Ndpp-map: a lifestyle intervention to manage health risks after pregnancy with gestational diabetes

The National Institute of Diabetes and Digestive and Kidney Diseases awarded $829,914 to Kaiser Foundation Hospitals on August 25, 2026, for a randomized controlled trial testing NDPP-MAP, a tailored hybrid online-telehealth adaptation of the National Diabetes Prevention Program designed for women with prior gestational diabetes.

The study will enroll 378 women with prior gestational diabetes identified from Kaiser Permanente Northwest records and randomize them to NDPP-MAP or standard NDPP. NDPP-MAP emphasizes glycemic improvement, flexible hybrid delivery, gestational diabetes-specific education, and facilitated access to metformin. Outcomes will be assessed remotely using validated methods for measuring A1C and other metabolic markers. The trial addresses a critical gap: while gestational diabetes affects approximately 8 percent of pregnancies and increases long-term type 2 diabetes risk to 60 percent by 30 years postpartum, the standard NDPP has shown limited effectiveness in this population, which faces unique metabolic risks, competing priorities, and suboptimal clinical care access. Preliminary research identified that women with prior gestational diabetes value online delivery convenience but need tailored education, individualized coaching, flexible modality and content options, and improved metformin access through provider prompting.

The award is made under the Diabetes, Digestive, and Kidney Diseases Extramural Research program (CFDA 93.847). Performance occurs in Portland, Oregon 97227, with a period of performance through June 30, 2031. The assistance type is a Project Grant.

Abstract

Gestational diabetes (GDM) affects approximately 8% of pregnancies and substantially increases long-term risk for type 2 diabetes (T2D) and cardiovascular disease (CVD). By 10 years postpartum, 1 in 5 women with prior GDM develop T2D, rising to 60% by 30 years. Women who had GDM are also twice as likely as other women to develop CVD within 10 years. Clinical guidelines recommend intensive preventive care for women who have had GDM, including lifestyle intervention and metformin, but in practice, these women receive little healthcare. The national diabetes prevention program (ndpp) is the leading lifestyle intervention for adults with prediabetes but has shown limited effectiveness among women with prior GDM, who face unique metabolic risks, have many competing priorities, and receive suboptimal clinical care. Our preliminary studies identified key barriers and opportunities for improving the effectiveness of the ndpp in this population. Women with prior GDM value the convenience of online delivery but report a need for tailored education, individualized coaching, and greater flexibility in both modality and content. Hybrid online-telehealth models and person-centered goal setting have shown strong promise for improving engagement and outcomes, and access to metformin can be improved by prompting providers to prescribe IT upon participant request. The proposed study will test the ndpp to manage risk after pregnancy (ndpp-map), which is a tailored, hybrid version of the ndpp emphasizing glycemic improvement, flexible delivery, and GDM-specific education, as well as facilitated access to metformin. In a randomized controlled trial of 378 women with prior GDM identified from kaiser permanente northwest records, participants will be randomized to ndpp-map or the standard ndpp. Outcomes will be assessed remotely using validated methods for measuring A1C, lipids, blood pressure, weight, and physical activity. Primary aims are to (1) determine the effects of ndpp-map versus standard ndpp on A1C (primary outcome) and CVD risk factors at 12 months; (2) test moderators of treatment effects (e.g., time since GDM, baseline weight, and baseline A1C); (3) examine within-arm variation by use of intervention components and metformin; and (4) assess cost and projected reimbursement relative to medicare benchmarks. Ndpp-map integrates evidence-based digital and behavioral strategies into an established infrastructure for national dissemination, addressing a critical GAP in postpartum preventive care. If effective, ndpp-map will offer a scalable, sustainable model to prevent chronic disease in millions of women after GDM.