Implementation of remote blood glucose monitoring for gestational diabetes in an underserved population

Abstract

1) Assess for disparities in frequency of blood glucose (BG) monitoring for gestational diabetes (GDM) between clinics with remote versus in-person BG monitoring programs in a pre-implementation period and 2) determine the impact of implementation of a remote BG monitoring program in an underserved population in a pre-post implementation design. We included patients with GDM receiving prenatal care at either private clinics (Clinic A) or resident clinics (Clinic B) within a university-based hospital setting. First, we performed a retrospective cohort study (Aim 1) comparing Clinic A (remote BG review) to Clinic B (in-person BG review) in the pre-implementation (PRE) period. We then performed a prospective cohort study (Aim 2) evaluating implementation of remote BG review in Clinic B in a pre- (1/1/19-12/31/19; PRE) versus post-implementation (1/1/21-12/31/21; POST) design. The primary outcome was frequency of BG review by a clinician per week diagnosed with GDM. Secondary outcomes included whether patients required medication, mode of delivery, and weight gain in pregnancy. 286 patients met inclusion criteria (Clinic A PRE: 182; Clinic B PRE: 54; Clinic B POST: 50). In the PRE period, patients in Clinic B were more likely to be Hispanic (37.0% vs. 8.2%), Black (38.9% vs. 18.7%), and be either uninsured (16.7% vs. 0.5%) or publicly insured (66.7% vs 9.9%) than in Clinic A. Patients in Clinic A received more BG reviews than Clinic B prior to implementation of remote BG review in Clinic B (83% vs. 41%, p< 0.01) (Table 1). For Aim 2, there were no demographic differences between PRE and POST groups in Clinic B. Importantly, implementation of remote BG monitoring at Clinic B significantly increased the frequency of BG log review (41% vs. 58%, p< 0.01) (Table 1). There were no differences in mode of delivery, total weight gain, or medication use. Remote blood glucose monitoring is an effective intervention to improve BG review among underserved patients with GDM. Future work should examine if interventions such as these can be used to decrease disparities in care.