IDF21-0288 Virtually Sugar Free: Overcoming Challenges of Managing Gestational Diabetes (GDM) during a Pandemic

Abstract

Background: Since the development of the COVID-19 pandemic, many areas of medicine have had to transition to virtual health care delivery in order to reduce viral transmission. This includes the Jim Pattison Outpatient Care and Surgical Centre Diabetes and Pregnancy clinic (JP DAP clinic) in Surrey, British Columbia, Canada which [JT1] provides multidisciplinary care for pregnant women with GDM. Our clinic, on average, has 720 clinician-patient encounters each month. Aim: With the joint efforts between Maternal-fetal medicine, Pediatrics and Endocrinology, we are conducting a quality improvement project to assess the impact that the transition to virtual care has had on the efficiency of the JP DAP clinic and maternal-fetal outcomes of our GDM patients. We are comparing and serially monitoring outcomes before and after transition to virtual care from March 2020 to March 2021. The aim of this project will be to measure, and potentially mitigate any harmful effects that transition to virtual care due to the COVID-19 pandemic could have on pregnant women with gestational diabetes. Method: The primary outcome measure is the time from referral to the first Endocrinologist appointment. Process measures include number of insulin starts and no-show rates. Balancing measures are the percentage of births with any one of the following maternal-fetal outcomes: large for gestational age, NICU admission, Caesarean section, neonatal hypoglycemia and/or jaundice. Results: Results of PDSA cycles have shown that several new implementations have resulted in the reduction in time from referral to the first appointment, including the introduction of virtual appointments, design of on-line education videos, and creation of time slots for appointments. The mean time of referral was reduced from 15 days to 12 days, and was sustained with these changes. However, we did observe a rise in maternal-fetal events during the second wave of the COVID-19 pandemic that started in September 2020 in British Columbia, Canada, and further data collection to investigate this trend is on-going. Discussion: Despite having to change the model of how healthcare was delivered during the COVID-19 pandemic, our existing data so far supports a hybrid model that utilizes both virtual and in-person consultations. This data will be useful for similar clinics by outlining some benefits and challenges we observed by integrating virtual care into the operation of our local DAP clinic. We also anticipate that our data will be useful in determining the role of virtual care in our clinic model after the COVID-19 pandemic.