Clinic to community connections

Cynthia Herrick, MD, MPHS

Lay Summary: 

Diabetes is the seventh leading cause of death in the United States and contributes to heart disease, the leading cause of death.  We must prevent diabetes to promote longer life.  The central goal of this project was to test a program that teaches practical skills to prevent diabetes.  The program focused on women who have high blood sugar first detected during pregnancy (gestational diabetes).  This condition usually resolves after pregnancy, but it is an early warning sign of future risk for diabetes.  Almost half of women will develop type 2 diabetes in the 5-10 years after a pregnancy with gestational diabetes.  

We know that time intensive programs focused on healthy diet, exercise and behavior change can cut diabetes risk in half.  However, these programs are not designed for women during and after pregnancy and are often not practical in this setting.  We proposed a modified program that fits the needs of this unique group.  Our program was designed to be delivered by a community health worker who can support women in addition to their doctors.  Through educational sessions during the last part of pregnancy and in the first 3 months postpartum, we hoped to promote early detection and prevention of type 2 diabetes for high-risk women.  

Unfortunately, complications and delays related to COVID19 as well as staff turnover prevented completion of our study; however, patient education materials developed for the study are currently undergoing evaluation and adaption for broader dissemination.

Abstract: 

 
Type 2 diabetes is a growing public health challenge and gestational diabetes predicts this preventable chronic disease at an early age.  Half of all women with gestational diabetes will go on to develop type 2 diabetes without intervention.  Diabetes is the seventh leading cause of death in the United States and contributes to heart disease, the leading cause of death.  Hence, interventions to detect and prevent diabetes are essential to promoting longevity.  

There are clear opportunities to intercede during and after pregnancy to prevent type 2 diabetes; however, it is difficult to operationalize these interventions in low resource settings and traditional healthcare models.  The purpose of this pilot award is to collect preliminary data on innovative approaches to care delivery to maximize diabetes prevention in vulnerable populations.  To achieve this goal, we proposed to 1) evaluate the effectiveness of a tailored community health worker delivered intervention to facilitate lifestyle change beginning in pregnancy and continuing into the postpartum period and 2)  assess critical implementation outcomes, including reach, adoption, implementation fidelity, and maintenance of the intervention.  

Delays related to the COVID19 pandemic and staff turnover led to premature termination of the study.  Patient education materials developed for the study are currently undergoing evaluation and adaption for broader dissemination.