Lifestyle Interventions to Prevent Diabetes in U.S. Home Visiting Programs

Randomized Controlled Trial of Lifestyle Interventions for the Prevention of Diabetes in US Home Visiting Programs

The study is examining the health effects of gestational diabetes mellitus (GDM) intervention and medically tailored meals within home visiting. A large study is proposed that will include nearly a thousand pregnant or recently pregnant adults with recent GDM and who are from different regions and backgrounds. Two treatment approaches are compared, and both are in home visiting. One treatment group is receiving enhanced lifestyle support for GDM along with meals, and the other is receiving just the enhanced lifestyle support. The study will examine whether these interventions help reduce diabetes and pre-diabetes through 12 months postpartum, as well as other health factors like weight and blood pressure.

Study Overview

• Status: Recruiting
• Conditions: Diabetes Mellitus; Gestational Diabetes Mellitus (GDM)
• Intervention / Treatment: Behavioral: GDM Enhanced; Behavioral: Meals

Detailed Description

Gestational diabetes mellitus (GDM) is rapidly rising in prevalence and has been linked with several short and long-term adverse maternal health outcomes, including type 2 diabetes (T2DM) and cardiovascular disease. The postpartum year is a time of heightened risk, and 32-46% of people with GDM develop type 2 diabetes (T2DM) or Pre-Diabetes (PreDM) during the postpartum year. To prevent maternal diabetes, US guidelines recommend behavioral counseling to promote healthy eating, activity, and weight, but dissemination channels have been lacking. Evidence-based home visiting programs, with their well-established infrastructure in every state and focus on maternal and child health, are a promising platform through which the recommended behavioral interventions could reach people with GDM and reduce health disparities. Effective GDM intervention within home visiting needs to be potent, build on existing content, and remain brief, so as not to displace other evidence-based content. Integrating referral to medically tailored meals (MtMs) is a Food is Medicine strategy that may prevent and mitigate maternal diabetes in home visiting. Access to MtMs has been expanding rapidly in the US, with 10 states currently having and 5 states pending Medicaid Service waivers that offer coverage for MtMs. Systematic reviews have found that providing MtMs allows patients to experience significantly better glucose and weight management, improved food insecurity and dietary quality, and greater treatment satisfaction. MtMs also benefit health systems, insurers, and governments through reduced costs and fewer hospitalizations and emergency department visits. However, national calls and systematic reviews have identified a major evidence gap and the need for adequately powered effectiveness trials to determine whether MtMs are effective in treating and preventing maternal diabetes. For MtMs to continue as a treatment approach for GDM, compelling evidence is needed that they work and for whom and in what context. The primary aim of this study is to evaluate the 12-month incidence T2DM/PreDM in people with GDM who receive GDM Enhanced + Meals vs. GDM Enhanced Only within home visiting. A robust implementation process evaluation will inform ensure successful sustainment and reach for diverse pregnant and postpartum people with GDM. A Hybrid Type 1 effectiveness-implementation trial is proposed. The study will recruit 978 perinatal, English or Spanish-speaking adults nationwide from three clinical centers serving the West, Midwest/South, and East regions. Home visiting clients (35% Black; 40% Hispanic) with recent GDM diagnosis and will be randomized within site and home visiting agency to one of two treatment arms: GDM enhanced lifestyle intervention plus MtMs (GDM Enhanced + Meals) or GDM Enhanced Only. The primary study aim is to evaluate the 12-month incidence of T2DM/PreDM. Secondary aims will examine treatment group differences in health factors (weight, blood pressure) and client-centered outcomes (diet quality, physical activity, home food environment, food security, quality of life, treatment satisfaction, self-efficacy, mood) at 3, 6, and 12 months postpartum. Key moderators (Black/White race, Hispanic/Non-Hispanic ethnicity, food security), and mediators (changes in weight, dietary quality, physical activity, and the home food environment) will be identified. The RE-AIM framework will guide an implementation process evaluation to plan for successful delivery and sustainment of the interventions. Findings from this from large scale, adequately powered trial of MtMs for maternal health will fill a major gap in the literature. If the MTM approach is found effective, there will be strong justification to bolster access (at state level) and referrals (within home visiting) to MtMs. Findings will inform tailored strategies to ensure successful sustainment in home visiting and reach for diverse pregnant and postpartum people with GDM.

• Study Type: Interventional
• Enrollment (Estimated): 978
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Brooke Latzke-Davis, BS; Phone Number: 805-756-5694; Email: blatzked@calpoly.edu

Study Locations

• United States
  • California
    • San Luis Obispo, California, United States, 93401
      • Recruiting
      • California Polytechnic State University
      • Contact: Suzanne Phelan, PhD; Phone Number: 8057562087; Email: sphelan@calpoly.edu
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Not yet recruiting
      • Northwestern University
      • Contact: Darius Tandon, PhD; Phone Number: 410-852-0399; Email: dtandon@northwestern.edu
  • Rhode Island
    • Providence, Rhode Island, United States, 02906
      • Not yet recruiting
      • Miriam Hospital
      • Contact: Rena R Wing, PhD; Phone Number: (401) 793-8959; Email: rwing@brownhealth.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Currently in home visiting
• Pregnant or < 3 months (13 weeks) postpartum
• Gestational Diabetes Mellitus diagnosis in most recent pregnancy (based on self-report)
• Aged 18 years or older
• English- or Spanish-speaking.
• Not currently being given medically tailored meals
• Willing to receive randomization to either group

Exclusion Criteria:

• Pre-existing diabetes (based on self-report)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Usual Home Visiting plus GDM Enhanced; This group receives usual home visitation plus GDM Enhanced intervention.	Behavioral: GDM Enhanced; The GDM Enhanced intervention is comprised of HV-delivered, evidence-based modules (10-20 minutes) with facilitator guides. The content prioritizes management and prevention of diabetes through healthy eating, physical activity, and stigma-informed weight management strategies.
Experimental: Usual HV + GDM Enhanced + Meals; This group will receive usual home visitation plus GDM Enhanced plus medically tailored meals.	Behavioral: GDM Enhanced; The GDM Enhanced intervention is comprised of HV-delivered, evidence-based modules (10-20 minutes) with facilitator guides. The content prioritizes management and prevention of diabetes through healthy eating, physical activity, and stigma-informed weight management strategies.; Behavioral: Meals; The Meal intervention includes medically tailored meals being provided to participants starting after randomization and tailored to their individual dietary preferences and cultural considerations.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diabetes/Pre-Diabetes	The Primary Outcome Measure in this study is a categorical outcome of glucose tolerance (i.e., healthy glucose tolerance vs. type 2 diabetes/pre-diabetes) at 12 months postpartum. The test will be conducted at CLIA-certified lab. A 2-hour oral glucose tolerance test (OGTT) will characterize people into one of two categories: 1) healthy glucose tolerance; or 2) type 2 diabetes (2-hour post 75g load glucose level of 200 mg/dL or greater) or pre-diabetes (a 2-hour post 75g load glucose level of 140 to 199 mg/d).	From enrollment to 12 months postpartum

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
HbA1c concentration	HbA1c will be measured utilizing an at-home test kit (finger-stick, whole-blood test)	From enrollment to 3, 6, and 12 months postpartum
Systolic blood pressure	Systolic blood pressure will be self-measured in the home with trained research assistants guiding the assessment	From enrollment to 3, 6, and 12 months postpartum
Diastolic blood pressure	Diastolic blood pressure will be self-measured in the home with trained research assistants guiding the assessment	From enrollment to 3, 6, and 12 months postpartum
Body weight	Body weight is obtained using remote scales provided to participants.	From enrollment to 3, 6, and 12 months postpartum
Child zBMI	Remote, guided parent measurements of child weight and length will be used to calculate the child's body mass index z-score (zBMI), along with parent-reported infant sex.	From 3 months to 6 and 12 months
Metabolic equivalent task minutes per week of moderate-to-vigorous physical activity	The International Physical Activity Questionnaire will be used to measure metabolic equivalent task (MET)-minutes per week of moderate-to-vigorous physical activity. Scores range from 0 to >10,000 MET-minutes/week, with higher scores indicating greater physical activity, which is considered a better outcome.	From enrollment to 3, 6, and 12 months postpartum
Home Food Environment	The home food environment checklist will be used to measure number of healthy foods in the home. Higher scores indicate a greater number of healthy foods present.	From enrollment to 3, 6, and 12 months postpartum
Food Security	The U.S. Household food security survey will be used to measure a categorical classification or high food security, marginal food security, low food security, and very low food security	From enrollment to 3, 6, and 12 months postpartum
Global Physical Health	The Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10-item scale will be used to assess Global Physical Health (GPH). Raw scores are converted to T-scores, standardized to the U.S. general population (mean = 50, SD = 10). T-scores typically range from 20 to 80, with higher scores indicating better health.	From enrollment to 3, 6, and 12 months postpartum
Global Mental Health	The Patient-Reported Outcomes Measurement Information System Global Health 10-item scale will be used to assess Global Mental Health. Raw scores are converted to T-scores, standardized to the U.S. general population (mean = 50, SD = 10). T-scores typically range from 20 to 80, with higher scores indicating better health.	From enrollment to 3, 6, and 12 months postpartum
Nutrition Self-Efficacy	The Nutrition Self-Efficacy Scale will be used to assess participants' confidence in their ability to engage in healthy eating, yielding a continuous self-efficacy score. Each item is rated on a 5-point Likert scale from 1 (not at all confident) to 5 (very confident), resulting in a total score range of 10 to 50. Higher scores reflect greater self-efficacy for healthy eating behaviors	From enrollment to 3, 6, and 12 months postpartum
Center for Epidemiologic Studies Depression Scale	The Center for Epidemiologic Studies Depression Scale - 10-item version (CES-D-10) will be used to assess depressive symptoms. Each item is rated on a 4-point Likert scale from 0 (rarely or none of the time) to 3 (most or all of the time), yielding a total score range of 0 to 30. Higher scores indicate greater depressive symptomatology.	From enrollment to 3, 6, and 12 months postpartum
Barriers to Healthy Eating	Barriers to Healthy Eating Questionnaire is 14-items and assesses perceived barriers to healthy eating. The total score is calculated by summing all 14 items. Total scores range from 0 to 14, with higher scores reflecting greater overall perceived barriers to following a healthy eating pattern.	From enrollment to 3, 6, and 12 months postpartum
Diet quality	The Automated Self-Administered (ASA) 24-hour Recall of the National Cancer Institute will be used by trained staff to obtain an interview-based assessment of dietary quality. Healthy Eating Index (HEI) scores will be calculated by linking ASA24 output to the HEI scoring algorithm, which evaluates diet quality based on alignment with the Dietary Guidelines for Americans.Scores range from 0 to 100.	From enrollment to 3, 6, and 12 months postpartum

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of Intervention Measure	The Feasibility of Intervention Measure will be used to assess participants' perceptions of how feasible the intervention is to implement. The scale includes 4 items, each rated on a 5-point Likert scale from 1 (completely disagree) to 5 (completely agree), resulting in a total score range of 4 to 20. Higher scores indicate greater perceived feasibility of the intervention.	12 months postpartum
Acceptability of Intervention Measure	The Acceptability of Intervention Measure (AIM) will be used to assess participants' perceptions of how acceptable the intervention is. The measure includes 4 items, each rated on a 5-point Likert scale from 1 (completely disagree) to 5 (completely agree), resulting in a total score range of 4 to 20. Higher scores indicate greater acceptability of the intervention.	12 months postpartum
Intervention Appropriateness Measure	The Intervention Appropriateness Measure (IAM) will be used to assess participants' perceptions of how suitable the intervention is. The scale consists of 4 items, each rated on a 5-point Likert scale from 1 (completely disagree) to 5 (completely agree), yielding a total score range of 4 to 20. Higher scores indicate greater perceived appropriateness of the intervention.	12 months postpartum

Collaborators and Investigators

• Sponsor: California Polytechnic State University-San Luis Obispo
• Collaborators: Patient-Centered Outcomes Research Institute; Northwestern University; Bradley Hospital; Lifespan/ The Miriam Hospital
• Investigators: Principal Investigator: Suzanne Phelan, PhD, California Polytechnic State University-San Luis Obispo

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2026
• Primary Completion (Estimated): April 30, 2030
• Study Completion (Estimated): April 30, 2030

Study Registration Dates

• First Submitted: April 6, 2025
• First Submitted That Met QC Criteria: May 15, 2025
• First Posted (Actual): May 23, 2025

Study Record Updates

• Last Update Posted (Actual): March 5, 2026
• Last Update Submitted That Met QC Criteria: March 3, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: gestational diabetes; home visiting; medically tailored meals; food is medicine
• Additional Relevant MeSH Terms: Urogenital Diseases; Endocrine System Diseases; Female Urogenital Diseases and Pregnancy Complications; Metabolic Diseases; Pregnancy Complications; Glucose Metabolism Disorders; Nutritional and Metabolic Diseases; Diabetes, Gestational; Diabetes Mellitus; Food; Diet, Food, and Nutrition; Physiological Phenomena; Food and Beverages; Meals
• Other Study ID Numbers: 2025-056; MMM-2024C1-37760 (Other Grant/Funding Number: Patient-Centered Outcomes Research Institute)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We will share de-identified individual participant data related to primary and secondary outcomes. These data may include measures of diabetes, physical activity, diet quality, and other health indicators.
• IPD Sharing Time Frame: April, 2031
• IPD Sharing Access Criteria: Data will be made available to qualified researchers upon reasonable request and completion of a data use agreement that protects participant confidentiality and outlines permitted uses of the data.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No