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Mothers After Gestational Diabetes in Australia (MAGDA) study: Preventing Diabetes in Pregnancy from Progressing to Type 2 Diabetes: Macrolevel System Change in South Australia and Victoria

Gestational diabetes mellitus (GDM) is an escalating problem worldwide with 7% of all pregnancies estimated to be complicated by GDM (1). The strongest predictor of developing Type 2 diabetes is a history of diabetes during pregnancy (2) - 30-50% of women who have GDM will go on to develop diabetes (3). Although lifestyle modification programs are effective in delaying or preventing diabetes (4-6), no intervention programs have been designed specifically for pregnant women. This project will develop and implement a system of care to reduce the risk of progression to diabetes post-GDM.

The work will be undertaken in four main phases:

  1. Screening and registering all women for GDM and recalling women from the GDM register to their GP for a two-yearly check-up for diabetes status.
  2. Implementing a randomised controlled trial, known as the GDM Diabetes Prevention Program (GDM-DPP), with a structured lifestyle modification group intervention for women who have had GDM.
  3. Economic assessments of screening, GDM registers and recall system and the GDM-DPP, designed to evaluate ‘value for-money' and the efficacy and efficiency of the DPP.
  4. Translation of research into policy to operational health services.

This study implements a chronic disease management system with long-term follow-up for a high risk population. Professor James Dunbar, the project's Chief Investigator and the GGT UDRH's Director, says "It's important to identify whether a system change for diabetes prevention [in women with a history of GDM] leads to a reduction in the risk of diabetes greater than that seen with usual care. The results of this study will be vital for developing policy over the next decade. The challenge, of course, will be to put the findings into action."

This is a unique project where stakeholders will work together to build an improved policy for prevention of diabetes in this high risk group of women. The partnership brings together two State health departments, the Department of Health Victoria (DH Victoria) and SA Health; General Practice Victoria (GPV) and two Non Government Organisations (NGO's), Diabetes Australia Vic (DAVic) and Diabetic Association of South Australia Inc. (Diabetes SA), along with a team of internationally-recognised academics and implementation researchers. The involvement of these key players underscores the strength and distinct nature of this partnership and the significance of its contribution to improving health.

Progress:

Staff recruitment has commenced with the appointment of a Senior Program Manager and Senior Research Fellow. A Project Board, Project Management Group and working groups have also been established.

The study will begin in late July 2011 with the screening and register management of women diagnosed with GDM at three designated study sites:

Project team members are developing new GDM-DPP materials in preparation for the pilot study of the intervention at the Royal Women's Hospital (August - November 2011).

The project is due to be completed in 2015.

List of references

 

Grant Details

Funding Bodies: National Health & Medical Research Council (NHMRC); Department of Health - Victoria; SA Health; Diabetes Australia Victoria.  Partnership Grant, Application ID 533956.

Chief Investigator A: Professor James Dunbar (GGT UDRH Flinders University & Deakin University)

Investigators: Professor James Best (University of Melbourne), Professor Edward Janus (Western Health, GGT UDRH Flinders University & Deakin University), Professor Rob Carter (Deakin University), Professor Jeremy Oats (Royal Woman's Hospital), Dr John Carnie (Department of Health Victoria) & Professor Paddy Phillips (Flinders University)

Partners: Department of Health - Victoria, SA Health, Diabetes Australia Victoria, General Practice Victoria, Diabetic Association of South Australia Inc, Flinders University and Melbourne University.

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