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DiabetesADAPT-MNCT01918345

Avoiding Diabetes After Pregnancy Trial in Moms

A study testing Home-based Physical Activity Program with Health Coach and Home-based Low-GI Diet Program with Health Coach in people with Diabetes, run by Women's College Hospital at 5 sites in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Mothers with previous gestational diabetes mellitus (GDM) represent a population at higher risk of future Type 2 diabetes mellitus (T2DM), which is preventable through lifestyle modification. Yet, no formal prevention programs exist for this population. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Diabetes
What is being tested?
Home-based Physical Activity Program with Health Coach and Home-based Low-GI Diet Program with Health Coach
Could I receive a placebo?
No, everyone receives an active treatment
How many people
345 participants
Where
5 sitesCanada
Study dates
Jul 2014to Jan 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years of age or older
  • Physician-diagnosed Gestational Diabetes Mellitus (GDM) during most recent pregnancy based on Canadian Diabetes Association (CDA) diagnostic criteria
  • 3-6 months postpartum after a GDM pregnancy
  • During GDM pregnancy, followed by a Diabetes In Pregnancy clinic at one of study sites (i.e. Sunnybrook Health Sciences Centre, Mount Sinai Hospital, St. Michael's Hospital, Toronto East General Hospital)
  • English-speaking

Who cannot join

  • Current diabetes (Type I or Type II) and/or treatment with any anti-diabetic therapy
  • Any major illness that may interfere with participation
  • Any obstetrical or fetal complication that may interfere with participation
  • Involvement in any other clinical trial requiring drug therapy
  • History of cardiovascular disease or ECG abnormalities on stress echo cardiogram
  • New pregnancy within postpartum period
Show all 9Show fewer
  • Any illness affecting carbohydrate digestion and/or metabolism including kidney disease, hepatitis, HIV/AIDS, celiac disease
  • Any other factor likely to limit study adherence, in the opinion of the principal investigator
  • (For the Effectiveness Phase ONLY) Participation in the Pilot Phase of the ADAPT-M Study

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

Canada5 sites
  • Scarborough Health Network

    Scarborough Village, Ontario, M1W 3W3

  • Michael Garron Hospital

    Toronto, Ontario, M4C 5M5

  • Sunnybrook Health Sciences Centre

    Toronto, Ontario, M4N 3M5

  • St. Michael's Hospital

    Toronto, Ontario, M5B 1W8

  • Mount Sinai Hospital

    Toronto, Ontario, M5T 3L9

Other trials in Canada

About this study

Official title: Avoiding Diabetes After Pregancy Trial in Moms (ADAPT-M): Pilot, Feasibility and Effectiveness Phases

Mothers with previous gestational diabetes mellitus (GDM) represent a population at higher risk of future Type 2 diabetes mellitus (T2DM), which is preventable through lifestyle modification. Yet, no formal prevention programs exist for this population. The postpartum period is a particularly vulnerable period for weight gain and unhealthy lifestyle in new mothers due to their competing demands of childcare and breastfeeding. This important time period may thus represent a 'window of opportunity' for women with previous GDM, whereby interventions to improve their lifestyle can be offered. Eligible women will be recruited during pregnancy from four hospitals and invited to participate in a home-based lifestyle intervention program starting from three to six months postpartum. This pilot study will investigate the feasibility and effectiveness of a physical activity and diet intervention. It will also explore the relationship between behaviour change and metabolic markers of T2DM in this high-risk population. Investigators hypothesize that the ADAPT-M program will be feasible and will be associated with an improvement in metabolic T2DM markers, as well as a high rate of satisfaction, adherence, and effectiveness.

Read the detailed description

Women diagnosed with gestational diabetes mellitus (GDM) are a readily identifiable population at high risk for type 2 diabetes (T2DM) to whom preventive interventions can be offered. There is evidence that T2DM can be prevented with lifestyle modification in older high-risk risk groups. However, preventive trials for women with recent GDM have had limited success in preventing T2DM, in part because they have failed to produce significant behaviour change. New mothers are a unique population with many competing demands and barriers to behaviour change. Home-based health coaching programs may be more effective in women with recent GDM, as they provide greater flexibility, goal-setting, and frequent follow-up, and have been associated with greater adherence and weight loss. Low glycemic-index diets are also associated with greater adherence and improved glycemia, but data are lacking in women with recent GDM.

The ADAPT-M (Avoiding Diabetes after Pregnancy Trial in moms) study will address these gaps by evaluating a home-based exercise and diet intervention that has been designed specifically for new mothers with recent GDM. An internationally renowned team of investigators and collaborators was brought together to create this intervention. This trial has been carefully designed based on our previous work, an extensive literature review, and the input from co-investigators with expertise in diabetes research, gestational diabetes, prenatal and postpartum care, diabetes education programs, home-based exercise coaching, nutrition and diet interventions, and clinical trials. Investigators will work closely with the Clinical Trials Unit of the Applied Health Research Centre (AHRC) of University of Toronto to develop, implement, and evaluate this trial.

This study is important because it addresses a crucial missed opportunity for diabetes prevention in a well-defined, high-risk population. This intervention is unique because it has been specifically tailored to optimize behaviour change by meeting the needs of new mothers. The findings from this study will have implications for diabetes caregivers, policy-makers, and researchers. This work will benefit women with prior GDM and their families by offering a much-needed effective and sustainable program aimed at reducing their risk of diabetes and improving long-term health.

Conditions
Diabetes
Being tested
Home-based Physical Activity Program with Health Coach, Home-based Low-GI Diet Program with Health Coach
Keywords
Diabetes, Diabetes Mellitus, Diabetes Mellitus, Type 2, Diabetes, gestational, Prevention & control, Postpartum Period, Mothers, Diet, Diabetic Diet, Exercise, Life Style, Motivation, Health Behavior, Insulin-Secreting Cells, Randomized Controlled Trial, Clinical Trial, Pilot Projects, Feasibility Studies
Medical subject headings
Diabetes Mellitus, Diabetes Mellitus, Type 2, Diabetes, Gestational, Motor Activity, Health Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Home-based Physical Activity Program with Health CoachBehavioural

    This arm will receive either a trained CDE or R. Kin as a health coach and a home-based physical activity program for 6 months. Health coaches will provide one-on-one motivational interviewing (MI) and goal-setting, and will account for baseline fitness, resources, childcare, and breastfeeding, to be undertaken at participants' homes or in their communities. Prescriptions will be based on minimum recommendations for moderate-intensity exercise for postpartum women. Participants will maintain at least 150 min/week of moderate activity at a target heart rate of 30-80% with a perceived exertion of 12-15 on the Borg Scale. They will also be counseled on resistance training and pelvic floor exercises. They will receive regular telephone-based coaching to advance goals. Phone-calls will be administered on a weekly basis during weeks 2-8 of the intervention, biweekly basis on weeks 10-12, and monthly basis on weeks 16-24.

  • Home-based Low-GI Diet Program with Health CoachBehavioural

    This arm will receive a trained CDE health coach and a home-based low-GI diet program for 6 months. Health coaches will provide baseline education during a one-on-one visit and use MI to introduce the dietary intervention. Low GI education will be layered on top of current standard care, which asks women to consume a diet comprised of 45-65% carbohydrates (25 g of dietary fibre), 10-30% protein, and 25-35% fat. As per standard care at the DEPs, this intake will be divided into 3 meals and 2 to 4 snacks. Resources for women will include a low GI dietary food substitution list, a recipe booklet, and a tip sheet on how to lower dietary GI. Women will receive regular telephone-based coaching to advance goals. Phone-calls will be administered on a weekly basis during weeks 2-8 of the intervention, biweekly basis on weeks 10-12, and monthly basis on weeks 16-24.

Study groups in NCT01918345
Study groupRoleWhat they receive
Standard Care (Control)No interventionThis group will receive a one-on-one counseling session during one visit with a Certified Diabetes Educator (CDE), who will provide standard advice on diabetes prevention and healthy lifestyle. They will receive a booklet on exercise and healthy diet as per current Canadian guidelines for healthy eating. This group will also receive a check-in telephone call from the Study Coordinator, half-way through the study. This group will not receive motivational interviewing, health coaching on low GI diet and/or exercise, or additional telephone follow-up.
Diet & Physical Activity Program with Health CoachExperimentalParticipants assigned to this arm will receive a combination of the home-based physical activity program with health coach and the home-based low-GI diet program with health coach, as described in the respective individual arms. The Health Coach for this group will be a CDE.
Receives: Behavioral: Home-based Physical Activity Program with Health Coach; Behavioral: Home-based Low-GI Diet Program with Health Coach
Physical Activity Program with Health CoachExperimentalParticipants will be counseled to follow physical activity recommendations for Canadians, which is at least 150 minutes of moderate physical activity per week. Participants will be asked to participate in aerobic, strength training and stretching activities. Health Coaches will use motivational interviewing, goal-setting and problem solving to assist participants in meeting their physical activity goals. More participants will be randomized to this group and the participants will either have CDE or a Registered Kinesiologist (R. Kin) as their health coach.
Receives: Behavioral: Home-based Physical Activity Program with Health Coach
Diet Program with Health CoachExperimentalParticipants will be counseled to follow recommendations for Canadians on healthy eating (Canada's Food Guide and Space on Your Plate. Low GI education will be layered on top of Canada's Food Guide recommendations. The goal for participants in the diet group is to lower their dietary GI by 8-10 units. Health Coaches will use motivational interviewing, goal-setting and problem solving to assist participants in meeting their dietary and low GI goals. The health coach for this group will be a CDE.
Receives: Behavioral: Home-based Low-GI Diet Program with Health Coach

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. For the Pilot Phase: Change in baseline-adjusted pancreatic beta-cell function

    Beta-cell function will be measured using the Insulin Secretion Sensitivity Index 2 (ISSI-2), which is an established oral glucose tolerance test (OGTT)-based measure of beta-cell function that has been validated against the disposition index from intravenous glucose tolerance test (ivGTT) and has been used in previous clinical trials. ISSI-2 is the product of insulin secretion [the ratio of area under-the-insulin-curve (AUCins) to area-under-the-glucose curve (AUCgluc)] and insulin sensitivity measured by the Matsuda index:

    ISSI-2 = (AUCins / AUCgluc) × [10000 / √(Fglu × Fins × Mglu × Mins)]

    Where Fglu = fasting glucose; Fins = fasting insulin; Mglu = mean glucose; Mins = mean insulin

    These measures will be calculated using the glucose and insulin values at baseline, and at 60 and 120 minutes following a 75-gram oral glucose load.

    Measured: Assessed at week 1 (baseline) and week 24 (study end) of intervention

  2. For the Effectiveness Phase: Change in baseline-adjusted weight

    For the effectiveness phase weight is now the primary outcome and change in baseline-adjusted pancreatic beta-cell function a secondary outcome. Weight in kilograms (kg) will be measured using a medical grade scale at the baseline and final health assessment.. We will also measure height in metres (m) using a medical grade stadiometer to calculate body-mass index (BMI, kg/m2). We will analyze the weight and height outcomes as continuous variables. We will then categorize BMI as under/normal weight (< 25 kg/m2), overweight (25.1-29.9 kg/m2), and obese (≥ 25 kg/m2). Finally, we will also calculate the proportion of participants who return to their pre-pregnancy weight or less, based on self-reported pre-pregnancy weight.

    Measured: Assessed at week 1 (baseline) and week 24 (study end) of intervention

Secondary outcomes (1)
  1. Feasibility

    Feasibility measures will include recruitment, pre- and post-randomization attrition, adherence and follow-up rates, and symptoms, side effects, and satisfaction of the interventions. Adherence to exercise will be assessed with the International Physical Activity Questionnaire (IPAQ), physical activity records and accelerometer administered/worn at baseline, mid-study (week 12 of intervention) and follow-up, which estimates whether activity guidelines are met. Participant log books will be reviewed to assess diet and exercise adherence. Optimal adherence will be defined as meeting activity guidelines or consuming low GI foods at least 60% of the time for the exercise and diet arms respectively. Safety of interventions will also be assessed based on self-reported symptoms and side effects during telephone follow-up and at study end.

    Participants will also complete questionnaires on satisfaction of the education and interventions throughout the study and at study end.

    Measured: Assessed at week 12 (mid-study) and 24 (study end) of intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Aug 2013 (estimated)
  2. Study startJul 2014
  3. Primary completionOct 2022
  4. Study completionJan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Factorial
Masking
None (open label)
Enrolment
345 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01918345
Sponsor's protocol ID
ADAPT2013
Acronym
ADAPT-M
Status last verified
Mar 2023
First submitted
31 Jul 2013
Last updated
9 Mar 2023
Results posted
No
Data monitoring committee
Yes

Publications

  • Ahimsadasan N, Wu W, Rahman I, Sherifali D, Lipscombe LL; ADAPT-M steering committee. The risk of postpartum depressive symptoms in immigrant women with recent gestational diabetes mellitus. Diabet Med. 2026 Jul;43(7):e70339. doi: 10.1111/dme.70339. Epub 2026 Apr 20.

    PubMed 42010789

Questions about this trial

What is this clinical trial studying?

A study testing Home-based Physical Activity Program with Health Coach and Home-based Low-GI Diet Program with Health Coach in people with Diabetes, run by Women's College Hospital at 5 sites in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 9 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

For the Pilot Phase: Change in baseline-adjusted pancreatic beta-cell function (time frame: Assessed at week 1 (baseline) and week 24 (study end) of intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01918345, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Mar 2023.

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Avoiding Diabetes After Pregnancy Trial in Moms | AzTrials