New trial hopes to improve health care for women with gestational diabetes

A new UC Davis Health trial is focusing on behavioral strategies to improve health care among racially and ethnically diverse patients with gestational diabetes.

Susan D. Brown, associate professor of internal medicine, recently presented on the SUNRISE trial at a forum hosted by the UC Davis Center for Healthcare Policy and Research and the Perinatal Origins of Disparities (POD) Center. Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the trial aims to identify effective interventions that increase preventive screening for type 2 diabetes after a gestational diabetes diagnosis.

“Gestational diabetes is a common condition that disproportionately affects people of color. It also increases chronic disease risk, which includes type 2 diabetes and cardiovascular disease,” Brown explained. “Health equity motivates much of my work. The long-term goal of this trial is to mitigate barriers that can get in the way of preventive healthcare for diverse patients.”

Gestational diabetes is a type of diabetes that can develop during pregnancy in people who don’t already have diabetes. Every year, nearly 10% of pregnancies in the United States are affected by gestational diabetes.

Patients diagnosed with gestational diabetes are over eight times more likely to develop type 2 diabetes after giving birth. They also have over two times higher risk of cardiovascular events within 10 years postpartum. 

Health equity motivates much of my work. The long-term goal of this trial is to mitigate barriers that can get in the way of preventive healthcare for diverse patients.”—Susan D. Brown

The American Diabetes Association recommends patients who had gestational diabetes screen for type 2 diabetes at 4-12 weeks postpartum with a two-hour oral glucose tolerance test.

“Postpartum screening for type 2 diabetes is covered and recommended for patients with gestational diabetes, but it is underutilized,” Brown said. “It is vital that we identify new strategies to foster prevention and improve the health of people who have been diagnosed with this condition. I believe we can leverage behavioral science to do that.”

For the trial, Brown teamed up with Assiamira Ferrara, senior research scientist at the Kaiser Permanente Northern California Division of Research. Together the team will work with patients at Kaiser Permanente Northern California who receive nurse telehealth care from the Regional Perinatal Service Center.

Michaela Kiernan, senior research scholar at Stanford School of Medicine, and Monique M. Hedderson, senior research scientist at the Kaiser Permanente Northern California Division of Research, are co-investigators for the trial.

“Our past work has shown that patient barriers to screening persist, including fear of a diabetes diagnosis, a low perceived risk for type 2 diabetes, competing priorities, and logistical barriers,” Brown explained. "Our goal moving forward is to identify behavioral strategies that directly target those patient barriers, informed by input from clinical stakeholders and what we continue to learn from patients themselves.”