Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Interactive blood glucose management platform for women with gestational diabetes: a pilot study (#127)

Sophie E Poulter 1 , Nina Meloncelli 1 , Michele Mack 1
  1. Queensland Health, Birtinya, QLD, Australia

Background

Gestational diabetes mellitus (GDM) affects 12-14% of pregnancies in Australia1.  The associated excess risk for mother and baby can be attenuated with close monitoring and tight glycaemic control, however comes at a cost of significant treatment burden for the woman and the healthcare system2-4. Innovative care models are needed.

Aims:

To determine the feasibility, safety, user satisfaction and impact on resource utilisation of a smartphone based, remote blood glucose level (BGL) monitoring platform in women with GDM compared with a historical control group treated using the standard model of care.

Methods:

This pre-post intervention study prospectively enrolled women with GDM diagnosed between 24-30 weeks gestation to the use of a smartphone based BGL management platform and compared them to historical control group of women diagnosed with GDM prior to the introduction of the application.

The NET-Health smartphone app allowed automatic, real time upload of BGLs to a central secure server where NET Health software scans the number and value of levels to determine if they were outside a prespecified range. If identified, an automatic email notification was sent to the healthcare provider for action.

Demographic data was collected at the time of enrollment. Occasions of service (OOS) and maternal and neonatal outcomes were recorded for comparison to previously collected historical data

Women completed a semi-quantitative validated satisfaction questionnaire post-delivery.

Results: 

A total of 192 women were included- 98 prospectively enrolled and 94 in the historical control group. The groups were well matched with no significant differences at enrollment apart from a higher number of women with a pre pregnancy BMI >30 in the intervention group.

There were no significant differences in maternal or neonatal clinical outcomes.

Intervention with the NET-Health application reduced resource utilisation, with 1.9 fewer occasions of service and 37 fewer minutes of clinician time which equated to $6800 saved per hundred women (based on clinician time only).

Trends toward longer gestation, more elective and fewer emergency caesarean sections with fewer neonatal complications and neonatal intensive care admissions were seen in the intervention group.

A total of 51 women (53%) answered the survey with high satisfaction across all questions asked (median score either 4-5/5).

Conclusions: 

Use of a smartphone based, remote BGL monitoring platform in women with GDM is feasible, safe, has a high rate of patient satisfaction and results in a reduction in resource utilisation without compromising outcomes. Further studies involving larger numbers are needed.

  1. 1. Laurie J, McIntyre H. A Review of the Current Status of Gestational Diabetes Mellitus in Australia – The clinical impact of changing population demographics and diagnostic criteria on prevalence Int. J. Environ. Res. Public Health 2020, 17, 9387- 9398
  2. 2. Lai FY, Johnson JA, Dover D et al. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: a population-based study in Alberta, Canada, 2005-11. J Diabetes 2016 Jan;8(1):45-55
  3. 3. Lowe WL, Lowe LP, Kuang A et al. Maternal glucose levels during pregnancy and childhood adiposity in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study. Diabetologia 62, 598–610 (2019)
  4. 4. Crowther CA, Hiller JE, Moss JR et al. Australian Carbohydrate Intolerance Study in pregnant women (ACHOIS) Trial Group. N Engl J Med. 2005 Jun 16; 352(24):2477-86