None listed
Conditions
Brief summary
GDM is the fastest growing type of diabetes in Australia, affecting approximately 1 in every 7 pregnancies. In the Illawarra Shoalhaven Local Health District (ISLHD) ~840 women per year attend the diabetes clinic for treatment/management of GDM. Here, there has been a significant increase in the number of GDM women requiring treatment for fasting hyperglycaemia. This is both because of an increased prevalence (overweight/obesity, gestational age of mother) and because of a lowering of the diagnostic criteria following results from the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. Despite this, there is no clear treatment approach for fasting hyperglycaemia. Elevated nocturnal (overnight) glucose levels, manifesting as elevated fasting hyperglycaemia, are due to a combination of insulin resistance and insufficiency. Consuming a meal/snack prior to bed can help maintain insulin levels across the night. However, despite popular advice from health care practitioners to consume a bedtime snack to help control fasting (and overnight) glucose, few studies exist to support this recommendation. Pilot data from a recent study conducted in our lab showed that 3-days of consuming a high-protein, low-carbohydrate snack consumed 30 minutes prior to bed significantly improves fasting glucose, insulin sensitivity and nocturnal hyperglycaemia compared to a moderate-carbohydrate snack or no bedtime snack in 15 patients with type 2 diabetes. The amount and glycemic index of carbohydrates in the last meal before bedtime has the largest impact on fasting and nocturnal hyperglycaemia. Therefore, if a snack should be consumed, minimising the carbohydrate appears to be of importance. Given the increasing prevalence of GDM and the complications of fasting hyperglycaemia for mother and baby (including risk for future diabetes), a safe, easily implemented and cost-effective intervention is urgently needed. The main objective of this research is to test whether consuming a snack 30 minutes prior to bed is a viable treatment option for fasting hyperglycaemia in women with GDM.
Interventions
ARM 1: a snack (i.e. greek yoghurt) consumed 30 minutes before bedtime every night for 6 weeks. The snack consists of 1 CHO exchange (15g of carbohydrate or ~60 calories of carbohydrate). The total calories of the snack is ~180 calories. Total carbohydrate exchange distribution throughout the day of 2,2,2,2,3,1 for breakfast, morning tea, lunch, afternoon tea, dinner and supper respectively.
ARM 2: a snack (i.e. flavoured yoghurt) consumed 30 minutes before bedtime every night for 6 weeks. The s
ARM 1: a snack (i.e. greek yoghurt) consumed 30 minutes before bedtime every night for 6 weeks. The snack consists of 1 CHO exchange (15g of carbohydrate or ~60 calories of carbohydrate). The total calories of the snack is ~180 calories. Total carbohydrate exchange distribution throughout the day of 2,2,2,2,3,1 for breakfast, morning tea, lunch, afternoon tea, dinner and supper respectively. ARM 2: a snack (i.e. flavoured yoghurt) consumed 30 minutes before bedtime every night for 6 weeks. The snack consists of 2 CHO exchange (30g of carbohydrate or ~120 calories of carbohydrate). The total calories of the snack is ~180 calories. Total carbohydrate exchange distribution throughout the day of 2,2,2,2,2,2 for breakfast, morning tea, lunch, afternoon tea, dinner and supper respectively. The intervention will be delivered by a dietitian, via teleconference if required. Both groups will receive standard care which is the advice to consume 12 CHO exchanges per day, however the distribution of exchanges will vary depending on the treatment group. Consumption of the bedtime snack will be recorded by participants using a check sheet.
Sponsors
University of Wollongong
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Diagnosed with GDM (physician, antenatal clinic or blood test). Singleton pregnancy. Able to start intervention between 28-<32 weeks gestation.
Exclusion criteria
Allergies or intolerance to components in dairy (i.e. lactose). High-risk pregnancy (i.e. twins, drug or alcohol abuse, chronic health problems, or pregnancy complications).
Outcome results
None listed