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

项目摘要 妊娠期糖尿病（GDM）对女性造成了长期的健康负担，这是由于妊娠期糖尿病的7倍。 2型糖尿病（T2 DM）和其他心血管疾病的风险增加。然而， 在GDM之后的过渡期内存在许多差距，由于动机增强，这是一个特别关键的时期， access.然而，少数妇女接受产后筛查，或成功地 过渡到初级保健。虽然T2 DM预防干预措施可以取得成功，但无法部署 没有保持和参与护理。解决产后经历的独特障碍 妇女需要创新的卫生保健提供模式，以促进预防GDM后的T2 DM。 在其他领域取得成功的一种潜在干预措施是患者导航，一种以障碍为重点的， 纵向的、以病人为中心的干预，为一套确定的卫生服务提供支持。 这项R34提案是一项为期两年的研究计划，旨在对“维持妇女参与”进行试点评估， GDM后实现过渡（SWEET），一种以GDM为重点的干预措施， 导航策略，以改善妊娠期糖尿病患者的健康状况。我们的目标是确定，通过随机 对照试验的40名妇女谁有GDM，无论那些谁接受SWEET导航干预 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。为了 为了提高自我效能，增加获取机会，并维持长期参与，SWEET干预将 提供GDM特定的个性化导航服务，利用现有的临床基础设施，包括 后勤支持、心理支持和健康教育，直至产后1年。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）和患者报告（糖尿病自我效能、激活和 暴露于SWEET与常规护理的女性的T2 DM风险感知）结果不同。目标2将评估 可行性和可接受性。SWEET旨在成为一种实用的临床综合干预措施。这 一项提案将产生关键数据，用于对GDM特异性产后患者进行全面试验 该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。 SWEET弥合了怀孕期间护理之间的鸿沟-专注于改善 孕妇及其后代-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善早期识别 2型糖尿病，生活方式的改变，保留护理，并过渡到初级保健后GDM。实现这些 目标将提高妇女的长期和随后的怀孕健康，这两者都符合 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.