Type 2 diabetes prevention in women with a history of gestational diabetes: addressing inequities in lifestyle interventions for women from socially disadvantaged cultural backgrounds.

Abstract

By 2050, 1.31 billion people will be living with type 2 diabetes (T2DM). Those with social disadvantage experience greater diabetes prevalence, morbidity and mortality. Gestational diabetes (GDM) is an established factor for T2DM, with 3-4 times greater risks among women who are Black, Hispanic and South and South East Asians. Lifestyle interventions that include diet and physical activity reduce T2DM in at-risk populations, including women with prior GDM, regardless of ethnicity. However, migrant women from non-Western backgrounds are less likely to engage with the programme despite its efficacy. This review paper aims to describe the social disparities in GDM globally, with a focus on equity issues and interventions in Australia. It outlines a five-part approach to solutions that move us towards equity in reach and uptake for women from non-Western migrant backgrounds in Australia. Culturally inclusive solutions start with evaluating reach in underserved groups through equity audits or stratified analyses and identifying groups where reach is low. Community partnerships can then be formed with key actors across health and social sectors identified through stakeholder mapping. Effective reach strategies, including implementation and evaluation plans, will be co-developed through these partnerships, addressing risk factors, enablers and barriers to a healthy lifestyle. Solutions that integrate medical and social services, such as social prescribing, could facilitate healthy lifestyle choices through restructuring the social environment of the individual. These steps lead to interventions that promote social cohesion and resilience, enabling individuals to attain health and well-being in the face of external challenges.