Abstract
BackgroundGestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before.ObjectiveThis study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting.MethodsThis mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore.ResultsThe patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers.ConclusionsA GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.
Highlights
BackgroundGestational diabetes mellitus (GDM) is a well-established risk factor for type 2 diabetes mellitus (T2DM)
GDM is defined as the onset or first diagnosis of high blood glucose concentrations during pregnancy, which usually resolves after childbirth [4]
An analysis of the cost-effectiveness of GDM screening in the same study population showed that compared with no screening and high-risk screening, universal screening is cost-effective to reduce maternal and fetal complications due to GDM [17]. These results suggest that when it comes to policy implementation considerations for GDM care, universal screening has been shown to be significantly effective compared with high-risk screening, which is the current practice for GDM screening in Singapore [18]
Summary
BackgroundGestational diabetes mellitus (GDM) is a well-established risk factor for type 2 diabetes mellitus (T2DM). Patients often experience difficulties in adopting the required behavioral changes in a brief period, which can significantly compromise blood glucose control [8]. This is challenging for both patients and health systems and leads to exhausted capacities and burnout [9,10]. Working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions: A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, for working women
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