History of Gestational Diabetes Presentation May 2015

National Diabetes Education Program US Department of Health and Human Services program jointly sponsored by: National Institutes of Health Centers for Disease Control and Prevention With over 200 public and private partners Seeks to reduce the burden of diabetes in the US by facilitating adoption of proven approaches to prevent or delay the onset and progression of diabetes and its complications. The National Diabetes Education Program or N-D-E-P is a joint program of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), along with more than 200 public and private partner organizations. The mission of the NDEP is to reduce the burden of diabetes in the United States by facilitating adoption of proven approaches to prevent or delay the onset and progression of diabetes and its complications. A few years ago, NDEP began to expand its outreach through its history of gestational diabetes campaign, “It’s Never Too Early…To Prevent Diabetes”. The NDEP has implemented outreach activities designed to raise awareness of: Future health risks for women with a history of GDM and her offspring; and Steps they can take to prevent or delay the onset of diabetes. The NDEP provides a number of outreach tools for partners who are interested in helping to get the word out in their communities. See the following slides for more information about the initiative and the variety of materials available to supplement outreach efforts.

Gestational Diabetes Mellitus (GDM) Diagnosed during pregnancy. Affects at least 7% and possibly as many as 18% of U.S. pregnancies. Occurs frequently with other risk factors for diabetes. GDM is a form of diabetes that is diagnosed during pregnancy – usually at around 28 weeks.  Gestational diabetes affects at least 7% and possibly as many as 18% of pregnancies in the United States. It occurs more frequently among women with a family history of diabetes, obese women and certain racial and ethnic groups including Latina, African American, American Indian, Asian, Pacific Islander, and Alaska Native women.

Why is Gestational Diabetes a Concern AFTER Pregnancy? Immediately after pregnancy, 5% to 10% of women with GDM have diabetes, usually type 2. 35% to 60% chance of developing diabetes in the 10 to 20 years after delivery. Risk for cardiovascular disease may be increased. Children of GDM pregnancies may be at greater risk for future obesity and type 2 diabetes. Buchanan TA, et al.Diabetes Care 2007; 30 Suppl 2: S105-11. Kitzmiller JL, et al. Diabetes Care 2007; 30 Suppl 2: S225-35. Even though gestational diabetes is, by definition, diabetes diagnosed during pregnancy, sometimes blood sugar (blood glucose) levels do not return to normal after delivery. Even if sugar levels do return to normal after pregnancy, a history of gestational diabetes (hGDM) has a lifelong impact on the mother’s risk for developing diabetes. Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. Women who had GDM have a 35% to 60% chance of developing diabetes in the 10 to 20 years after delivery. Children of GDM pregnancies may be at greater future risk for obesity and type 2 diabetes. Also, the risk for cardiovascular disease is increased in women with a history of GDM. Studies in women with prior GDM suggest that a chronic inflammatory response may be present and represents an early feature of the cluster of CVD risk factors that relate to insulin resistance and the metabolic syndrome. Buchanan TA, Xiang A, Kjos SL, Watanabe R: What is gestational diabetes? Diabetes Care 2007; 30 Suppl 2: S105-11. Kitzmiller JL, Dang-Kilduff L, Taslimi MM: Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care 2007; 30 Suppl 2: S225-35.

Good News! Small steps can lower type 2 diabetes risk. Lifestyle changes include dietary changes and physical activity to lead to modest weight reduction and maintenance. Early detection of prediabetes may provide an opportunity to prevent or delay the onset of type 2 diabetes. The good news is there are steps women with a history of GDM can take to prevent or delay diabetes and lower that risk, which we learned from the Diabetes Prevention Program (or D-P-P) sponsored by NIH. The DPP showed that people at risk for type 2 diabetes were able to lower their risk for developing diabetes by weight loss through lifestyle changes – by being more active and eating healthy foods. Among DPP participants with a history of GDM, both lifestyle changes and metformin lowered their risk for type 2 diabetes by 50 percent or more. A follow-up study showed that people in the DPP who lost weight by being active and eating healthy foods or who took metformin, still had a reduced risk for type 2 diabetes 10 years later. Modest but important steps can lower diabetes risk, primarily type 2, while helping to keep the whole family healthy. These include: Lifestyle modifications, which include dietary changes and physical activity to lead to weight reduction and maintenance. Timely detection of prediabetes, which provides an opportunity to prevent or delay the onset of type 2 diabetes through diet, physical activity, weight management, and/or pharmacological intervention.

Awareness of post GDM issues Awareness is low about health risks for women who have a history of GDM. Many women do not receive and/or are not aware of the need for follow-up testing. NDEP is raising awareness among providers about the importance of continuing to track and monitor GDM moms long after the pregnancy has ended. There is low level awareness of the health risks for women who have a HISTORY of gestational diabetes. Many women post GDM do not receive and/or aren’t aware of the need for follow-up testing. NDEP is raising awareness among providers about the importance of continuing to track and monitor GDM moms long after the pregnancy has ended.

It’s Never Too Early . . . to Prevent Type 2 Diabetes Outreach Goals: ↓number of women with history of GDM who develop diabetes ↑awareness of health risks for children of that pregnancy ↑ awareness of timely testing ↑ provider counseling about future health risks/steps to prevent type 2 diabetes ↑ adoption and maintenance of healthy behaviors Women with a history of gestational diabetes provide a unique opportunity for identification of, and intervention in, a population at high risk for developing diabetes. The National Diabetes Education Program (NDEP) is encouraging our partners in the primary care community to help raise awareness about the future health risks that gestational diabetes places on the mother and her child affected by a GDM pregnancy. These messages are informed by the results of the Diabetes Prevention Program (DPP) clinical trial sponsored by NIH. Outreach Goals: (on slide) ↓ number of women with history of GDM who develop diabetes ↑ awareness of health risks for children of that pregnancy ↑ awareness of timely testing ↑ provider counseling about future health risks and steps to take to prevent type 2 diabetes ↑ adoption and maintenance of healthy behaviors

What You Can Do to Help Encourage women with a history of GDM to: Continue positive lifestyle habits after delivery. Get screened 6 to 12 weeks post partum – if test is normal, get tested at least every 3 years. If prediabetes is diagnosed, get tested annually for diabetes. Breastfeed to help mom lose weight and improve the child’s health. Aim for pre-pregnancy weight within 6 to 12 months. If still overweight, work to lose 5%-7% body weight over time. Make healthy food choices/eat smaller portions. Be active 30 minutes 5 days a week. What can you do to help? Encourage women with hGDM to do the following: Continue with the positive lifestyle habits made to manage gestational diabetes after delivery. Get tested for diabetes 6 to 12 weeks after the baby is born. If the test results show that blood sugar is higher than normal, but not high enough to be diabetes, also called prediabetes, get tested every year. If the test is normal, get tested every 3 years. Breastfeed your baby to help you lose weight and improve your child’s health. Aim to get back to pre-pregnancy weight within 6 to 12 months, then if still overweight, work to lose weight over time. The DPP showed that losing 5 to 7% of body weight and regular physical activity 30 minutes a day, 5 days a week was effective in reducing the risk of the development of diabetes by 50%. At the 10 year follow up to the DPP, a 34% risk reduction was seen. Make healthy food choices and eat smaller portions. There is strong evidence that life-style changes or the diabetes drug metformin can prevent or delay type 2 diabetes in many of these women at high risk.

Resources Available from NDEP www.YourDiabetesInfo.org/GDM Use/adapt/share materials from NDEP: Ready-to-use articles Toolkits Tip Sheets/Fact Sheets Web banners Print and Broadcast PSAs Information available in English and Spanish How can you help raise awareness of these critical health messages to women at risk? The NDEP provides a number of outreach tools for partners who are interested in helping to get the word out in their communities. Materials can be found at YourDiabetesInfo.org/GDM (YourDiabetesInfo.org – slash – G-D-M). These resources include ready-to-use drop in articles, print and broadcast PSAs, web banners, tip sheets and toolkits. NDEP’s Did You Have Gestational Diabetes When You Were Pregnant? What You Need to Know tip sheet was developed specifically for women with a history of gestational diabetes. NDEP’s Small Steps. Big Rewards. Your GAME PLAN to Prevent Type 2 Diabetes: Information for Patients booklet helps people learn their risk for getting diabetes and implement a program to prevent or delay the onset of the disease. GAME PLAN also includes a food and activity tracker as well as a calorie and fat counter. NDEP has many other print materials on diabetes prevention available for patients, many of which are also offered in Spanish.

Connect with NDEP Online and social media outreach: “Like” NDEP on Facebook (facebook.com/ndepgov) Follow NDEP on Twitter (@NDEP) Subscribe to NDEP’s monthly e-newsletter, News & Notes Subscribe to NDEP’s RSS Feed You can receive information and updates from NDEP several ways: Connect with NDEP via Facebook (facebook.com/ndepgov) and Twitter (@NDEP). In addition, you can subscribe to the NDEP’s monthly e-newsletter, News & Notes, as well as NDEP’s “What’s New” RSS feed from the NDEP homepage, YourDiabetesInfo.org.

Behavior Change Resources NDEP’s Diabetes HealthSense Online Library: www.YourDiabetesInfo.org/HealthSense Diabetes HealthSense is an online library that provides easy access to more than 160 resources from more than 80 organizations that support people with diabetes, people at risk for the disease, and those who care for them in making changes to live well or facilitating behavior change in others. Diabetes HealthSense also offers research articles for health care professionals interested in finding out more about the science of behavior change. All materials have been independently reviewed by experts in psychosocial issues and behavior change. Following are some examples of resources in Diabetes HealthSense targeted to women and families.

Fit for Two Behaviors Physical activity Healthy eating Audiences Adults Source: Weight-control Information Network www.win.niddk.nih.gov The Weight-control Information Network’s Fit for Two booklet provides tips and ideas to improve your eating plan and become more physically active before, during, and after your pregnancy. Eating well can help you have a healthy pregnancy and a healthy newborn. Being physically active may help you have a more comfortable 9 months and an easier delivery. Use the ideas and tips in this booklet to improve your eating plan and become more physically active before, during, and after your pregnancy. Make changes now, and be a healthy example for your family for a lifetime.

Food for Thought: Eating Well On a Budget Behaviors Healthy Eating Audiences Families Source: PBS http://www.sesamestreet.org/parents/topicsandactivities/toolkits/food Food for Thought: Eating Well On a Budget is a bilingual, multimedia program designed to help parents who have children between the ages of 2 and 8, cope with limited access to affordable and nutritious food. This program assists parents in helping their children make healthy food choices and start healthy habits to prevent diabetes. The materials use Sesame Street characters to teach lessons on nutrition and healthy activities.

NDEP Behavior Change Video Series Available on Diabetes HealthSense at www.YourDiabetesInfo.org/HealthSense Series of short videos focused on helping people make lifestyle changes and cope with the demands of diabetes. The NDEP offers a series of 3-to 5-minute videos to help people make lifestyle changes and cope with the demands of diabetes. Videos address topics such as setting goals to improve health, living with diabetes, finding the support you need, as well as segments on diabetes prevention and physical activity. The videos shown on this slide feature women who have a history of gestational diabetes and are taking steps with their families to prevent type 2 diabetes.