Lifestyle modification interventions among women with gestational diabetes mellitus (GDM) history have shown to be effective on preventing or delaying the onset of diabetes, however, the differentiating benefits of lifestyle interventions due to socioeconomic inequalities have remained understudied. The Intensive LifeStyle Modification Program (ILSM) was tailored for women with a history of GDM in low-resource rural areas of China. The current study aimed to examine the effect of the ILSM intervention on physiological and behavioral outcomes between subgroups of women from different socioeconomic backgrounds. This study used the baseline, 3-month, 6-month, and 18-month data from a cluster randomized controlled trial in rural women with GDM history in Hunan Province of China. The lifestyle program consisted of a combination of in-person group sessions and telephone consultation sessions on dietary intake, physical activity, and stress management. Using generalized estimating equation, we conducted several subgroup analyses based on indicators of socioeconomic status, including age, ethnicity, income, employment, and education. A total of 320 women were analyzed. The ILSM intervention showed a consistent significance on reducing fasting blood glucose across subgroups. On the contrary, women with full-time employment and high income (≥3000RMB, approximately 425 dollars, per month) were reported to have greater benefits on intentions to eat low-glycemic foods, BMI and waist circumference, and diabetes risk. Women with younger age (≤35 years) or high education (15 years of education or above) were more likely to benefit on improving higher intentions to eat low-glycemic foods and lowering diabetes risk. Interestingly, compared to ethnic majority, ethnic minority women were more likely to increase intentions to eat low-glycemic foods. The ILSM program demonstrated a consistent significance on reducing fasting blood glucose across women from different socioeconomic backgrounds along with an increase of intentions to eat low-glycemic foods for ethnic minority women, despite of showing ineffective in lower socioeconomic status women on intention to have healthy diet, BMI, waist circumference, and diabetes risk. To fully address health disparities from socioeconomic inequalities, lifestyle interventions should be tailored for individuals with older age, lower education levels, and lower income without full-time employment. Chinese Clinical Trial Registry (ChiCTR2000037956), registered on 3rd Jan 2018.
Wang et al. (Sat,) studied this question.