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Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines. [ABSTRACT FROM AUTHOR]

Background: A woman with a history of GDM has a high risk of developing type two diabetes (T2DM) in her future life. Lifestyle modifications are known to attenuate the progression of GDM to T2DM. Therefore, the aim of this study was to assess the impact of a simple, cost effective, culturally acceptable lifestyle intervention programme on the trajectory towards T2DM in women with a history of GDM. Methods: This cluster randomized trial was conducted in 100 postpartum women in three selected districts of Sri Lanka. The subjects were divided into intervention (n = 50) and control groups (n = 50) by cluster randomization method. A culturally adapted protocol (comprised of dietary and physical activity modifications) was administered to the intervention group. The glycemic profile was assessed using fasting and 2-hour post-OGTT plasma glucose and HbA1c, and insulin resistance by HOMA-IR at baseline and after one year of intervention. Results: The mean age (SD) of the subjects in the intervention and control groups were 33.0 (5.1) and 34.3 (6.5) years respectively. All glycemic and insulin resistance parameters (i.e. Fasting plasma glucose- FPG, 2-hour post-OGTT plasma glucose, HbA1c and HOMA-ir) were comparable (p > 0.05) between the two groups at baseline. FPG, 2 h post OGTT, HbA1c and HOMA-ir values between intervention vs. control (p) at 12 months were 87.3 vs. 123.2 (< 0.01); 106.5 vs. 156.1 (0.01); 5.3 vs. 6.8 (< 0.01) and 0.9 vs. 2.3 (< 0.01) respectively. All glycemic parameters showed a significant reduction in the intervention group at 12 months compared to baseline. In contrast, the control group showed a significant increase in FPG, 2-hour post-OGTT plasma glucose and HbA1c at 12 months compared to baseline. In multiple linear regression model adjusted for age, parity and family history, the control group showed an approximately 33 times risk of developing insulin resistance compared to the intervention group. Conclusion: The culturally acceptable and individualized lifestyle intervention was able to produce remarkable reductions in glycaemic and insulin resistance parameters among postpartum women with a history of GDM. Trial registration: Ethical clearance was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura, Sri Lanka (ERC 52/14), Sri Lanka Clinical trial registration number Sri Lanka Clinical Trials Registry (SLCTR/2015/021 date 25.09.2015). [ABSTRACT FROM AUTHOR]

Background. Mothers with a history of gestational diabetes mellitus (GDM) have a high risk of progressing to type 2 diabetes mellitus (T2DM) in the future. This progression can be attenuated by appropriate lifestyle interventions. We aimed to understand the perceptions of mothers with GDM and their healthcare workers regarding postpartum physical activity with a view to design a lifestyle intervention programme. Methods. We did this qualitative study in three selected districts of Sri Lanka. We also conducted six focus group discussions with 30 antenatal mothers with a history of GDM in a previous pregnancy, and six in-depth interviews with 3 postnatal nurses and 3 field midwives caring for postpartum mothers to explore their perceptions on postpartum physical exercises. Framework analysis was used to analyse the data. The transcripts were analysed using a Microsoft matrix and themes were generated. Results. Eight themes related to physical exercises emerged from both groups of participants. Two themes, 'Myths regarding postpartum physical activity' and 'Lack of awareness of the importance of postpartum physical activity' emerged from both groups of participants. Three themes, 'Time pressure', 'Stigma' and 'Child demands' emerged only from mothers while three themes, 'Traditional and cultural beliefs', 'Lack of influence from healthcare workers' and 'Lack of motivation' emerged solely from healthcare workers. Conclusions. The findings, especially the facilitators and barriers deserve the attention of health policy-makers when designing appropriate interventions to enhance postpartum physical exercises to attenuate the development of T2DM in women with GDM. [ABSTRACT FROM AUTHOR]

Background: Energy homeostasis plays a vital role in achieving glycemic control in people with type 2 diabetes mellitus (T2DM). Exercise is known to increase energy expenditure. However, its role in energy intake has not been explored in people with T2DM. Thus, this study aimed at determining the impact of long-term aerobic and combined exercises in modulating hunger, satiety and energy intake in T2DM. Methods: A randomized controlled trial, with 108 people with T2DM, aged 35–60 years were assigned into an aerobic, combined (aerobic and resistance) and a control group. Primary outcomes were subjective levels of hunger and satiety measured by a 100 mm visual analogue scale in relation to a standard breakfast meal (453 kcal) and energy and macronutrient intake determined by a 3-day diet diary at 0, 3 and 6 months. Results: Aerobic and combined groups exhibited reduced hunger and increased satiety at 3 and 6 months (p < 0.05). The combined group demonstrated a profound increase in satiety at 3 and 6 months compared to aerobics (3 months; p = 0.008, 6 months; p = 0.002) and controls (3 months; p = 0.006, 6 months, p = 0.014). Mean daily energy intake was reduced only at 6 months in the aerobic group (p = 0.012), whereas it was reduced in the combined group at 3 and at 6 months compared to controls (3 months: p = 0.026, 6 months: p = 0.022). Conclusions: Long-term aerobic and combined exercises produced a reduction in hunger, energy intake and increase satiety in people with T2DM. Despite energy expenditure, exercise seems to play a significant role in reducing energy intake as well. Combined exercises show more advantages over aerobic exercise since combined exercises have a greater impact on satiety and energy intake in people with T2DM. Trial registration number: SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029. [ABSTRACT FROM AUTHOR]

Background: Regular exercise is a key element in the management of type 2 diabetes mellitus (T2DM). Although the importance of regular exercises on glycemic control in people with diabetes is studied extensively, evidence is lacking on its impact on sweet taste perception. Thus, the aim of this study was to determine the impact of aerobic exercises on taste perception for sucrose in people with diabetes. Methods: A sample of 225 people with diabetes aged 35-60 years was assigned randomly into 3 groups; aerobic exercise, combined exercise and a control group. The outcomes of the combined exercise group is not reported. The aerobic exercise group performed brisk walking 30min/day, 4-5days/week for 6 months. The primary outcome measures were supra-threshold intensity ratings and preference for sucrose assessed at baseline, at 3 and 6 months using 'general Labeled Magnitude Scale' and 'Monell 2-series-forced choice method' respectively. Glycated haemoglobin (HbA1c) level was assessed at baseline and at 6 months to determine glycemic control. Results: Aerobic exercise group showed significantly increased ratings (mm) for higher sucrose concentrations at 3 months (mean difference for 2.02M; +6.63±2.50, p=0.048 and for 0.64M; +7.26±2.76, p=0.026) and at 6 months (mean difference for 0.64M; +7.79±4.49, p= 0.044) compared to baseline and also when compared to controls (mean difference for 2.02M between baseline and 3 months; intervention: +6.63±2.50, control: -4.01±1.79, p=0.02 and between baseline and 6 months for 2.02M; intervention: +3.15±0.57, control: -7.96±0.40, p=0.022 and for 0.64M; intervention: +7.79±4.49, control: -8.98±0.99, p=0.003). A significantly reduced preference (mol/L) was seen both at 3 (mean difference; -0.03±0.02, p= 0.037) and at 6 months (mean difference; -0.05±0.12, p=0.011) compared to baseline within the intervention group. Also, a significant reduction was seen in the intervention group compared to controls at 6 months (mean difference; intervention: -0.05±0.12, control: 0.01±0.03, p=0.044). HbA1c was significantly reduced in the intervention group compared to controls at 6 months (mean difference; intervention -0.43±1.6%, control +0.33±1.8%, p=0.018). Conclusion: Regular aerobic exercises increase the sweet taste sensitivity, especially for higher concentrations of sucrose and decrease sweet taste preference in people with diabetes. These alterations in sweet taste perception, are likely to contribute to a better glycemic control in people with diabetes. Trial registration: This trial was registered at the Sri Lanka Clinical Trial registry on 16/12/2015. (Trial registration number- SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029). [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) attenuates the development of type 2 diabetes mellitus in postpartum women with prior gestational diabetes mellitus (GDM). PA is assessed by calculating the energy expenditure (EE), thus accurate estimation of EE is crucial. International PA Questionnaire (IPAQ) and activity diary are widely used subjective methods while pedometer provides objective evidence of PA and EE. Aims and Objectives: This study aims to compare subjective and objective methods of assessing EE as a measure of PA in postpartum women with a history of GDM. Materials and Methods: Fifty postpartum women who had a history of GDM were advised to maintain activity diaries and pedometer readings for 1 week each month up to 1 year and IPAQ was administered at the end of 6 and 12 months. EE was calculated by all three methods separately and Bland-Altman plots were used to assess the level of agreement between IPAQ and the other tools at 6 and 12 months. Friedman test was performed to compare estimated EE between the three methods. Results: There was a poor agreement between the subjective and objective methods. According to Bland-Altman plot results, the highest mean difference was observed between IPAQ and pedometer at 12 months (mean difference was 75.9). This observation indicated an underestimation of pedometer values at 12 months. EE assessed by two subjective methods were statistically comparable at both time points whereas, EE assessed by pedometer was significantly lower (P<0.017) compared to self-reported tools. Conclusion: Assessment of EE by subjective methods which are based on personal judgment may cause overestimation of PA. In contrast, pedometer readings are likely to underestimate the PA as it only reports kinetics activities. Therefore, a combination of subjective and objective methods is recommended to ameliorate the reliability and validity. [ABSTRACT FROM AUTHOR]

Background: The link between sweet taste perception and carbohydrate intake in diabetics who perform regular combined exercises has not been explored. Aims and Objectives: This study aimed at determining the impact of combined exercises on taste perception for sucrose and carbohydrate intake in patients with type 2 diabetes mellitus. Materials and Methods: A clinical trial was conducted with 225 patients with T2DM, aged 35-60 years assigned randomly into three groups; aerobic, combined, and a control group. Outcomes of the aerobic group were not reported. Combined group performed brisk walking 4-5 days/week and resistance exercises 2-3 days/week for 6 months. Supra-threshold intensity ratings, preference for sucrose, and carbohydrate intake assessed at baseline, at 3 and 6 months were measured using "general Labeled Magnitude Scale," "Monell 2-series-forced choice method," and a 3-day diet diary, respectively. Results: Ratings for the highest (combined vs. control: +3.15±0.57 vs. -7.96±0.40 mol/L, P=0.022) and the second-highest sucrose concentrations (combined vs. control: +7.79±4.49 vs. -8.98±0.99 mol/L, P=0.003) in the combined group were significantly higher with significant time × group interaction (2.02M: P=0.002, 0.64M: P=0.003). Preference for sucrose was lower in the combined group (combined vs. control: -0.08±0.14 vs. +0.01±0.03 mol/L, P=0.002), and the time × group interaction was not significant. Carbohydrate intake (combined vs. control: -46.97±21.60 vs. -6.30±9.36 g, P=0.001) and HbA1c level (combined vs. control: -0.66±1.81 vs. +0.33±1.84%, P=0.008) were reduced in the combined group, and taste sensitivity significantly predicted the carbohydrate intake with combined exercises (R2=0.64, P=0.01). Conclusion: Regular combined exercises increase sweet taste sensitivity for higher concentrations of sucrose. Taste sensitivity, not the preference determines the carbohydrate intake in exercising diabetics. [ABSTRACT FROM AUTHOR]