Good glycaemic control in women with gestational diabetes mellitus (GDM) improves pregnancy outcomes. Current standard of care involves frequent (1-2 weekly) diabetes clinic review. Since 2016, implementation of the new World Health Organisation diagnostic criteria has resulted in 23–25% increase in prevalence of GDM at our institution, with substantial burden on our resources.
A new model-of-care (MOC) using smartphone meters and linking data with the diabetes team was piloted in April 2017. English speaking women with a compatible smartphone were invited to participate. Blood glucose levels (BGLs) were reviewed weekly on internet portal. The women had 4 weekly clinic reviews at antenatal clinic until 36 weeks’ gestation and then weekly until delivery. If BGLs were unacceptable on the portal, women were seen in clinic earlier.
Aim: To evaluate the safety and effectiveness of this MOC and whether it leads to reduction of clinic visits.
Method: The intervention group consisted of women who participated in the pilot study (April 2017– December 2017) while the control group included women with GDM who attended antenatal clinic between October 2016 and March 2017. We conducted an audit retrospectively on background characteristics, pregnancy outcomes and number of diabetes-related clinic visits for both groups.
There were 272 women in control group and 163 in intervention group. No difference in background characteristics was found between the 2 groups except a greater need for interpreters in the control group (43.2 vs 6.5%, p<0.001). The number of clinic appointments was significantly fewer in the intervention group (6.4±2.9 vs 7.3±3.6 visits, p=0.009). After excluding women requiring interpreters, those in the intervention group still had fewer clinic appointments (6.3±2.9 vs 7.1±3.6 visits, p=0.038). No difference in pregnancy outcomes, including mode of delivery, admission to special care nursery, birthweight and neonatal hypoglycaemia, between the two groups was observed (p>0.05).
Our study found that this new MOC was safe and the women required fewer diabetes-related clinic visits during pregnancy.