Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. The Face-it, four-stage health promotion intervention reduced the risk of diabetes among women with prior gestational diabetes

2. Conducting qualitative research, reviewing prior evidence, intervention implementation, pilot testing, and outcome evaluation were essential steps in optimizing the prevention of Type 2 diabetes after gestational diabetes

Evidence Rating Level: 2 (Good)

Gestational diabetes mellitus (GDM), being one of the most common gestational medical conditions, leaves women at an increased risk of developing early onset type 2 diabetes mellitus (T2DM) and cardiovascular disease following their pregnancy. Additionally, the offspring of the women diagnosed with GDM were found to be eight times more likely to develop T2DM and prediabetes later in life. For women who have a history of GDM, research has found that lifestyle changes can have a positive impact on their long-term risk of developing T2DM. In order to promote these lifestyle changes, the Face-it study adopted elements from two frameworks by MRC and Hawkins et al, using the Medical Research Council UK Development of complex interventions in primary care framework. This study systematically developed a health promotion intervention designed to reduce the risk of diabetes among women with prior GDM and their children. The study used a four stage process, over the course of two years, to analyze and compare the effectiveness of this intervention. The first stage included researching the existing interventions and their limitations. Stage two consisted of discussing and receiving feedback from women with prior GDM and her family to model interventions. Next, stage 3 introduced prototyping, pilot testing, and intervention delivery. Finally stage 4 addressed evaluation of core outcomes while communicating with stakeholders. The complexity of the Face-it study can present both a strength and limitation. The use of multiple stages, stakeholders, and interventions speaks to the dedication and time-consuming process that went into optimizing this framework. However, Face-it may be difficult to apply in certain contexts. For example, low income, rural communities where resources are scarce may not have the infrastructure required to properly implement the Face-it approach. Overall, this study highlighted the clinical burden of GDM as well as the potentially dangerous progression to T2DM. The development of the Face-it intervention presents a comprehensive, systematic approach to prevention of diabetes after pregnancy. This four-step approach offers a template that may be applied to other health burdens in the future and can be transferable into other health sectors as a preventative tool.

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