Gestational diabetes as a risk factor for Type 2 Diabetes

Colombian project aims to promote healthier pregnancies and awareness of gestational diabetes

Photo: More than 300 pregnant women gathered to a health education session in Barranquilla, Colombia. Ane Bonde from Steno was one of the speakers.


Rationale and aim
Gestational Diabetes (GD) is a complication to pregnancy and a risk factor for Type 2 Diabetes (T2D) later in life for both mother and offspring.

In high income countries, screening for GD and treatment of diagnosed cases is widespread, but follow up with T2D prevention purpose after delivery is not taking place or unsystematic at best. In low and middle income countries, screening for GD is unsystematic or not taking place, hence prevention after delivery is rarely on the agenda.

GD unknown in Colombia
In Colombia, a middle income country, screening for GD is unsystematic and GD’s prevalence is unknown. This is the background for “Vida Nueva”, a World Diabetes Foundation (WDF) project run by the health authorities in the city of Barranquilla, Colombia. The Steno Health Promotion Center, (SHPC) is an advisory partner along with other national and international institutions.

The objective of the Vida Nueva Project is to strengthen the capacity of the health care system in Barranquilla, Colombia to detect and treat GD.

One of the first results of Vida Nueva is an updated guideline with a new screening strategy for diagnosis and treatment of GD. (Mendoza, Damm, Bonde et al 2012). This was agreed upon by the local partner institutions during a revision process in the first semester of 2012. The partners chose to build the screening strategy upon on the recommendations from the International Association of Diabetes in Pregnancy Study Groups (Diabetes Care, 2010).

Research projects
In addition to our advisory role, SHPC will conduct research with local university partners. While the Vida Nueva project revolves around improving the screening in antenatal care, we will focus on contributions to the evidence base on the prevalence of GD, the feasibility of the chosen screening strategy, and perspectives for the prevention of T2D in women with previous GD (depending on achieved funding).

Design, method and theory
Vida Nueva is a capacity building project.  Design, method and theory will vary in relation to the various future research projects.

Target groups
Pregnant women in Barranquilla are Vida Nueva’s target group. They receive health education and are screened for GD. The next generation of babies are also targeted indirectly.
Furthermore, Vida Nueva targets health care professionals from the local health provider institutions through training courses and seminars.

Expected outcomes
Through Vida Nueva, we expect the women of Barranquilla to gain healthier pregnancies and improved pregnancy outcomes. We also expect a health care system in Barranquilla capable of managing GD. In addition, we expect an improved evidence base on the prevalence of GD in Colombia and GD screening strategies.

Funding
Vida Nueva is funded by World Diabetes Foundation and Novo Nordisk A/S.

Collaborators
The Health Secretariat of Municipality of Barranquilla, Centro de Investigación Sanitaria (local NGO), Colombian Diabetes Association, Colombian Association of Endocrinology, Universidad del Norte; Universidad Libre, Universidad del Atlántico, HJELT Institute at University of Helsinki, Finland, Department of Obstetrics (Diabetes in Pregnancy), National Hospital (Rigshospitalet), Novo Nordisk A/S.

Oral presentations at international conferences
Mendoza, H., et al. (2012): Screening and management of Gestational Diabetes in Barranquilla, Colomiba. 7th World Congress of Diabetes and its Complications. Madrid, Spain. 11-13 November.


Bonde, A., Navarro, E., Mendoza, H., Acosta, T., Barengo, N., & Aagaard-Hansen, J. (2011): Gestational diabetes and equity in Barranquilla, Colombia – a research plan. 6th International Conference organized by International Society for Equity in Health, “Making Policy a Health Equity Building Process”, Cartagena, Colombia, 26-28 September.


Barengo, N. (2011): Pregnancy as an entry point for diabetes prevention. Experiences from Colombia: The Vida Nueva project. 6th International Symposium on Diabetes and Pregnancy, Salzburg, Austria, 23-26 March.


Publications
Mendoza, H., Damm, P., Bonde, A. et al. (2012). Detección y Manejo de Diabetes Gestacional. Guía de atención. [Screening and management of Gestational Diabetes. Guideline]. Alcaldía de Barranquilla-World Diabetes Foundation. ISBN. 978-958-57899-0-6

Inspirational articles
Ferrara, A. & Ehrlich, SF. (2011). Strategies for Diabetes Prevention Before and After Pregnancy in Women with GDM. Current Diabetes Reviews, 7(2):75-83.


International Association of Diabetes and Pregnancy Study Groups Consensus Panel (2010). International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care, 30(3):677-82.


Kapur, A. (2011). Pregnancy: A window of opportunity for improving current and future health. International Journal of Gynecology & Obstetrics, 11(5).Sup.1:550-51.


Moses, RG. (2010). New Consensus Criteria for GDM. Problem solved or a Pandora’s box? Diabetes Care, 30(3):690-91.


Nielsen, KK., Courten, M. & Kapur, A. (2012). The urgent need for universally applicable simple screening procedures and diagnostic criteria for gestational diabetes mellitus - lessons from projects funded by the World Diabetes Foundation. Global Health Action, 5:17522.

Sidst opdateret 24-07-2015

Responsible

Ane Høstgaard Bonde
Researcher
Prevention Research

Jens Aagaard-Hansen
Senior Researcher
Prevention Research