The MoMMii Study. Diabetes Prevention Intervention on Families With Past Gestational Diabetes
Condition: Gestational Diabetes Mellitus With Baby Delivered
MeSH terms: Diabetes, Gestational; Diabetes Mellitus
Study type: Interventional

Summary: 
      Women with gestational diabetes (GDM) have increased risk of developing type 2 diabetes;
      their children show more insulin resistance and diabetes compared to offspring of mother
      without diabetes in pregnancy. An increased diabetes risk is also observed among partner of
      adult with prediabetes/type 2 diabetes. The investigators have pilot-tested a program for
      diabetes risk reduction among women within 5 years of a GDM pregnancy (MoMM program). The
      investigators are now enhancing the program to engage directly the partner (MoMMii program).

      In MoMMii, 66 couples with a history GDM in the mother will participate in a multimodal
      diabetes prevention program that includes healthy meal preparation training, discussion of
      eating and physical activity behaviours and developing home environments that facilitate
      healthy habits, pedometer-based step count monitoring, and participation in family-based
      activities (frisbee, soccer) as well as individual exercise (e.g., use of exercise equipment,
      floor resistance exercises). Participants will be encouraged to communicate between sessions
      with study personnel and with one another to create a between family support network. All
      mothers and fathers will participate in five sessions over six months. The investigators will
      examine changes in health-related behaviours, blood pressure, glucose levels, and insulin
      sensitivity/resistance in both mothers and fathers.
    

Detailed description: 
      The primary goal of the project is to determine if, among families with a history of
      gestational diabetes mellitus (GDM) in the mother in the prior five years, a family-based
      multimodal health behaviour intervention (group cooking and eating/physical activity
      counselling, telephone-based app and text support, building of peer and within-family social
      support for health behaviour change) will lead to reductions in post 75g glucose load serum
      glucose values in mothers and fathers. The previous MoMM pilot study demonstrated an 8%
      reduction in mothers, similar in magnitude to that observed in a large diabetes prevention
      trial conducted among adults with impaired glucose tolerance (Tuomieltho et al, N Engl J Med
      2001). MoMMii will ascertain if expansion to a family-based approach amplifies effects in
      mothers and demonstrates impact in fathers and children. Thus, MoMMii will shift the focus
      from the mother to the family. A systematic review and meta-analysis showed diabetes risk to
      be shared between spouses (Leong et al, BMC Medicine, 2014). GDM also confers higher risk for
      insulin resistance and overweight in offspring. Thus, this project plans to create a
      collaborative home environment that facilitates choices consistent with diabetes prevention
      for all family members. Sixty-six families will be recruited through GDM clinics at McGill
      University Health Centre and other centres. Five in-person sessions (meal preparation
      training, eating and physical activity counselling) will take place once a month at the
      PERFORM Centre, Concordia University. Each session will involve discussion of strategies to
      achieve healthy eating, hands-on meal preparation, and group-based physical activity.
      Sessions will engage couples as well as mothers and fathers separately. 'Healthy living'
      concepts will be integrated into the on-site childcare structure (meal preparation, games,
      videos). The intervention team will include a dietitian and kinesiologist. A health coach
      will facilitate networking among participating families and development of lay group leaders
      to sustain health behaviour changes between sessions and post program. Outcomes will be
      evaluated in mothers, fathers (e.g., fasting and post load glucose and insulin resistance
      measures, fruit/vegetable intake, step counts, eating behaviours, blood pressure) and
      offspring (dietary/physical activity habits).
    

Intervention name(s): Nutrition/physical activity intervention
Intervention type(s): Behavioral
Intervention description(s): Please see arm description
Other intervention name(s): Lifestyle intervention; Diabetes prevention intervention
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: behavioural; diabetes prevention; physical activity; healthy eating; gestational diabetes