Sustaining Women's Engagement and Enabling Transitions after Gestational Diabetes Mellitus (SWEET)

项目总结 妊娠期糖尿病(GDM)给女性带来了巨大的长期健康负担，原因是 罹患2型糖尿病(T2 DM)和其他心血管疾病的风险增加。然而，还有一些 千年发展目标之后的过渡期存在许多差距，这是一个特别关键的时期，因为增强了动力和 进入。然而，少数妇女接受产后血糖异常筛查或成功 过渡到初级保健。虽然T2 DM预防干预措施可以成功，但不能部署 没有保留和参与护理。解决产后遇到的独特障碍 妇女需要创新的医疗保健提供模式，以促进妊娠期糖尿病后T2 DM的预防。 在其他领域取得成功的一个潜在干预措施是患者导航，一种以障碍为重点的 以患者为中心的纵向干预，为一套明确的健康服务提供支持。 这份R34提案是一项为期两年的研究计划，旨在对持续的妇女参与度和 启用GDM后过渡(甜蜜)，这是一种以GDM为重点的干预措施，将适用于障碍减少患者 妊娠合并妊娠期糖尿病后改善健康的导航策略。我们的目标是通过随机的 对40名患有妊娠期糖尿病的妇女进行对照试验，无论那些接受甜蜜导航干预的妇女 与那些接受常规护理的人相比，出生后1年的糖尿病相关健康状况有所改善。按顺序 为了提高自我效能感，增加接触机会，并保持长期参与，甜蜜的干预将 提供特定于GDM的个性化导航服务，利用现有的临床基础设施，包括 通过产后一年的后勤支持、心理社会支持和健康教育。目标1将评估 无论是临床(体重、血糖控制、腹围和血压)、卫生服务 (产后和初级保健就诊次数)和患者报告(糖尿病自我效能、激活和 T2 DM风险认知)在接受甜蜜护理和常规护理的妇女中，结果不同。AIM 2将评估 可行性和可接受性。甜蜜的设计是一种务实的临床综合干预措施。这 该提案将产生对特定于妊娠期糖尿病的产后患者进行全面试验的关键数据 导航计划，将解决有关长期孕产妇健康和T2 DM预防的关键问题。 甜蜜弥合了孕期护理之间的鸿沟-专注于改善 孕妇及其子女--以及长期妇女保健--侧重于慢性病 管理和预防保健。我们致力于确定如何改进早期识别 2型糖尿病、生活方式改变、保留护理和妊娠期糖尿病后向初级保健过渡。实现这些目标 目标将加强妇女的长期和后续怀孕健康，这两者都与 NIDDK的使命是预防或改善围产期后T2 DM的影响。

PROJECT SUMMARY Gestational diabetes mellitus (GDM) poses a substantial long-term health burden to women due to the 7-fold increased risk of developing type 2 diabetes mellitus (T2DM) and other cardiovascular disorders. Yet, there are many gaps in the transition period after GDM, which is a particularly critical time due to enhanced motivation and access. Nevertheless, a minority of women receive postpartum screening for dysglycemia or have successful transition to primary care. Although T2DM prevention interventions can be successful, they cannot be deployed without retention and engagement in care. Addressing the unique barriers experienced by postpartum women requires innovative models of health care delivery to promote prevention of T2DM after GDM. One potential intervention with demonstrated successes in other arenas is patient navigation, a barrier-focused, longitudinal, patient-centered intervention that offers support for a defined set of health services. This R34 proposal is a 2-year research plan for a pilot assessment of Sustaining Women's Engagement and Enabling Transitions after GDM (SWEET), a GDM-focused intervention that will apply barrier-reduction patient navigation strategies to improve health after a pregnancy with GDM. We aim to determine, via a randomized controlled trial of 40 women who have had GDM, whether those who receive the SWEET navigation intervention have improved diabetes-related health at 1 year after birth compared to those who receive usual care. In order to promote self-efficacy, enhance access, and sustain long-term engagement, the SWEET intervention will provide GDM-specific, individualized navigation services that leverage existing clinical infrastructure, including logistical support, psychosocial support, and health education, through 1-year postpartum. Aim 1 will evaluate whether clinical (weight, glycemic control, abdominal circumference, and blood pressure), health services (postpartum and primary care visit attendance), and patient-reported (diabetes self-efficacy, activation, and T2DM risk perception) outcomes differ in women exposed to SWEET versus usual care. Aim 2 will evaluate feasibility and acceptability. SWEET is designed to be a pragmatic and clinically-integrated intervention. This proposal will generate key data for the conduct of a full-scale trial of a GDM-specific postpartum patient navigation program that will address critical questions about long-term maternal health and T2DM prevention. SWEET bridges the chasm between care during pregnancy – focused on improving the health of the pregnant woman and her offspring – and long-term women’s health care – focused on chronic disease management and preventive health. We are dedicated to identifying how we can improve early identification of T2DM, lifestyle modification, retention in care, and transitions to primary care after GDM. Achieving these goals will enhance women’s long-term and subsequent pregnancy health, both of which are consistent with the NIDDK mission to prevent or ameliorate the effects of T2DM beyond the perinatal period.