DALI

Vitamin D And LIfestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention

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 Obiettivo del progetto (Objective)

'Europe is facing a rapidly growing threat from Type 2 diabetes mellitus (T2D), which is undoubtedly associated with an unhealthy diet and a more sedentary lifestyle. Evidence is accumulating that gestational diabetes mellitus (GDM) may be playing a role in this process. Thus it provides a significant opportunity for preventing future T2D. Not only is GDM prevalence on the rise, but intrauterine exposure to hyperglycaemia predisposes the offspring to diabetes and obesity. Another putative contributing factor is a low vitamin D status, which is also increasing in prevalence and may have causal links with both obesity and decreased glucose tolerance. The main aims of this project are: 1) to establish the current status of the prevalence of GDM in Europe and facilitate the adoption of a single diagnostic approach and 2) to deliver the best strategy that prevents GDM. The latter was deemed as not fully feasible within the scope of this call and our decision was to test the most relevant approaches (diet, exercise, vitamin D, alone or in combination) against surrogate variables of GDM (fasting blood glucose, insulin sensitivity, pregnancy weight gain) to come up with the best intervention for entry into a definitive GDM prevention trial. Deliverables include the sample size and modus operandi for such a trial. Value will be added to the project by 1) Assessing variables modifying the uptake of preventive interventions, 2) Exploring health costs of GDM and potential savings of preventive approaches, 3) Improving pathophysiological understanding by assessing intervention effect on several parameters in mother and foetus and 4) Facilitating future research through a well defined cohort of mother-offspring pairs and comprehensive biobanking.'

Introduzione (Teaser)

Onset of glucose intolerance during pregnancy, gestational diabetes mellitus (GDM), harms some babies and contributes to the type 2 diabetes (T2D) pandemic. A European project is paving the way for a holistic strategy to prevent GDM.

Descrizione progetto (Article)

GDM is a serious condition with possibly dire consequences for both mother and baby in pregnancy. Women with past GDM comprise up to around 30 % of women who present with T2D. Moreover, exposure in the womb to GDM might predispose children to diabetes and obesity in later life.

The EU-funded http://www.dali-project.eu (DALI) (Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention) project is working on protecting both mothers and babies from the damage that GDM can cause. They are investigating three interventions to prevent GDM: physical activity, diet and vitamin D supplementation, either alone or in combination. Variables to be measured in the trials include maternal glucose tolerance, maternal weight gain and insulin sensitivity.

Project work so far has resulted in completion of the pilot study, and recruitment for the full trial is ongoing. DALI implemented training workshops for lifestyle coaches and nurses; 440 pregnant women completed the trial for lifestyle intervention testing, out of whom 101 developed GDM.

Vitamin D and placebo was distributed to the relevant study sites. Out of 144 women enrolled in the vitamin D intervention so far, 92 completed the trial and 28 developed GDM.

Researchers have established the DALI biobank and optimised their web-based database. Sample collection and analyses as well as data entry are ongoing.

Promotion of the project has been carried out via newspapers, a research fair and media interviews. A manuscript describing the DALI trial was published in BMC Pregnancy & Childbirth and the pilot study is in press with Diabetes Care. In addition, several free papers were presented as posters or orally at national and international meetings.

DALI is a comprehensive research programme that on completion will enhance our understanding of GDM and enable the development of effective preventative measures. DALI will also provide information on factors predisposing to GDM and its prevalence in various European populations.

Project data and the DALI biobank could form the basis for wider pan-European studies in the future. Standardising screening and GDM diagnostic tools along with the identification of GDM phenotypes could mean personalised GDM treatment in the future. Ultimately, preventing T2D onset will not only reduce patient suffering but also alleviate the immense economic burden of this disease.