Association between Social Vulnerability and Achieving Glycemic Control among Pregnant Women with Pregestational Diabetes

Venkatesh, Kartik K.; Germann, Katherine; Joseph, Joshua J.; Kiefer, Miranda K.; Thung, Stephen; Costantine, Maged M.; Landon, Mark B.; Gabbe, Steven G.; Fareed, Naleef

doi:10.1016/j.ajog.2021.11.1129

Cited by 4 publications

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“…Pregnant women with pregestational diabetes who have higher SVI scores are less likely to achieve glycemic control as measured by HbA1c. 22 As part of the diabetes in pregnancy care program in the current observational study, social determinants of health were not formally assessed. Nevertheless, it is possible that access to an integrated diabetes and prenatal care program, including providing clinical care that connected glycemic control to pregnancy outcomes and in a standardized team-based approach inclusive of maternal-fetal medicine specialists, endocrinologists, and diabetes nurse educators, also impacted social determinants of health.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…We hypothesized that an integrated pregnancy and diabetes care program may decrease differences in HbA1c between non-Hispanic Black and White women from early to late pregnancy by addressing social determinants of health, including timely prenatal and diabetes care at the same time, providing clinical care that connected glycemic control to pregnancy outcomes, and providing care in a standardized team-based approach. 22 Our objective was to determine whether the change in HbA1c from early to late pregnancy differed between non-Hispanic Black and White pregnant women with pregestational diabetes. We compared HbA1c measures cross-sectionally at two time points in early and late pregnancy and longitudinally from early to late pregnancy.…”

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confidence: 99%

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Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes

et al. 2022

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Objective:To determine whether change in HbA1c from early to late pregnancy differs between non-Hispanic Black and White women with prepregnancy diabetes. Study design:A retrospective analysis from an integrated prenatal and diabetes care program from 2012-2016. We compared HbA1c as a continuous measure, and secondarily, HbA1c<6.5%, cross-sectionally and longitudinally in early (~10 weeks) and late (~31 weeks) pregnancy. Linear and logistic regression were used, and adjusted for age, body mass index, White diabetes class, pharmacotherapy, diabetes type, gestational age at baseline HbA1c measurement, and baseline hemoglobin. Results:Among 296 non-Hispanic Black (35%) and White pregnant women (65%) with prepregnancy diabetes (39% type 1, 61% type 2), Black women were more likely experience increased social determinants of health as measured by the Social Vulnerability Index (SVI), and were less likely to have type 1 diabetes and have more severe diabetes versus White women (p<0.05). Black women had higher mean HbA1c (7.8 vs. 7.4%; Beta: 0.75;95%CI: 0.30 to 1.19), and were less likely to have a HbA1c<6.5% at 10 weeks compared to White women (24 vs. 35%;AOR:0.45;95%CI: 0.24 to 0.81); but not after adjusting for SVI. At 31 weeks, both groups had similar mean HbA1c (both 6.5%) and were equally as likely to have a HbA1c<6.5% (57 vs. 54%). From early to late pregnancy, Black women had a higher percentage decrease in HbA1c (1.3% vs. 0.9%;Beta=0.63; 95%CI: 0.27 to 0.99), and were equally as likely to have an improvement or stable HbA1C <6.5% from 10 to 31 weeks, with both groups having a similar mean HbA1c (6.5%) at 31 weeks. Conclusion:Despite experiencing greater community-level social determinants of health, Black women with pregestational diabetes had a larger reduction in HbA1c and were able to equally achieve target HbA1c<6.5% by late pregnancy compared to White women as part of an integrated diabetes and prenatal care prog

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Section: Discussionmentioning

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Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes

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“… 9 , 10 SDoH impact the ability of Medicaid-enrolled pregnant individuals with T2D to achieve glycemic control, including lack of reliable transportation to attend visits, access to healthy diet and exercise resources, and convenient methods to log self-monitored glucose values and adjust insulin dosing. 11 – 18 Limited education and income may further exacerbate barriers to care for Medicaid-enrolled individuals with T2D who are unable to engage in activities that achieve glycemic control. 19 When social needs are not met, T2D management may become increasingly difficult.…”

Section: Introductionmentioning

confidence: 99%

Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

et al. 2023

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Background A tailored and integrated technology solution (patient mHealth application and provider dashboard) can provide a 360° view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy that could improve health outcomes and address health inequities. Objectives To develop a set of user specifications for the mHealth and dashboard applications, develop prototypes based on user needs, and collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment. Methods Study activities followed a double-diamond framework with a participatory design mindset. Activities were divided into two phases focused on a qualitative inquiry about participant needs and values (phase 1) and design, development, and usability testing of low and high-fidelity prototypes (phase 2). Results We identified themes that exemplified pregnancy experience among Medicaid-enrolled individuals with T2D. Patients ( n = 7) and providers ( n = 7) expressed a core set of expectations for the mHealth and dashboard applications. Participants provided feedback to improve the mHealth and dashboard. For both applications, participants reported scores for the NASA Task load Survey (TLX) that were in the 20th percentile of national TLX scores. Conclusions Digital health tools have the ability to transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences—then using them, along with prior studies and theory, to develop applications—holds great potential in tackling complicated health care issues.

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“…SDoH are the conditions in which people are born, grow, live, work, and age, and they include factors such as insurance status and SES, which is consistently a strong predictor for diabetes onset and progression [9,10]. SDoH impact the ability of Medicaidenrolled pregnant individuals with T2D to achieve glycemic control through the absence of facilitators such as reliable transportation to attend visits, access to resources to engage in healthy diet and exercise, and convenient methods to log self-monitored glucose values and adjust insulin dosing [11][12][13][14][15][16][17][18]. Limited education and income may further exacerbate barriers to care for Medicaid-enrolled individuals with T2D, who are unable to engage in activities that achieve glycemic control [19].…”

Section: Introductionmentioning

confidence: 99%

Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

Fareed

Singh²,

Boettcher

et al. 2022

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BackgroundMeaningful integration of mobile health (mHealth) applications that capture and provide feedback on important dimensions is lacking and is required to promote behavioral changes that are linked to better maternal and birth outcomes among pregnant individuals. The design and use of digital health technologies among individuals covered by public health insurance is typically overlooked and has implications for how this group can manage their health with the support of technology. Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy struggle to manage their diabetes due to clinical and social needs barriers. There is an opportunity to develop a tailored and integrated technology solution (patient mHealth application and provider dashboard) that provides a 360-degree view of the patient for this group that could improve health outcomes and address health inequities.ObjectiveOur objective is to describe a formative study that developed an integrated patient based mHealth and provider dashboard application system for management among Medicaid-enrolled pregnant patients with T2D. Our goals were to: 1) develop a set of user specifications for the mHealth and dashboard applications; 2) develop prototypes based on user needs; and 3) collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment.MethodsStudy activities followed a double diamond framework with a participatory design mindset. We first conducted a literature review to articulate the problem. Phase I subsequently involved a qualitative inquiry of the needs faced by patients and their providers and current clinical workflows at our AMC (Discover), and brainstorming activities (Define) to ideate and define the value specifications our mHealth and dashboard applications to our end-users. Phase II involved the design and development of low- and high-fidelity prototypes that incorporated a core set of functions based on our Phase I findings and the theoretical underpinnings of social cognitive theory (Develop). We conducted usability and cognitive tests of our high-fidelity prototypes with potential users to gather feedback about the content, function, and aesthetics of the prototypes (Delivery).ResultsWe recruited seven patients and seven providers in our study. All participants completed Phase I, and three patients (42%) and four providers (57%) completed Phase II. We identified three themes that exemplified pregnancy experience among Medicaid-enrolled individuals with T2D: managing exhaustion, adherence to a new regimen, and preparing for pregnancy. Patients expressed a core set of expected features for an mHealth application: electronically captured and managed information, access to support systems, use of diabetes technology, and help through problem solving and personalized recommendations. Providers indicated a general set of expectations for a dashboard application, including features such as dynamic and actionable data, unmet social needs, enhanced patient-provider communication. We developed “as-is” and “to-be” swim lanes to depict clinical workflows and critical gaps, and we designed high-fidelity prototypes using this information. Participants provided notable feedback to improve the mHealth application (e.g., from a content perspective, patients asked for more details about the achievement of goals) and dashboard (e.g., from a functional perspective, providers suggested to add a checklist for patient completion of educational resources related to T2D during pregnancy). For both applications, participants reported scores for the NASA Task Load Survey (TLX) that were in the 20th percentile of national TLX scores.ConclusionsDigital health tools have the ability to transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences – and then using that information, along with prior studies and theory, to develop applications – holds great potential in tackling complicated health care issues. The methods described in our study can be used as a template for future design considerations specific to the development of digital health interventions, including those focused on understudied populations.

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Association between Social Vulnerability and Achieving Glycemic Control among Pregnant Women with Pregestational Diabetes

Cited by 4 publications

References 0 publications

Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes

Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes

Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

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