained to be significant and positive predictors for postpartum diabetes. CONCLUSIONS: For women with prior GDM, 2h plasma glucose and HbA1c during pregnancy are independent predictors of postpartum diabetes, but fasting plasma glucose during pregnancy is not.

Pregnancy outcomes of Chinese women with gestational diabetes mellitus defined by the IADPSG's but not by the 1999 WHO's criteria.

OBJECTIVE: To compare pregnancy outcomes of women with gestational diabetes mellitus (GDM) newly defined by the International Association of Diabetes and Pregnancy Study Group (IADPSG)'s criteria vs GDM cases missed by a shift from the 1999 World Health Organization (WHO)'s criteria to the IADPSG's. METHODS: From 2010 to 2012, we recruited 17 808 women who registered within 12 weeks of gestation in Tianjin, China. All women underwent a 50-g 1-h glucose challenge test (GCT) at 24-28 weeks of gestation and further underwent a 75-g 2-h oral glucose tolerance test (OGTT) if the GCT result was ≥7·8 mmol/l. Women were divided into four groups, i.e., GDM defined by both criteria, GDM defined by the IADPSG's only, GDM defined by the 1999 WHO's only and non-GDM by either of them. Large for gestational age (LGA), macrosomia, pregnancy-induced hypertension (PIH) and preterm birth were compared among the four groups. Logistic regression was used to control for confounders. RESULTS: The use of IADPSG's and the 1999 WHO's criteria detected that 7·7% (n = 1378) and 6·8% (n = 1206) of women had GDM, respectively, with 429 GDM newly identified and 257 women missed by a shift from the 1999 WHO's to the IADPSG's. The IADPSG's newly defined GDM had significantly increased risks of LGA (adjusted OR: 2·23, 95%CI: 1·36-3·64) and macrosomia (2·65, 95%CI: 1·50-4·66) than the 1999 WHO's only defined GDM cases. CONCLUSIONS: A shift of the 1999 WHO's criteria to the IADPSG's diagnosed more GDM cases who had worse pregnancy outcomes than those cases missed.

Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China.

OBJECTIVE: We compared the increases in the prevalence of gestational diabetes mellitus (GDM) based on the 1999 World Health Organization (WHO) criteria and its risk factors in Tianjin, China, over a 12-year period. We also examined the changes in the prevalence using the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG). METHODS: In 2010-2012, 18589 women who registered within 12 weeks of gestation underwent a glucose challenge test (GCT) at 24-28 gestational weeks. Amongst them, 2953 women with 1-hour plasma glucose ≥ 7.8 mmol/L underwent a 75-gram 2-hour oral glucose tolerance test (OGTT) and 781 women had a positive GCT but absented from the standard OGTT. An adjusted prevalence of GDM was calculated for the whole cohort of women by including an estimate of the proportion of women with positive GCTs who did not have OGTTs but would have been expected to have GDM. Logistic regression was used to obtain odds ratios and 95% confidence intervals using the IADPSG criteria. The prevalence of GDM risk factors was compared to the 1999 survey. RESULTS: The adjusted prevalence of GDM by the 1999 WHO criteria was 8.1%, a 3.5-fold increase as in 1999. Using the IADPSG criteria increased the adjusted prevalence further to 9.3%. Advanced age, higher pre-pregnancy body mass index, Han-nationality, higher systolic blood pressure (BP), a family history of diabetes, weight gain during pregnancy and habitual smoking were risk factors for GDM. Compared to the 1999 survey, the prevalence of overweight plus obesity had increased by 1.8 folds, age ≥ 30 years by 2.3 folds, systolic BP by 2.3 mmHg over the 12-year period. CONCLUSIONS: Increasing prevalence of overweight/obesity and older age at pregnancy were accompanied by increasing prevalence of GDM, further increased by change in diagnostic criteria.

A randomised translational trial of lifestyle intervention using a 3-tier shared care approach on pregnancy outcomes in Chinese women with gestational diabetes mellitus but without diabetes.

BACKGROUND: There are no randomised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group's (IADPSG) criteria. We tested the effectiveness of lifestyle modifications implemented in a 3-tier's shared care (SC) on pregnancy outcomes of GDM. METHODS: Between December 2010 and October 2012, we randomly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 (interquartile range: 25.4-27.3) gestational weeks in Tianjin, China, to receive SC or usual care (UC). The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group. The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension (PIH). RESULTS: Women in the SC (n = 339) and UC (n = 361) groups delivered their infants at similar gestational weeks. Birth weight of infants in the SC group was lower than that in the UC group (3469 vs. 3371 grams, P = 0.021). The rate of macrosomia was 11.2% (38/339) in the SC group compared to 17.5% (63/361) in the UC group with relative risk (RR) of 0.64 (95% CI: 0.44-0.93). The rate of PIH was 8.0% (27/339) in the SC compared to 4.4% (16/361) in the UC with RR of 1.80 (0.99-3.28). Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC. CONCLUSIONS: Lifestyle modifications using a SC system improved pregnancy outcomes in Chinese women with GDM. TRIAL REGISTRATION: Clinicaltrials.gov; NCT01565564.

Different associations of diabetes with ß-cell dysfunction and insulin resistance among obese and nonobese Chinese women with prior gestational diabetes mellitus.

OBJECTIVE: To examine the relative contributions of ß-cell dysfunction and insulin resistance to postpartum diabetes risk among obese and nonobese women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We performed a cross-sectional survey 1-5 years after 1,263 women who had GDM gave birth. Polytomous logistic regression models were used to assess the associations of ß-cell dysfunction (the lower quartile of HOMA-%ß), insulin resistance (the upper quartile of HOMA-IR), decreased insulin sensitivity (the lower quartile of HOMA-%S), and different categories of BMI with prediabetes and diabetes risk. RESULTS: ß-Cell dysfunction, insulin resistance, and decreased insulin sensitivity all were significantly associated with hyperglycemic status across normal weight, overweight, and obese groups, and the patterns of insulin resistance and decreased insulin sensitivity were similar. BMI was inversely associated with ß-cell dysfunction and positively associated with insulin resistance across normal glucose, prediabetes, and diabetes categories. Compared with women with normal glucose and weight, obese women with normal glucose had increased ß-cell secretory function (odds ratio [OR] 0.09 [95% CI 0.02-0.37]) and insulin resistance (OR 17.4 [95% CI 9.47-31.9]). Normal weight diabetic women displayed the most ß-cell dysfunction (OR 13.6 [95% CI 4.06-45.3]), whereas obese diabetic women displayed the highest insulin resistance (OR 45.8 [95% CI 18.5-113]). CONCLUSIONS: For women with prior GDM, ß-cell dysfunction had more pronounced contribution to postpartum diabetes among nonobese subjects, whereas insulin resistance contributed more to postpartum hyperglycemia among obese subjects.

Tianjin Gestational Diabetes Mellitus Prevention Program: study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program.

OBJECTIVE: To assess whether lifestyle intervention can reduce type 2 diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus (GDM) Prevention Program. METHODS: 1180 women who were diagnosed with GDM from 2005 to 2009 were randomly assigned to either a lifestyle intervention (n=586) or a control group (n=594). Major elements of the intervention include six face-to-face meetings with study dietitians in the first year, and two additional sessions and two telephone calls in second year. RESULTS: During the first year, average body weight loss in the first 404 subjects was 1.40 kg (2.1%) in the intervention group vs 0.21 kg (0.3%) in the control group (P=0.001), and the decrease was more significant among baseline overweight women (body bass index [BMI]≥24 kg/m²) in the intervention (2.91 kg/4.2%) compared with that in the control group (0.51 kg/0.7%) (P<0.001). In addition, women in the intervention group, compared with those in the control group, have decreased BMI, body fat, waist circumference, and plasma insulin levels, and have improved behaviors including increased leisure time activity and dietary fiber intake and decreased sedentary time and fat consumptions. CONCLUSION: The interim results support the efficacy and feasibility of the lifestyle intervention program.

Prevalence of diabetes and impaired fasting glucose among 769,792 rural Chinese adults.

OBJECTIVE: To investigate the prevalence of diabetes and impaired fasting glucose (IFG) among rural Chinese adults. METHODS: A cross-sectional whole-population health survey of 364781 men and 405011 women aged 35 years and over was undertaken in 2004 in Tianjin rural area. An overnight fasting capillary whole blood specimen was collected for glucose measurement and information on history of previously diagnosed diabetes was obtained by a standard questionnaire. RESULTS: Using the World Health Organization standard, the age-standardized prevalence of IFG (fasting capillary whole blood glucose 5.6-6.0 mmol/l), screen-detected (previously undiagnosed) diabetes (>or=6.1 mmol/l) and previously diagnosed diabetes were 13.7%, 7.9% and 0.4% in men, 14.5%, 9.7% and 0.9% in women, and 14.1%, 8.8% and 0.7% in men and women combined, respectively. The prevalence of IFG, screen-detected diabetes and previously diagnosed diabetes was higher in women than in men (all p<0.001). The prevalence of IFG and diabetes was higher in participants of rural Tianjin than in the overall Chinese rural and urban population based on the Fourth National Nutritional Survey carried out in 2002. CONCLUSION: The prevalence of IFG and diabetes is relatively high in the rural population in Tianjin and it has become an important public health problem in China.

Prevalence of overweight and obesity among 2.6 million rural Chinese adults.

OBJECTIVE: To investigate the prevalence of overweight and obesity among Chinese rural adults based on the World Health Organization and Chinese standards. METHODS: A cross-sectional whole-population health survey of 1,250,062 men and 1,372,026 women aged 15 years and over was undertaken in Tianjin true rural areas in 2004 (response rate, 85.6%). Height and weight were measured using a standardized protocol. RESULTS: Using the World Health Organization standard, the age-standardized prevalence of overweight (body mass index [BMI] 25-29.9 kg/m(2)) and obesity (BMI> or =30 kg/m(2)) was 21.8% and 3.1% in men, 23.1% and 4.7% in women, and 22.5% and 3.9% in men and women combined, respectively. Using the Chinese standard, the age-standardized prevalence of overweight (BMI 24-27.9 kg/m(2)) and obesity (BMI> or =28 kg/m(2)) was 31.3% and 7.0% in men, 28.7% and 9.7% in women, and 30.0% and 8.4% in men and women combined, respectively. The prevalence of overweight and obesity was higher among Tianjin rural adults than in the whole Chinese rural population based on the 2002 Fourth National Nutritional Survey. CONCLUSIONS: The prevalence of overweight or overweight/obesity is relatively high in this Chinese rural population and might be an important lifestyle-related public health problem in China.