Adapting the National Diabetes Prevention Programme in Ireland in partnership with women post gestational diabetes

Background: The Diabetes Prevention Programme (DPP) in Ireland is the Health Service Executive's (HSE's) owned and accredited group self-management education (SME) and support programme for people living with pre-diabetes. This clinical and behavioural intervention supports people with pre-diabetes to self-manage their health and lifestyle to prevent progression to type 2 diabetes. The evaluation of the DPP demonstrated that half of all people with pre-diabetes who completed the intervention returned their blood glucose levels to the normal range. Women who develop gestational diabetes (GDM) are 10 times more likely to develop type 2 diabetes compared to women who do not. Approximately, 50% of women post-GDM will develop type 2 diabetes, with the greatest risk in the first 5 years post-GDM. The HSE recognised the need to adapt the DPP to support this cohort of women to engage in the programme.

 

Methods: We engaged with key stakeholders including, academics, health care professionals and women post-GDM to inform the adaptations to curriculum.

 

We invited a group of women who previously had GDM to participate in testing the bespoke adapted programme, recruited post-partum via maternity hospital partners. These women attended the group intervention online for 12 months (6 weekly sessions, 8 monthly sessions) and they contributed feedback throughout the process at the following time points:

• informally at the end of each session ‘in conversation’;
• formally through self-administered online questionnaire at 2 time points;
• online interviews mid-way and;
• a volunteer shared her lived experience at two time points.

 

Outputs: •Delivered an adapted DPP curriculum that includes messages tailored to women post-partum and post-GDM including; evidence-based messages on physical activity, mental health, family nutrition, deemed acceptable by these women.

• Developed a training module for dietitian educators to support them to deliver the adapted DPP post-GDM, this included contributions from the lived experience of a patient partner.

 

Key Learnings: Engagement with key stakeholders ensured that the curriculum was adapted to meet the needs of this cohort.

Engaging with the target audience as early and as often as possible when adapting the programme had many benefits:

• Perspective of these women was reflected throughout;
• Gave the team confidence that the adapted programme is acceptable to this cohort and is meeting their needs.
• The women valued the opportunity to engage in an evidence based, dietitian led intervention that enabled them to participate in a behavioural intervention to reduce their diabetes risk. The online setting was the preferred mode of delivery. Online delivery enabled women to log in from the comfort of their own home and bring their babies to the session.

 

Implications: The evidence shows that the best approach to preventing type 2 diabetes is to target high-risk individuals with interventions that focus on lifestyle modification, behaviour change, and self-management supports over a long duration. Adaptations are needed to improve reach, access and uptake to the DPP by high risk or 'hard to reach' groups. This process may be used in the future to further adapt the DPP for such cohorts.