Counselling did not prevent gestational diabetes

Taking a blood test during pregnancy

Clinical question:

In women at risk of developing gestational diabetes, does a counselling programme focused on diet and exercise reduce the risk of progression?

Gestational diabetes can usually be controlled through changes to diet and lifestyle.  This study looked at whether they can be prevent it from developing in the first place.

The evidence

The researchers recruited 399 women with at least one risk factor for gestational diabetes.  Fourteen municipalities in Finland were randomised to deliver either a counselling programme to these women involving both dietary and exercise advice, or to provide standard care.

They found that there no significant difference between the groups in the proportion of women going on to develop gestational diabetes.

Appraisal hints

Users of this research should consider:

  • With only 14 municipalities to randomise, which were further stratified by demographics, it seems likely that the two groups of patients may not have been similar at the start of the trial.
  • Although it’s not possible to “blind” this type of study, it is possible to blind the outcomes assessors.  It seems that this step was not taken.
  • A high proportion of patients had abnormal oral glucose tolerance tests at baseline, indicating that they already had some form of diabetes.  These patients were excluded from the study;  however, perhaps these are the patients we would expect to benefit most from the programme.

Reference

The full text of this article is available from the link below:

Luoto R, Kinnunen TI et al. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS Med. 2011 May;8(5):e1001036. Epub 2011 May 17.

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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