The ADAPT-M Team L-R: Christina Yu, Dr. Lorraine Lipscombe, Susan Jackson and Stephanie de Sequeira

Preventing Diabetes from Home

Helping new moms reduce their future risk of diabetes

Approximately two-thirds of Canadians have at least one risk factor for developing type 2 diabetes and the number of individuals requiring help from prevention programs is widening. Research shows that programs aimed at improving diet and exercise habits are successful in reducing diabetes risk, yet few organized programs exist within our healthcare system.

“Diabetes prevention programs are resource-intensive and the volume of people at risk who could benefit from these types of programs is overwhelming for an already stressed healthcare system,” notes Dr. Lorraine Lipscombe, scientist at Women’s College Research Institute (WCRI) and director of the Division of Endocrinology at Women’s College Hospital (WCH). “However, for groups that are at high-risk of developing type 2 diabetes, there is an urgent need to develop and implement focused programs.”

One of these high-risk groups is women who have had gestational diabetes, as they have a seven-fold risk of developing type 2 diabetes later in life. These women often have competing demands for their time, including parenting responsibilities, sleep deprivation and a lack of childcare support to help them access services even if they were available.

For a long time, there wasn’t much evidence about what would work to reduce diabetes risk in this population, where self-care is often not the highest priority. Risk perception is a common issue, as these women do not realize that they may develop type 2 diabetes within five to 10 years after giving birth.

“The first year postpartum is an especially vulnerable time in their lives for women to develop bad habits that can further worsen their risk of diabetes, which is why we developed the Avoiding Diabetes after Pregnancy Trial in Moms, also known as ADAPT-M,” adds Dr. Lipscombe. “ADAPT-M is a formalized program that gives women strategies and tools to promote self-care during this demanding time, allowing them to make lifestyle changes right away to reduce their diabetes risk.”

The first phase of ADAPT-M’s development involved working with the Women’s Cardiovascular Health Initiative (WCHI). WCHI had already developed a successful program for improving heart health, but the program included key components that would also benefit this population of women. Following the success of testing ADAPT-M in the existing program, the team moved forward with phase two, which involved the implementation of a pilot trial.

In the pilot, the team refined the ADAPT-M materials to make them more specific and relevant to diabetes prevention and changes during the postpartum period, using trained diabetes educators to facilitate the program. Approximately 105 women finished the pilot program with the majority of women completing 80 per cent of their coaching phone calls and reporting high satisfaction.

“We are now in the third phase of the ADAPT-M project, which is aimed at studying strategies to improve engagement in the program,” says Dr. Lipscombe. “We’ve made the program materials available online so they are easier to access, engaged additional coaches to give more flexibility to participants and are having better conversations earlier on with women during pregnancy to confirm their commitment so that they come back after giving birth to complete the program.”

Once the full trial of ADAPT-M has been completed, the team plans to work with community diabetes education programs to incorporate ADAPT-M into their existing programs. They will also be engaging with primary care providers, particularly family health teams, who care for and follow-up with women after their birth who may be at risk for type 2 diabetes.

“Most importantly, we need a sustainable training program to build capacity,” Dr. Lipscombe emphasizes. “We will be working with our existing diabetes educators to develop a virtual training program so that ADAPT-M can be implemented in communities across Canada.”