Type 2 Diabetes Risk in Women With Gestational Diabetes

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Candidate: The candidate received her M.D. and M.P.H. from Columbia University, performed her internal medicine residency at the University of California, San Francisco, and completed a Robert Wood Johnson Clinical Scholars fellowship in health services research. She currently practices women's health care in Obstetrics & Gynecology, and she is interested in a research career improving the quality of care for women with glucose intolerance. Sponsor and Environment: William Herman, M.D. M.P.H., a diabetologist and the Michigan Diabetes Research and Training Director, has trained numerous investigators in the field of diabetes epidemiology and health services. Dr. Herman is PI of the Translating Research Into Action for Diabetes (TRIAD) Study, which examines the quality of diabetes care. He is quite familiar with the research methods proposed in this project and will oversee Dr. Kim's formal education. Research: The long-term goal of this proposal is to improve the quality of care for women with glucose intolerance, particularly women with gestational diabetes (GDM), or glucose intolerance first recognized during pregnancy. Twenty percent of women with GDM develop type 2 diabetes (DM) within 5 years after delivery. It is unknown if modest prevention strategies would be effective in women with GDM to prevent DM. First, Dr. Kim will examine the current quality of care for women with a history of GDM. Specifically, she will examine the counseling given for DM prevention and available resources for DM prevention, and correlation with patient and physician characteristics. This study will use a cross-sectional design, consisting of women with a history of GDM (n=400). Information will be obtained primarily from patient and physician surveys. This study will use the infrastructure of the TRIAD study for subject identification, data collection, and analysis. The candidate will then conduct a pilot study randomizing women with GDM to usual care vs. an intervention (group- or telephone support) (n=100). We will adapt existing interventions to women with GDM, and preliminary focus group work will further refine the interventions. A key component is their feasibility in general practice. The pilot will generate sample size estimates for a future trial, whose main outcome will be reduced incidence of DM. These projects address the growing incidence of GDM, which is increasing due to advancing maternal age and obesity, as well as the increasing rates of DM, a major public health problem.