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Telehealth for gestational diabetes

Research summary

Researchers: Lise Loerup, Dr Oliver Gibson, Prof. Lionel Tarassenko, Dr Carmelo Velardo

Clinical collaborators: Dr Lucy McKillop (Nuffield Department of Obstetrics and Gynaecology), Dr Jonathan Levy (Oxford Centre for Diabetes, Endocrinology and Metabolism), Prof. Andrew Farmer (Dept of Primary Health Care)

Funding: Oxford Biomedical Research Centre (OxBRC)

The potential benefits of treating gestational diabetes mellitus (GDM) include reductions in ill-health in the woman and/or the baby during or immediately after pregnancy, as well as the benefits of reducing the risk of progression to Type 2 diabetes in the longer term. Widening screening criteria, lower diagnostic thresholds and underlying demographic changes threaten to overwhelm resource-limited services for women with GDM. The management of GDM requires intensive self-monitoring of blood glucose (BG) and treatment with diet, tablets or insulin during the pregnancy.

We have developed a GDM self-management application on an Android smartphone linked to a Bluetooth-enabled blood glucose meter.  The patient tags the blood glucose readings (fasting, pre-prandial and post-prandial) and enters her insulin dose (if appropriate). Feedback is provided in the form of summaries of blood glucose data, as well as prompts and reminders as appropriate.

The software on the care team’s website allows them to view BG results in real time and to institute an intervention between clinic visits (e.g. increase the insulin dose). Algorithms on the server track the trends in the BG readings and the diabetes midwives are automatically notified if their patients have a number of readings outside the target zone.

50 patients in two hospitals have taken part in a cohort study of our system. After 41 women had finished using the system, 15,609 blood glucose results had been transmitted, 99% with a meal tag; 16% included free text comments from the patient about diet or other aspects of self-management.  403 text messages were sent by the clinical care team, including 110 medication adjustments.

The system allows remote delivery of care and has been positively received by patients and healthcare professionals.  Improved workflows and greater efficiency have resulted from medication adjustments between clinic visits and faster communication between members of the care team.