***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria has identified a prevalence of gestational diabetes mellitus ( GDM ) of 12.4 % in women living in Irel and . Women with prior GDM are at increased risk of developing type 2 diabetes later in life . A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes , and medical management . No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM . Through a two-group , parallel r and omised controlled trial ( RCT ) , this study aims to assess the clinical impact , cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM . Methods / Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction ( impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) ) , are r and omly assigned to a  control arm ( n = 27 ) or to the Croí MyAction intervention group ( n = 27 ) . The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required . The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction . Croí MyAction involves 2.5 hour sessions once per week ( for 12 weeks ) comprising a group exercise programme , group health promotion or education seminars , and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions . R and omisation and allocation to the intervention arms is carried out by an independent research er , ensuring that the allocation sequence is concealed from study research ers until the interventions are assigned . The primary analysis is based on glucose dysfunction , comparing a mean reduction in fasting plasma glucose ( FPG ) levels on a 75 gram oral glucose tolerance test ( OGTT ) in the two groups at a one-year , post-intervention follow-up . The trial is funded by the Irish Health Research Board ( HRB ) . Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee , Galway University Hospitals , Health Service Executive of Irel and ( Ref : C.A.691).Trial registration Current Controlled Trials IS RCT N41202110 Background Gestational diabetes mellitus ( GDM ) is defined as glucose intolerance with its onset or first recognition during pregnancy . Post-GDM women have a life-time risk exceeding 70 % of developing type 2 diabetes mellitus ( T2DM ) . Lifestyle modifications reduce the incidence of T2DM by up to 58 % for high-risk individuals . Methods / Design The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program ( MAGDA-DPP ) is a r and omized controlled trial aim ing to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women . This trial has an intervention group participating in a diabetes prevention program ( DPP ) , and a control group receiving usual care from their general practitioners during the same time period . The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals , and two follow-up telephone calls .  A total of 574 women will be recruited , with 287 in each arm . The women will undergo blood tests , anthropometric measurements , and self-reported health status , diet , physical activity , quality of life , depression , risk perception and healthcare service usage , at baseline and 12 months . At completion , primary outcome ( changes in diabetes risk ) and secondary outcome ( changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors ) will be assessed in both groups . Discussion This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women . The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population .Trial registration Australian New Zeal and Clinical Trials Registry ANZCTRN The Pioglitazone In Prevention Of Diabetes ( PIPOD ) study was conducted to evaluate beta-cell function , insulin resistance , and the incidence of diabetes during treatment with pioglitazone in Hispanic women with prior gestational diabetes who had completed participation in the Troglitazone In Prevention Of Diabetes ( TRIPOD ) study . Women who completed the TRIPOD study were offered participation in the PIPOD study for a planned 3 years of drug treatment and 6 months of postdrug washout . Oral glucose tolerance tests were performed annually on pioglitazone and at the end of the postdrug washout . Intravenous glucose tolerance tests ( IVGTTs ) for assessment of insulin sensitivity and beta-cell function were conducted at baseline , after 1 year on pioglitazone , and at the end of the postdrug washout . Of 95 women who were not diabetic at the end of the TRIPOD study , 89 enrolled in the PIPOD study , 86 completed at least one follow-up visit , and 65 completed all study visits , including the postdrug tests . Comparison of changes in beta-cell compensation for insulin resistance across the TRIPOD and PIPOD studies revealed that pioglitazone stopped the decline in beta-cell function that occurred during placebo treatment in the TRIPOD study and maintained the stability of beta-cell function that had occurred during troglitazone treatment in the TRIPOD study . The risk of diabetes , which occurred at an average rate of 4.6 % per year , was lowest in women with the largest reduction in total IVGTT insulin area after 1 year of treatment . The similarity of findings between the PIPOD and TRIPOD studies support a class effect of thiazolidinedione drugs to enhance insulin sensitivity , reduce insulin secretory dem and s , and preserve pancreatic beta-cell function , all in association with a relatively low rate of type 2 diabetes , in Hispanic women with prior gestational diabetes AIM Women diagnosed to have Gestational Diabetes Mellitus ( GDM ) are at increased risk of developing diabetes in future . Thus , diagnosis of GDM is an important public health issue . In a r and om survey 16.2 % of pregnant women were found to have GDM in the Chennai urban population . Hence we undertook a planned community based study to ascertain the prevalence of GDM . MATERIAL S AND METHODS We conducted a prospect i ve screening for  GDM in the urban , semi urban and rural areas . All pregnant women irrespective of gestational weeks underwent a 75 g glucose challenge test in the fasting state . Diagnosis of GDM was made if the 2 hr plasma glucose was > or = 140 mg/dl ( WHO criteria ) . RESULTS A total of 4151 , 3960 and 3945 pregnant women were screened in urban , semi urban and rural areas , respectively .  GDM was detected in 739 ( 17.8 % ) women in urban , 548 ( 13.8 % ) in semi urban and 392 ( 9.9 % ) in rural areas . Out of 1679 GDM women , 1204 ( 72 % ) were detected in first visit and the remaining 28 % in subsequent visits . A significant increase ( P < 0.0001 ) in the prevalence of GDM was observed with family history of diabetes , increased maternal age and BMI . A trend for increased prevalence of GDM was observed in women with less physical activity , however , not statistically significant . CONCLUSION In this community based study , the prevalence of GDM varied in the urban , semi urban and rural areas . Age > or = 25 years , BMI > or = 25 and family history of diabetes were found to be risk factors for GDM Aims /hypothesisWe determined the effects of 6 years of lifestyle intervention in persons with impaired glucose tolerance ( IGT ) on the development of retinopathy , nephropathy and neuropathy over a 20 year period . Methods In 1986 , 577 adults with IGT from 33 clinics in Da Qing , China were r and omly assigned by clinic to a control group or one of three lifestyle intervention groups ( diet , exercise , and diet plus exercise ) . Active intervention was carried out from 1986 to 1992 . In 2006 we conducted a 20 year follow-up study of the original participants to compare the incidence of microvascular complications in the combined intervention group vs the control group . Results Follow-up information was obtained on 542 ( 94 % ) of the 577 original participants . The cumulative incidence of severe retinopathy was 9.2 % in the combined intervention group and 16.2 % in the control group ( p = 0.03 , log-rank test ) . After adjusting for clinic and age , the incidence of severe retinopathy was 47 % lower in the intervention group than the control group ( hazard rate ratio 0.53 , 95 % CI 0.29–0.99 , p = 0.048 ) . No significant differences were found in the incidence of severe nephropathy ( hazard rate ratio 1.05 , 95 % CI 0.16–7.05 , intervention vs control , p = 0.96 ) or in the prevalence of neuropathy ( 8.6 % vs 9.1 % , p = 0.89 ) among the 20 year survivors . Conclusions /interpretationLifestyle intervention for 6 years in IGT was associated with a 47 % reduction in the incidence of severe , vision-threatening retinopathy over a 20 year interval , primarily due to the reduced incidence of diabetes in the intervention group . However , similar benefits were not seen for nephropathy or neuropathy OBJECTIVE : Women with a history of gestational diabetes mellitus ( GDM ) are at high risk for developing type 2 diabetes ( diabetes mellitus , DM ) . The American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM , but the American College of Obstetricians and Gynecologists ( ACOG ) is not as directive . We sought to examine postpartum glycemic testing in women diagnosed with GDM . METHODS : We conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001 . Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined , and predictors of postpartum DM screening were examined using Cox proportional hazards testing . RESULTS : Only 37 % of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association ( fasting glucose or oral glucose tolerance test [ OGTT ] ) , with a median time from delivery to the first such testing of 428 days . By comparison , 94 % of women underwent postpartum cervical cancer screening  using a Papanicolaou ( Pap ) test , with a median time from delivery to Pap testing of 49 days . Even when r and om glucose testing was included in a broad definition of postpartum DM screening ( r and om or fasting glucose , glycosylated hemoglobin , or OGTT ) , only two thirds of women ( 67 % ) received a postpartum glycemic assessment . CONCLUSION : In the population studied , only 37 % of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association . Efforts to improve postpartum DM screening in this high-risk group are warranted . LEVEL OF EVIDENCE : CONTEXT A past history of gestational diabetes mellitus ( GDM ) confers a very high risk of postpartum development of diabetes , particularly type 2 diabetes . OBJECTIVE The Diabetes Prevention Program ( DPP ) sought to identify individuals with impaired glucose tolerance ( IGT ) and intervene in an effort to prevent or delay their progression to diabetes . This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM . DESIGN The DPP was a r and omized , controlled clinical trial . SETTING The study was a multicenter , National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites . PATIENTS A total of 2190 women were r and omized into the DPP and provided information for past history of GDM . This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM . INTERVENTIONS Subjects were r and omized to either st and ard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention . MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing . Assessment s of insulin secretion and insulin sensitivity were also performed . RESULTS Whereas entering the study with similar glucose levels , women with a history of GDM r and omized to placebo had a crude incidence rate of diabetes 71 % higher than that of women without such a history . Among women reporting a history of GDM , both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50 % compared with the placebo group , whereas this reduction was 49 and 14 % , respectively in parous women without GDM 
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Results Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst , with no clear or consistent correlation to health care provider , health system or client characteristics .
Immediately following a GDM pregnancy many women , when properly informed , desire and intend to maintain healthy lifestyles to prevent future diabetes , but find the effort challenging .
Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower .
Studies reveal that sense of self-efficacy and social support are key determinants .