Currently about one million Australians were diagnosed with diabetes. Most (85%) of those had type 2 diabetes (T2DM). Local and international data suggest that about one-third to half of those with diabetes was undiagnosed. More than half of the population in Australia is overweight and obese, which puts them at higher risk of T2DM. Diabetes is associated with a wide range of macrovascular and microvascular complications including blindness, amputations, renal disease, and cardiovascular diseases. Currently A$1507 million or 2.3% of the health budget was spent on diabetes. It is projected that by 2033 T2DM will pose an economic burden of A$8 billion, with a 436% increase in projected expenditure compared to 2002-3. This projected increase was driven by demographic factors, increase in obesity prevalence, extra services per case, and currently untreated diabetes.
GDM is defined as any degree of glucose intolerance with onset or first diagnosis during pregnancy. About 10-13% of all pregnancies in Australia are complicated by GDM. Pregnancies with GDM are more likely to have adverse outcomes including macrosomia, perinatal mortality, preeclampsia and caesarean delivery. Offsprings born to mothers with GDM are also at increased risk of obesity, abnormal glucose metabolism and cardiovascular diseases later in life. About 30-84% of GDM patients re-develop the condition in subsequent pregnancies. One of the most significant long-term health impacts of GDM is the significantly increased risk of developing diabetes. The greatest increase in the incidence of type 2 diabetes following GDM occurs within the first five years, with up to 50% of women with prior GDM developing T2DM within this timeframe. As a young, at-risk group for T2DM, women with prior GDM represent a great opportunity for public health intervention in T2DM prevention.
In many cases T2DM is a preventable disease. Studies have consistently shown that dietary modification along with moderate physical activity reduces the incidence of diabetes in high-risk populations. Lifestyle intervention has also been shown to reduce the development of diabetes in women who had GDM (averaging 12 years from index pregnancy) by 50%.
A well-timed lifestyle intervention program for women post-GDM that includes determination of individual risk of developing Type 2 Diabetes, setting priorities, problem solving and goal setting for lifestyle modification to reduce the likelihood of progression to T2DM, has the potential to positively change the longer term health of these women and their children.