Diabetes During Pregnancy: Effect of MHealth Remote Monitoring of Blood Glucose on Glycemic Control – A Randomized Controlled Trial
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Abstract
Purpose/Objective of the Project:
Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) during pregnancy are associated with higher incidence of perinatal complications and neonatal death. The control of blood glucose (BG) reduces these risks.
Methodology/Approach:
We developed and piloted a BG mHealth remote monitoring system based on a smartphone platform. BG readings from a Bluetooth-enabled glucometer were automatically transmitted by smartphone to application servers that immediately sent results and self-care messages, based on pre-defined care paths, back to the smartphone. There was also a data viewing portal for both clinicians and patients. Nonadherence to the preset home BG measurement schedule automatically triggered a reminder and critical alerts were sent to patients and their physician. The present study tests the system’s effectiveness in a randomized controlled trial. Of 99 patients recruited, 79 had GDM (38 control, 41 intervention) and 20, DM2 (10 control, 10 intervention).
Findings/Results:
GDM subjects in the intervention (mHealth) group demonstrated significantly better adherence to the BG measurement schedule (4 per day recommended) being 3.7 readings per day compared to 3.3 in the control group (p=0.014). The average BG value in the T2DM group was significantly lower in the intervention vs. control group (5.9 mmol/L vs. 6.1 mmol/L, p<0.0007). In a multivariate analysis adjusting for other covariates (day, BMI, weight gain, mom’s age) the intervention group continued to have significantly lower BG values (p=0.0024). Due to the small sample size, health outcome measures including birth weight and incidence of perinatal complications did not indicate significant between-group differences. Further study is required.
Conclusions/Implications/Recommendations:
This study demonstrated that an mHealth remote monitoring system with self-care support improved adherence to home BG measurement schedule in the GDM group and better BG control in the T2DM group. These benefits should result in improved health outcomes, but will require a large study population to show an effect.
Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) during pregnancy are associated with higher incidence of perinatal complications and neonatal death. The control of blood glucose (BG) reduces these risks.
Methodology/Approach:
We developed and piloted a BG mHealth remote monitoring system based on a smartphone platform. BG readings from a Bluetooth-enabled glucometer were automatically transmitted by smartphone to application servers that immediately sent results and self-care messages, based on pre-defined care paths, back to the smartphone. There was also a data viewing portal for both clinicians and patients. Nonadherence to the preset home BG measurement schedule automatically triggered a reminder and critical alerts were sent to patients and their physician. The present study tests the system’s effectiveness in a randomized controlled trial. Of 99 patients recruited, 79 had GDM (38 control, 41 intervention) and 20, DM2 (10 control, 10 intervention).
Findings/Results:
GDM subjects in the intervention (mHealth) group demonstrated significantly better adherence to the BG measurement schedule (4 per day recommended) being 3.7 readings per day compared to 3.3 in the control group (p=0.014). The average BG value in the T2DM group was significantly lower in the intervention vs. control group (5.9 mmol/L vs. 6.1 mmol/L, p<0.0007). In a multivariate analysis adjusting for other covariates (day, BMI, weight gain, mom’s age) the intervention group continued to have significantly lower BG values (p=0.0024). Due to the small sample size, health outcome measures including birth weight and incidence of perinatal complications did not indicate significant between-group differences. Further study is required.
Conclusions/Implications/Recommendations:
This study demonstrated that an mHealth remote monitoring system with self-care support improved adherence to home BG measurement schedule in the GDM group and better BG control in the T2DM group. These benefits should result in improved health outcomes, but will require a large study population to show an effect.
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