DESI-GDM

Overview

What is DESI-GDM?

Some women without diabetes develop high blood sugar levels late in pregnancy, a condition known as gestational diabetes (GDM). Approximately half of women with gestational diabetes develop type 2 diabetes within five years of giving birth and gestational diabetes predicts future heart disease and stroke in the mother. It also increases the lifetime risk of diabetes in her child up to eight-fold. Some people are more prone to develop gestational diabetes than others. South Asians are people whose ancestors are from India, Pakistan, Bangladesh or Sri Lanka. They are the largest non-white ethnic group in Canada. Recently, we have shown that about one in three South Asian women in Ontario develop gestational diabetes, a rate much higher than in other non-Asian populations. Untreated, GDM can increase the risk of a large-for-gestational age baby and maternal and offspring risks of obesity and type 2 diabetes. Interventions that can prevent gestational diabetes in this population may reduce future risk of diabetes, heart disease and stroke in both mother and baby.

This study will assess whether a culturally tailored, personalized nutrition intervention delivered by a trained health coach to pregnant South Asian women:

Improves blood sugar levels to a greater extent than usual dietary advice
Reduces the incidence of gestational diabetes mellitus to a greater extent than usual dietary advice

Recent Publications

WEBSITE

A culturally tailored personaliseD nutrition intErvention in South ASIan women at risk of Gestational Diabetes Mellitus (DESI-GDM): a randomised controlled trial protocol

Stennett RN, Adamo KB, Anand SS, Bajaj HS, Bangdiwala SI, Desai D, Gerstein HC, Kandasamy S, Khan F, Lear SA, McDonald SD, Pocsai T, Ritvo P, Rogge A, Schulze KM, Sherifali D, Stearns JC, Wahi G, Williams NC, Zulyniak MA, de Souza RJ. A culturally tailored personaliseD nutrition intErvention in South ASIan women at risk of Gestational Diabetes Mellitus (DESI-GDM): a randomised controlled trial protocol. BMJ Open. 2023 May 2;13(5):e072353. doi: 10.1136/bmjopen-2023-072353. PMID: 37130668; PMCID: PMC10163497.

WEBSITE

Causes and consequences of gestational diabetes in South Asians living in Canada: results from a prospective cohort study

Anand SS, Gupta M, Teo KK, Schulze KM, Desai D, Abdalla N, Zulyniak M, de Souza R, Wahi G, Shaikh M, Beyene J, de Villa E, Morrison K, McDonald SD, Gerstein H; South Asian Birth Cohort (START) - Canada Investigators. Causes and consequences of gestational diabetes in South Asians living in Canada: results from a prospective cohort study. CMAJ Open. 2017 Aug 9;5(3):E604-E611. doi: 10.9778/cmajo.20170027. PMID: 28800568; PMCID: PMC5621966.

WEBSITE

Fine-tuning of Genome-Wide Polygenic Risk Scores and Prediction of Gestational Diabetes in South Asian Women

Lamri A, Mao S, Desai D, Gupta M, Paré G, Anand SS. Fine-tuning of Genome-Wide Polygenic Risk Scores and Prediction of Gestational Diabetes in South Asian Women. Sci Rep. 2020 Jun 2;10(1):8941. doi: 10.1038/s41598-020-65360-y. PMID: 32488059; PMCID: PMC7265287.

Information for Participants

Purpose of DESI-GDM

Why is this research being done?

Some women without diabetes develop high blood sugar levels during pregnancy, this condition is called gestational diabetes (GDM)
Pregnant South Asian individuals develop GDM two times as often as white individuals
Diet changes during pregnancy may improve blood sugar levels
We think seeing a nutrition coach during pregnancy can help improve diet, but are unsure if this will have a large impact on blood sugar levels

Participation

Visits

Attend two visits, at our clinic or virtually. You will be compensated with a $25 gift card for baseline and follow-up visit.

Baseline visit: Three to four months gestation, one to one-and-a-half hours
Follow-up visit: Six to months gestation, two hours

Sample Collection

Baseline visit: fasting blood samples and fasting urine sample
Follow-up visit: fasting blood sample, fasting urine sample, glucose testing and additional blood samples for long-term storage (optional)

The Intervention

If you are randomly selected, you will be asked to…

Meet with a health coach to develop goals and a plan to achieve them
Follow-up with your health coach every two weeks
Install two applications on your mobile device
Wear a Fitbit for up to 16 weeks
Agree to receive up to five text messages per week related to diet and exercise

“I couldn’t be happier with my experience being enrolled in the DESI-GDM study! The staff were lovely, explained everything clearly and answered all my questions. The surveys are also simple and sweet and don’t take very long to complete. I recommend this opportunity to all pregnant South Asian moms! It is terrific way to help our community!”

– DESI-GDM Participant

Eligibility

Who is eligible?

Being of South Asian ancestry (self-identified)
Are 12-18 weeks pregnant and singleton pregnancy
At least two of the following GDM risk factors:
- At least 29 years old
- A poor quality diet
- Family history of diabetes mellitus
- GDM during a previous pregnancy
- A pre-pregnancy body mass index (BMI) of at least 23

If any of the following apply to you, you are not eligible:

A diagnosis of type 1 or type 2 diabetes
High blood pressure
Poor understanding of English
Unwilling to modify diet
At high risk of adverse pregnancy outcome other than GDM
Enrolment in another study
Do not have a smartphone
Not willing to walk
Excessive nausea and/or vomiting

Information for Physicians

“Hi, my name is Dr. Naila Furqan and I’m a Family Physician in Ontario.

DESI-GDM is a research study that is determining the effectiveness of health coaching to improve diet during pregnancy, and I have referred many patients into the DESI-GDM study.

The referral process of the study is a very simple and straightforward one. I introduce the study to the patient and if she agrees to share her contact information and learn more details about the study, I fill out a referral form and fax it to the study team.

I would strongly recommend the study to all the South Asian pregnant women to participate and all the health care providers to help in the recruitment process for this great cause.”

– Dr. Naila Furqan (MD, CCFP)

About the Study

Some women without diabetes develop high blood sugar levels late in pregnancy, a condition known as gestational diabetes (GDM). Approximately half of women with gestational diabetes develop type 2 diabetes within five years of giving birth, and gestational diabetes predicts future heart disease and stroke in the mother. It also increases the lifetime risk of diabetes in her child up to eight-fold. Some people are more prone to develop gestational diabetes than others. South Asians are people whose ancestors are from India, Pakistan, Bangladesh or Sri Lanka. They are the largest non-white ethnic group in Canada. Recently, we have shown that about one in three South Asian women in Ontario develop gestational diabetes, a rate much higher than in other non-Asian populations. Untreated, GDM can increase the risk of a large-for-gestational age baby and maternal and offspring risks of obesity and type 2 diabetes. Interventions that can prevent gestational diabetes in this population may reduce future risk of diabetes, heart disease and stroke in both mother and baby.

This study will assess whether a culturally tailored, personalized nutrition intervention delivered by a trained health coach to pregnant South Asian women:

Improves blood sugar levels to a greater extent than usual dietary advice
Reduces the incidence of gestational diabetes mellitus to a greater extent than usual dietary advice

Eligibility

Who is eligible?

Being of South Asian ancestry (self-identified)
Are 12-18 weeks pregnant and singleton pregnancy
At least two of the following GDM risk factors:
- At least 29 years old
- A poor quality diet
- Family history of diabetes mellitus
- GDM during a previous pregnancy
- A pre-pregnancy body mass index (BMI) of at least 23

If any of the following apply, you are not eligible:

A diagnosis of type 1 or type 2 diabetes
High blood pressure
Poor understanding of English
Unwilling to modify diet
At high risk of adverse pregnancy outcome other than GDM
Enrolment in another study
Do not have a smartphone
Not willing to walk
Excessive nausea and/or vomiting

Downloadable Resources

DESI-GDM informational flyer for your clinic (design 1) Download (PDF)

DESI-GDM informational flyer for your clinic (design 2) Download (PDF)

DESI-GDM informational brochure for participants Download (PDF)

Publications

WEBSITE

A culturally tailored personaliseD nutrition intErvention in South ASIan women at risk of Gestational Diabetes Mellitus (DESI-GDM): a randomised controlled trial protocol

WEBSITE

Causes and consequences of gestational diabetes in South Asians living in Canada: results from a prospective cohort study

WEBSITE

Fine-tuning of Genome-Wide Polygenic Risk Scores and Prediction of Gestational Diabetes in South Asian Women

WEBSITE

Studies to Improve Perinatal Health through Diet and Lifestyle among South Asian Women Living in Canada: A Brief History and Future Research Directions

Desai D, Kandasamy S, Limbachia J, Zulyniak MA, Ritvo P, Sherifali D, Wahi G, Anand SS, de Souza RJ. Studies to Improve Perinatal Health through Diet and Lifestyle among South Asian Women Living in Canada: A Brief History and Future Research Directions. Nutrients. 2021 Aug 24;13(9):2932. doi: 10.3390/nu13092932. PMID: 34578810; PMCID: PMC8465246.

WEBSITE

The effects of various diets on glycemic outcomes during pregnancy: A systematic review and network meta-analysis

Ha V, Bonner AJ, Jadoo JK, Beyene J, Anand SS, de Souza RJ. The effects of various diets on glycemic outcomes during pregnancy: A systematic review and network meta-analysis. PLoS One. 2017 Aug 3;12(8):e0182095. doi: 10.1371/journal.pone.0182095. PMID: 28771519; PMCID: PMC5542432.

WEBSITE

The genetic risk of gestational diabetes in South Asian women

Lamri A, Limbachia J, Schulze KM, Desai D, Kelly B, de Souza RJ, Paré G, Lawlor DA, Wright J, Anand SS; Born in Bradford and START investigators. The genetic risk of gestational diabetes in South Asian women. Elife. 2022 Nov 22;11:e81498. doi: 10.7554/eLife.81498. PMID: 36412575; PMCID: PMC9683781.

Frequently Asked Questions

What does DESI-GDM stand for?

A culturally tailored personalized nutrition intervention in South Asian women at risk of Gestational Diabetes Mellitus: a randomized trial (DESI-GDM).

What is the purpose of the study?

Women who don’t have diabetes may develop high blood sugar levels only during pregnancy, which is called gestational diabetes. This may put her and the baby at risk for diabetes or heart disease in the future. It has been found that one in three South Asian pregnant women develop this condition. However, it is possible that diet changes may improve blood sugar levels during pregnancy. This study is being done to test if a personalized nutrition plan designed by a health coach for South Asian pregnant women will:

Improve their blood sugar levels
Prevent gestational diabetes

We are hoping to recruit 190 participants.

Who is running this study?

The study is being run by a team of health researchers, led by Dr. Russell de Souza RD ScD, via the Population Research Institute (PHRI), a joint institute of McMaster University and Hamilton Health Sciences.

What are the benefits for me?

If you are randomly selected to be a part of our intervention group, rather than the control group, you will meet with a health coach who will create a nutrition plan personalised to you. You will also get to learn more about your food intake and exercise patterns, as well, via apps and the supervision of the health coach. Lastly, you will be giving back to society! Your participation in the research will help us create possible solutions or preventative measures to lower the occurrences of gestational diabetes in pregnant women.

Is there a specific schedule for the study?

There are three time points in the study:

Baseline visit (week 12-18 of pregnancy)
Oral glucose tolerance test (OGTT) visit (week 24-28 of pregnancy)
After-birth checkpoint

What is the commitment for the study?

The time commitment is approximately 30-45 minutes for the baseline visit, two to three hours for the oral glucose tolerance test visit and about 10-20 minutes for the after-birth check point.

If you are in the intervention group, you will meet virtually with the health coach biweekly for about four months and get weekly SMS messages reminding you to be physically active. We may contact you briefly in between visits for simple things, like clarifying data you gave us, reminding you to complete the surveys or reminding you of upcoming time point appointments.

How flexible are the time point appointments?

The study is very flexible and works around your time schedule. We ask for your availability and set appointments based on what is convenient for you. Please note that we must ensure that the time point appointments fall during the specified pregnancy week ranges for each time point, as mentioned above.

Do I have to do this visit in person or is there an online option?

You can do this study virtually via phone call, online (i.e., Zoom) or in-person at either our Brampton or Mississauga sites:

110 Cottrelle Boulevard
Brampton, Ontario
L6S 0E2

121-2550 Argentia Road
Mississauga, Ontario
L5N 5R1

Do I have to be from Brampton only to participate?

No. Anyone in Southern Ontario can participate.

Am I getting compensated for this study?

You will receive two $25 gift cards. One at the end of the baseline visit and one at the end of the oral glucose tolerance test visit.

What are the risks?

The study poses very minimal risks to you and your baby. These include bruising, pain or fainting during blood collection. Please note that these occurrences are rare and that the blood collection will be done by certified phlebotomists or certified health professionals.

What will happen to my samples?

Your blood samples taken during the oral glucose tolerance test will be used to measure your blood sugar levels and then discarded. If you choose to provide additional blood sample for research purposes, these will be stored and processed in our secured laboratories at Hamilton Health Sciences and will be labeled anonymously – your personal identification will not be used to label these samples.

Is it mandatory to give samples?

Completing the oral glucose tolerance test is a requirement of this study. However, you can refuse to provide additional samples and still be a part of the study.

Do I have to pay for the health coach, tests and other resources if I am chosen for the intervention group?

No, all tests and resources will be provided to you by the research team. We ask that you return the FitBit upon completing the study. The health coach’s service will be free of charge to you.

Will my information be kept private?

Yes, confidentiality and your privacy are very important to us.

Your data will not be shared with anyone except for your consent, as the law requires that. All your data will be anonymously labeled using a random identification number and will not be linked to you. This data will be stored on a secured server in a locked research office.

Can I withdraw at any point in time?

Yes, you can withdraw at any point in the study. If you decide to withdraw from the study, there will be no cost to you nor any impact on your ability to access healthcare.