Perceived and Actual Cardio-metabolic Risk among Women with a Recent History of Gestational Diabetes Erin Poe Ferranti, RN, MSN, MPH Sandra B. Dunbar,

Perceived and Actual Cardio-metabolic Risk among Women with a

Recent History of Gestational Diabetes

Erin Poe Ferranti, RN, MSN, MPHSandra B. Dunbar, RN, DSN, FAHA, FAAN

Carolyn M. Reilly, RN, PhDJennifer Foster, RN, MPH, CNM, PhD

Marji McCullough, ScD, RD K.M. Venkat Narayan, MD, MSc, MBA

Thomas R. Ziegler, MDMelinda K. Higgins, PhD

Introduction and Background

• Gestational Diabetes Mellitus (GDM)– 7-15% of pregnancies – Adds additional $3305 to pregnancy cost (Barbour et al., 2007; Nicholson et al., 2008; Quick & Chen, 2009)

• Type 2 Diabetes (T2DM)– 20-50% will progress to T2DM within 10 years

(Kim et al., 2002)

– Only 50% of GDM women get screened at the 6-week post-partum visit (Tovar et al., 2011)

• Metabolic Syndrome (MetS)– 3x higher in GDM women (Lauenborg et al., 2005)

Purpose

To examine perceived and actual cardiometabolic risk among GDM women.

• Dissertation Study:– To examine individual and family-level influences of

dietary quality and to explore cardiometabolic risk among women with a recent history of GDM.

Research Questions

• RQ1: How do women with a recent history of gestational diabetes perceive their risk for future development of T2DM and MetS?

• RQ2: Do GDM women with additional risk factors have a higher perception of risk for developing T2DM and metabolic syndrome?

Eligibility Criteria

• Inclusion Criteria:– Reside in Georgia– Ages 18-45– English or Spanish

fluency– Within 5 years of GDM

pregnancy

• Exclusion Criteria:– Currently pregnant or

breastfeeding– Development of T2DM– History of polycystic

ovary syndrome– Following a prescriptive

diet, weight-loss program, or working with a dietician

Methods

• Descriptive, Correlation Study• Recruitment

– self-referral – chart review

• Consent and Telephone Screening• Questionnaires mailed• Study visit completed

Variables and MeasuresVariables Instrument

Perceived Risk

10 year risk perceptionKnowledge of risk factorsOptimistic biasWorry Personal Control

Risk Perception Survey for Developing Diabetes, adapted for GDM populations • Knowledge of risk factors ( a

= .70)• Optimistic Bias ( = .65)a• Worry ( = .64)a• Personal Control ( = .72)a

Actual Risk Hemoglobin A1C > 5.7%Height and weight: Body Mass IndexMetabolic Syndrome (>3 abnormal): Blood Pressure Waist Circumference HDL-Cholesterol Triglycerides Fasting Glucose

Bayer A1CNow+ meter

Charder HM200P Portstad Portable Stadiometer, Lifesource UC-321 scale

Manually auscultatedSeca girth measuring tapeCardioChek meterCardioChek meterCardioChek meter

Laboratory Instruments

• CardioChek PA Meter– certified by the Center

for Disease Control and Prevention’s Cholesterol Reference Method Laboratory Network

– Coefficient of variation = 0.9%-2.0%

• Bayer A1C Now+ Meter– certified by the National

Glycohemoglobin Standardization Program

– 99% accuracy– Coefficient of variation =

3.0-4.0%.

Data Collection Procedures

• Review informed consent and HIPAA authorization

• Review completeness of questionnaires

• Assess blood pressure (average of 2 measurements)

• Assess height, weight and waist circumference

• Confirm fasting status• Prep finger and perform

fingerstick, collect sample

• Transcribe and review results with participant

• Provide basic counseling for any abnormal findings

• Review education material

Sample (n=55)

• Mean age: 36.1 + 5.6 years• 49% Caucasian, 35% African-American, 15%

Asian/Other, 20% Hispanic

• Mean years since last GDM delivery: 2.5 + 1.5

• 64% completed bachelors or graduate school

• 84% have ever breastfed

Participant Reported Follow-Up

64%

36% 44%

n=20

n=24

n=35

Perceived risk for getting T2DM in 10 years

Almost no chance Slight chance Moderate chance High chance

11%

37%

30%

22%n=20

n=16 n=12

n=6

Perceived risk

Risk Perceptions Mean Scores

Personal Control 3.2 + 0.5

Optimistic Bias 2.7 + 0.7

Worry 2.2 + 0.6

Note: Each subscale score range is 0 – 4, with higher scores reflecting more risk perception.

Actual Risk: Disease Outcomes

53%

16%

24%

7%

Actual Risk

No MetS or Diabetes Risk

Both MetS and Diabetes Risk

Diabetes Risk only

MetS only

n=13

n=4

n=9

n=29

Actual Risk: Diabetes

Series1

60.0%

34.5%

5.5%

n=33

n=19

n=3

A1C < 5.7 A1C = 5.7 – 6.4 A1C > 6.5

Actual Risk: BMI

Underweight Normal Overweight Obese Morbidly Obese

1.8%

23.6%

32.7% 34.5%

7.3%

BMI Status

n=18

n=19

n=4

n=13

Individual abnormal risk factors: Metabolic Syndrome

Blood Pressure Waist Circumference Fasting Glucose HDL-Cholesterol Triglycerides

37%

67%

6%

24%18%n=20

n=37

n=13n=10

Associations between perceived and actual risk

Perceived Risk

[ordinal scales]

BMI

[continuous]*

Actual RiskDiabetes Risk

[continuous]*

Metabolic Syndrome

[0/1 dichotomous]**

10-year Risk 0.23 (p=0.10) 0.14 (p=0.31) -2.76 (p= 0.01)

Personal Control -0.07 (p=0.60) -0.15(p= 0.29) -1.25 (p=0.22)

Optimistic Bias -0.38 (p=0.005) -0.05 (p=0.72) 0.26 (p=0.80)

Worry 0.37 (p=0.006) 0.23(p=0.10) -2.89 (p=0.01)

* Spearman’s Rho was calculated for the correlations between the continuous and risk perception subscales.

** T-tests were calculated for the differences between presence of metabolic syndrome risk and the risk perception subscales

Discussion/Conclusion

• Knowledge:– of diabetes risk factors is moderate

• Moderate perception of risk despite multiple risk factors

• 47% have MetS, pre-diabetes or both

• 75% are overweight or obese

Discussion/Conclusion

• Women with MetS:– Higher perception of 10-year risk– Higher perception of worry for T2DM

• Women with high BMI:– Higher perception of worry– Less optimistic

• Women with diabetes risk:– No significant differences in risk perception

Promising findings

Recently made lifestyle changes Planning to make lifestyle changes

69%

89%

31%

11%

Yes No

Implications for nursing research and practice

• Research– Effective intervention strategies to minimize risk for

GDM women

• Practice– Better screening, follow-up and risk estimation– Education and collaboration of providers

Funding

• NRSA: 1F31NR012605-01. National Institute of Nursing Research, National Institutes of Health

• STTI: Jean Stone Megenity Research Award, Alpha Epsilon Chapter, Sigma Theta Tau International

• AHA: 11CRP7590060. Clinical Research Program Grant, Greater Southeast Affiliate, American Heart Association

• Nurses Educational Funds Scholarship• Emory RedCap database; Research and Health

Sciences IT Division grant support (UL1RR025008)

Acknowledgements

• Committee and Co-Authors

– Dr. Sandi Dunbar, Dr. Carolyn Reilly, Dr. Jenny Foster, Dr. Marji McCullough, Dr. Venkat Narayan, Dr. Tom Ziegler

• Research Assistants

– Jillian Kinton and Analy Varajas-Gonzalez• Participants• Sites

– Emory Clinic, Emory Healthcare, Hall County Health Department

• Partners

– Dr. Melinda Higgins, Jean Harrell, Jasmine Hoffman, Tammy Loucks