Abstract
The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. The objective was to determine women's satisfaction with using the GDm-health system and their attitudes toward their diabetes care. In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 ± 4 weeks (mean ± SD), and 17 women previous GDM recommended for BG monitoring (18 ± 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach's alpha was .89 with factor analysis corresponding with question thematic trends. This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial (clinicaltrials.gov NCT01916694).
Highlights
The increase in gestational diabetes mellitus (GDM) is challenging maternity services
In response to increasing clinical demand for GDM services, we have developed a novel, automated, interactive, smartphone-app-based blood glucose (BG) monitoring system.[10]
In women with previous GDM, local practice is to commence home BG monitoring from the second trimester of pregnancy. This project was aimed at women with GDM not requiring pharmacological therapy after 1 week of BG monitoring, diagnosed prior to 34 weeks gestation, with singleton, otherwise uncomplicated pregnancies who could communicate in English
Summary
In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. The screening policy for GDM was in line with 2008 NICE recommendations for diabetes in pregnancy.[2] In women with previous GDM, local practice is to commence home BG monitoring from the second trimester of pregnancy This project was aimed at women with GDM not requiring pharmacological therapy after 1 week of BG monitoring, diagnosed prior to 34 weeks gestation, with singleton, otherwise uncomplicated pregnancies who could communicate in English. It was felt these women were likely the most suitable for a future care model incorporating GDm-health. If a woman agreed to participate, she was asked to perform all BG monitoring and communication with the team between clinic appointments using the GDm-health system, rather than standard paper-based monitoring and phone calls (as required) to the midwife
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