St Hilda's College, Oxford University, Oxford, Oxfordshire, UK.
Centre for Intelligent Healthcare, Coventry University, Coventry, UK
BMJ Open Diabetes Res Care. 2021 Apr;9(1). doi: 10.1136/bmjdrc-2020-002077.
Women with past gestational diabetes mellitus (GDM) are at risk of subsequent type 2 diabetes and adverse cardiovascular events. Digital and telemedicine interventions targeting weight loss and reductions in body mass index (BMI) may help reduce risk for women with GDM. The aim was to compare the effectiveness of digital or telemedicine intervention with usual care. Randomized controlled trials (RCTs) were identified in Embase, Medline, CINAHL, PsycINFO and the Cochrane Library. Included trials recruited women with prior GDM but without pre-existing diabetes, and tested a digital or telemedicine intervention with or without an in-person component. Data extraction was carried out independently by two authors. The search yielded 898 citations. Eighteen articles reporting 15 trials were included, of which 8 tested digital interventions. Reported outcomes included weight, BMI, fasting plasma glucose and waist circumference. None of the included trials reported type 2 diabetes incidence or cardiovascular risk. Data were pooled using a random-effects model. The point estimate favored the intervention but was non-significant for both BMI (-0.90 kg/m, 95% CI -1.89 to 0.09; p=0.08) and weight (-1.83 kg, 95% CI -4.08 to 0.42, p=0.11). Trials evaluating digital and telemedicine interventions identified clinically relevant, but non-significant improvements in BMI and weight compared with control. No trials assessed type 2 diabetes occurrence as an outcome. More well-designed RCTs with adequate power and long-term follow-up are needed to identify the impact of these interventions on type 2 diabetes occurrence.
患有既往妊娠糖尿病（GDM）的女性有发生 2 型糖尿病和不良心血管事件的风险。针对体重减轻和体重指数（BMI）降低的数字和远程医疗干预措施可能有助于降低 GDM 女性的风险。目的是比较数字或远程医疗干预与常规护理的效果。在 Embase、Medline、CINAHL、PsycINFO 和 Cochrane Library 中确定了随机对照试验（RCT）。纳入的试验招募了有既往 GDM 但无既往糖尿病的女性，并测试了具有或不具有面对面成分的数字或远程医疗干预措施。数据提取由两名作者独立进行。搜索产生了 898 条引文。有 18 篇文章报道了 15 项试验，其中 8 项测试了数字干预措施。报告的结果包括体重、BMI、空腹血糖和腰围。纳入的试验均未报告 2 型糖尿病发病率或心血管风险。使用随机效应模型汇总数据。干预措施的点估计值有利，但 BMI（-0.90 kg/m，95%CI-1.89 至 0.09；p=0.08）和体重（-1.83 kg，95%CI-4.08 至 0.42，p=0.11）均无统计学意义。评估数字和远程医疗干预措施的试验发现，与对照组相比，BMI 和体重有临床相关但无统计学意义的改善。没有试验将 2 型糖尿病的发生作为结局进行评估。需要更多设计良好、具有足够效力和长期随访的 RCT 来确定这些干预措施对 2 型糖尿病发生的影响。
