Incorporation of information and communication technology into healthcare management has provided novel solutions to combat operational and financial challenges through the development of telemedicine pathways. Gestational diabetes is a perfectly suited condition on which to model such strategies through the potential for remote surveillance of self-monitored glycaemia. We sought to evaluate the impact of a smartphone app-assisted self-management programme for GDM on a variety of maternal and neonatal outcomes.
We developed a bespoke smartphone app linked to a secure hospital portal following focus group discussions and guidance from key end user stakeholders. All women with a first time diagnosis of GDM treated with lifestyle and medical nutrition therapy were invited to participate. Bluetooth enabled glucometers and a secure link to the patient-facing app were provided to consenting patients. Glycemic indices, perinatal outcome and service usage data were assessed and compared with a matched historical control. Continuous data were assessed using independent samples t-test and categorical data were assessed using Chi squared and Fischer’s exact tests.
169 women engaged with app-assisted care and their data were compared with 162 patients from a historical cohort. A greater number of glycemic indices were logged for those in the app group compared with the matched historical control. App-use was associated with a 2-point reduction in the mean fasting blood glucose level (p=0.022 ), a 5-point reduction in mean postprandial blood glucose level (p< 0.001) and fewer instances of above threshold blood glucose values. The interval time between diagnosis and requirement for supplemental hypoglycaemic therapy was increased among the app-assisted care group (p=0.008). Maternal and neonatal outcome data were similar between the groups however, rates of caesarean delivery were lower among app users primarily due to fewer elective CS. Among app-assisted care patients fewer clinical encounters and shorter postnatal stays were identified (p< 0.012 ; p< 0.0045). Cost effective analysis significantly favoured an app-based approach.
App-assisted care resulted in the achievement of optimised glycemic control for 80% of participants with reductions in both mean fasting and postprandial blood glucose levels. This improvement in glycemic control was associated with maintenance of high standards related to maternal and perinatal outcomes while facilitating patient centred care. Translation of this telemedicine solution into clinical practice has a beneficial impact on the number of patients requiring in-person review for treatment intensification resulting in a significant reduction in health economic metrics for both the patient and their healthcare provider.