# An Equity Audit of a Statewide Cardiometabolic Risk Reduction Pilot Programme for Women with a History of Gestational Diabetes

## TL;DR

This study evaluated a diabetes prevention program for women with gestational diabetes in Australia, finding that an adapted version reached more culturally diverse participants but had lower completion rates among disadvantaged groups.

## Contribution

The study introduces an equity audit using the PROGRESS framework to compare program completion rates across adapted and standard cardiometabolic risk-reduction programs.

## Key findings

- The Life! GDM program reached more non-English-speaking women, particularly from South and Central Asian backgrounds.
- In the standard Life! program, single participants and those who self-referred had significantly different completion odds.
- Lower completion rates in the Life! GDM program suggest a need for improved support for disadvantaged participants.

## Abstract

Background: This equity audit assessed enrolment and completion of a state-funded cardiometabolic risk-reduction programme for women with prior gestational diabetes in Victoria, Australia. The analyses compared completion rates between the standard prevention programme Life! with one specifically adapted for women with prior gestational diabetes (Life! GDM) using the PROGRESS equity framework. Methods: Women with a history of GDM in the Life! GDM or the mainstream Life! programme in 2022–2025 were included. Multinomial logistic regression was used to impute categorical variables, logistic regression for binary variables, and linear regression for continuous variables. Estimates were combined across imputed datasets using Rubin’s rules. Results: A total of 2261 women were included: 370 in Life! GDM, and 1891 in Life! from 2022 to 2025, with completion rates of 36.7% and 52.2%, respectively. Compared with women in Life!, women in Life! GDM were more likely to come from non-English-speaking backgrounds, particularly South and Central Asian (30.5% vs. 17.0%) and South-East Asian backgrounds (13.0% vs. 4.3%). After multiple imputation, multivariable logistic regression showed that none of the examined participant characteristics were significantly associated with programme completion in Life! GDM. In the Life! cohort, completion was significantly associated with marital status, with single participants having lower odds of completion (OR = 0.59, 95% CI: 0.41–0.85), and with referral channel, with self-referral associated with higher odds of completion (OR = 1.71, 95% CI: 1.39–2.12). Conclusions: The adapted programme appeared to have reached more culturally and linguistically diverse women; however, lower completion among those experiencing disadvantage highlights the need for enhanced support and retention strategies to ensure equitable postpartum diabetes prevention.