Regional differences in type 2 diabetes prevention priorities for women with previous gestational diabetes: A multi-methods consensus study

OBJECTIVES: To identify values, principles, and research priorities for type 2 diabetes mellitus (T2DM) prevention in women with previous gestational diabetes mellitus (GDM) across five regions, and evaluate the appropriateness of modified Delphi and nominal group consensus methods in diverse cultural settings. STUDY DESIGN: Mixed-methods. METHODS: Health professionals and women with previous GDM from five regions were invited to participate in the priority-setting activities according to a modified Delphi process and nominal group technique. The Child Health and Nutrition Research Initiative was used to develop the assessment criteria, which included answerability, effectiveness, deliverability, the maximum potential for improving the health and well-being of postpartum mothers, and the effect on equity. Participants ranked items in three rounds of the Delphi process. Evaluation surveys and semi-structured interviews were conducted to understand participants' experiences of the process. RESULTS: Fifty health professionals and 50 women with previous GDM participated in the priority-setting process and evaluation survey, with 11 individuals also taking part in interviews. Regional differences emerged in priority rankings for values and principles. Africa emphasised cost-effectiveness and capacity building; the Americas prioritised people-centred approaches and continuity of care; Asia focused on equity-driven services and family support; Europe highlighted combating misinformation; Oceania emphasised planning skills. Consensus methods were feasible and acceptable across the regions. CONCLUSION: T2DM prevention priorities for women with a history of GDM vary across geographical regions, suggesting a need for local and tailored approaches for effective implementation. Consensus approaches involving the community in implementation efforts are acceptable across diverse geographical contexts.