Pan Ying, Tang Jia, Lu Bing, Kuang Ming, Zhao Mengjie, Liu Hongying, Zhong Shao
Department of General Medicine, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China.
Hangzhou Kang Ming Information Technology Co., Ltd, 301 Building 12, Haichuang Park 998 Wenyi West Road, Hangzhou, Zhejiang Province, 310000, China, 86 021 64045531.
J Med Internet Res. 2025 Jul 29;27:e71075. doi: 10.2196/71075.
Gestational diabetes mellitus (GDM) is associated with an elevated risk of adverse maternal and neonatal outcomes. Dietary management is a cornerstone of GDM treatment due to its beneficial effects on metabolic control. However, suboptimal adherence to dietary recommendations has diminished its potential benefits in achieving optimal glycemic outcomes. Cognitive behavioral therapy (CBT)-based interventions have emerged as a promising approach to enhance dietary compliance and glycemic control in patients with GDM.
This study aims to investigate the effects of a CBT-based digital dietary intervention on glycemic control and pregnancy outcomes in patients with GDM.
The intervention group received standard care plus a digital dietary intervention based on CBT principles, delivered via a customized WeChat (Tencent Inc) mini program. This intervention included structured dietary education and behavioral strategies focused on appropriate food selection and meal sequencing. The control group received standard care alone. The primary outcome was the glycemic qualification rate, and secondary outcomes included fasting blood glucose, postprandial blood glucose (PBG), General Self-Efficacy Scale scores, and incidence of macrosomia. Self-monitored blood glucose data were collected and analyzed at biweekly follow-up visits from enrollment until delivery.
Of the 200 participants, 171 completed the study. The average age was 31.2 (SD 4) years, and the average gestational age at enrollment was 26.3 (SD 1.6) weeks. Baseline HbA1c levels were similar between groups (5.2% vs 5.1%; P=.97). The glycemic qualification rate was significantly higher in the intervention group than in the control group at follow-up 3 (mean 87.9%, SD 14.9% vs 81.9%, SD 17.8%; P=.02), follow-up 4 (mean 91.0%, SD 9.9% vs 87.2%, SD 14.4 %; P=.04), follow-up 5 (mean 94.0%, SD 7.4% vs 91.5%, SD 9.5%; P=.04), and follow-up 6 (mean 94.3%, SD 6.7% vs 91.8%, SD 8.9%). PBG levels were significantly lower in the intervention group after lunch (1 h: mean 5.9, SD 0.7 vs 6.0, SD 0.7 mmol/L; P=.0 2 h2h: 5.1, SD 0.7 vs 5.3, SD 0.8 mmol/L; P=.03) and dinner (1 h: mean 6.0, SD 0.5 vs 6.2, SD 0.6; 2 h: 5.5, SD 0.7 vs 5.7, SD 0.8 mmol/L). However, no significant differences were observed in fasting blood glucose or PBG after breakfast between the groups. The intervention group showed significantly higher General Self-Efficacy Scale scores than the control group (mean 195.4, SD 6.9 vs 192.9, SD 5.8). The incidence of macrosomia was significantly lower in the intervention group than in the control group (5% vs 15%; P=.04).
The findings of this randomized controlled trial suggest that a CBT-based digital dietary intervention can significantly enhance glycemic control, particularly PBG levels, and may contribute to improved pregnancy outcomes with a reduced incidence of macrosomia in women with GDM.
妊娠期糖尿病（GDM）与母婴不良结局风险升高相关。饮食管理因其对代谢控制的有益作用，是GDM治疗的基石。然而，对饮食建议的依从性欠佳削弱了其在实现最佳血糖结局方面的潜在益处。基于认知行为疗法（CBT）的干预措施已成为一种有前景的方法，可提高GDM患者的饮食依从性和血糖控制。
本研究旨在探讨基于CBT的数字饮食干预对GDM患者血糖控制和妊娠结局的影响。
干预组接受标准护理加基于CBT原则的数字饮食干预，通过定制的微信（腾讯公司）小程序提供。该干预包括结构化饮食教育和行为策略，重点是适当的食物选择和进餐顺序。对照组仅接受标准护理。主要结局是血糖达标率，次要结局包括空腹血糖、餐后血糖（PBG）、一般自我效能感量表得分和巨大儿发生率。从入组到分娩，在每两周的随访中收集并分析自我监测的血糖数据。
200名参与者中，171名完成了研究。平均年龄为31.2（标准差4）岁，入组时的平均孕周为26.3（标准差1.6）周。两组的基线糖化血红蛋白（HbA1c）水平相似（5.2%对5.1%；P = 0.97）。在随访3（干预组平均87.9%，标准差14.9%；对照组平均81.9%，标准差17.8%；P = 0.02）、随访4（干预组平均91.0%，标准差9.9%；对照组平均87.2%，标准差14.4%；P = 0.04）、随访5（干预组平均94.0%，标准差7.4%；对照组平均91.5%，标准差9.5%；P = 0.04）和随访6（干预组平均94.3%，标准差6.7%；对照组平均91.8%，标准差8.9%）时，干预组的血糖达标率显著高于对照组。干预组午餐后（1小时：干预组平均5.9，标准差0.7；对照组平均6.0，标准差0.7 mmol/L；P = 0.02；2小时：干预组5.1，标准差0.7；对照组5.3，标准差0.8 mmol/L；P = 0.03）和晚餐后（1小时：干预组平均6.0，标准差0.5；对照组平均6.2，标准差0.6；2小时：干预组5.5，标准差0.7；对照组5.7，标准差0.8 mmol/L）的PBG水平显著低于对照组。然而，两组早餐后的空腹血糖或PBG无显著差异。干预组的一般自我效能感量表得分显著高于对照组（干预组平均195.4，标准差6.9；对照组平均192.9，标准差5.8）。干预组的巨大儿发生率显著低于对照组（5%对15%；P = 0.04）。
这项随机对照试验的结果表明，基于CBT的数字饮食干预可显著增强血糖控制，尤其是PBG水平，并可能有助于改善GDM女性的妊娠结局，降低巨大儿发生率。
