It is estimated that gestational diabetes mellitus (GDM) affects 5% – 16% of all pregnancies in the UK. It is important for the health of the mother and baby that glucose control is maintained with titration, increasing or decreasing dose depending on blood glucose control, of medication as well as dietary modification. The dynamic physiology of pregnancy causes medication requirements to vary, hence frequent review and adjustments are required. Conventional management of GDM involves the patient measuring her blood glucose up to six times per day, using an electronic blood glucose meter, and writing the results in a paper diary. The patient is required to visit the hospital every two to four weeks, where the healthcare professional can review the results and adjust the medication dose as necessary. The cost and burden of GDM for both health provider and patient is, therefore, considerable.
It is likely that improving the management of GDM and reducing the number of clinic visits would offer significant benefits to patients and service providers alike. The ideal solution for the management of GDM would incorporate real-time management of blood glucose control and communication with the patient. The newly developed Oxford GDm-health management system, developed with BRC funding, addresses both of these needs. The system has been designed with extensive input from both patients and clinicians and comprises a smartphone app, with a Bluetooth-enabled blood glucose meter, for the patient; and a secure website, with optimised data presentation and alerting algorithms for healthcare professionals. The app automatically transmits the blood glucose measurements to the website, along with annotations entered by the patient. In addition, the app provides visual feedback on blood glucose control to the patient. The system has a built-in capability for communication between healthcare professionals and the patients, and allows the former to send text messages to the patient’s phone with a view to helping them with the self-management of their condition. The system also allows communication between healthcare professionals – ideal for team-based care. Electronic capture of data also allows detailed auditing of care and outcomes.
After beta testing with a small sub-group, GDm-health was incorporated into the management of 50 volunteers with excellent patient satisfaction. A randomised controlled trial was completed in 2016, comparing clinical, economic and satisfaction measures between women using the Oxford GDm-health management system and those receiving usual care (TREAT-GDm, clinicaltrials.gov NCT01916694). The app is now available for both the iOS and Android operating systems. The photo below is a screen shot from an Android device.
Hannah Scott, a patient under the care of the John Radcliffe Hospital Maternity Diabetes Service, 2014, said:
“Being diagnosed with Gestational Diabetes at 28 weeks pregnant with my second pregnancy was extremely worrying. The remote monitoring system provided me with the real-time reassurance and guidance I needed to get my blood sugar levels under control through mainly my diet. I genuinely believe that without the real-time advice from the diabetes midwife that this trial provided I wouldn’t have stayed as in control and therefore the amount of medication (metformin) and insulin required would have been greatly increased.
The diabetes midwife was able to discuss my readings with a consultant and communicate medication and insulin changes with me through text messages in between clinic appointments. Without the monitoring more hospital appointments would have been required (the clinics are already extremely busy). In addition to the enhanced communication from the midwife, the data visualisations in the app allowed us to spot (and understand) problem trends easily instead of just trying to pick them out on a handwritten form.
With the constant help and feedback I remained healthy throughout the remainder of my pregnancy and my son was born naturally at 38 weeks weighing a healthy weight of 7lb 13oz.
I felt very lucky to have been part of the TREAT-GDm trial.”