Leveraging Technology to Improve Diabetes Care in Pregnancy

Crimmins, Sarah; Ginn-Meadow, Angela; Jessel, Rebecca H.; Rosen, Julie

doi:10.2337/cd20-0047

Cited by 7 publications

(8 citation statements)

References 43 publications

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“…A total sample size of 124 participants (62 per study arm) will provide at least 80% power to detect such a difference between the two groups after accounting for up to 10% loss-to-follow-up based on a one-sided Fisher’s exact test. The loss-to-follow-up rate of 10% is based on prior diabetes in pregnancy trials at our centre 32 33…”

Section: Search Resultsmentioning

confidence: 99%

“… 62 63 For T2D in pregnancy, studies using a tailored mHealth app with CGM remain to be conducted. 33 64 ACHIEVE integrates health information technology tools and a dynamic, closed loop system, so that patients and providers can track treatment goals and care pathways.…”

Section: Discussionmentioning

confidence: 99%

“…Few existing apps for prenatal care provide comprehensive evidence-based educational content, tracking tools, UCD and the potential for integration with the EHR 62 63. For T2D in pregnancy, studies using a tailored mHealth app with CGM remain to be conducted 33 64. ACHIEVE integrates health information technology tools and a dynamic, closed loop system, so that patients and providers can track treatment goals and care pathways.…”

Section: Discussionmentioning

confidence: 99%

“… 33 CGM has been shown to improve glycaemic control and decrease the risk of adverse pregnancy outcomes for individuals with type 1 diabetes, 34 but its impact among pregnant individuals with T2D remains largely unstudied. 33 …”

Section: Introductionmentioning

confidence: 99%

“…Electronic data linked to patients’ mHealth apps can allow the care team to actively engage with patients in their care and help them to achieve treatment goals 31 32. In addition, continuous glucose monitoring (CGM) is a personal mobile technology that allows identification of precise, individualised patterns of dysglycaemia 33. CGM has been shown to improve glycaemic control and decrease the risk of adverse pregnancy outcomes for individuals with type 1 diabetes,34 but its impact among pregnant individuals with T2D remains largely unstudied 33…”

Section: Introductionmentioning

confidence: 99%

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Multicomponent provider–patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study

Venkatesh,

Joseph,

Swoboda

et al. 2023

BMJ Open

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Introduction Type 2 diabetes (T2D) is one of the most frequent comorbid medical conditions in pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the pregnant individual and infant. Achieving glycaemic control can be challenging for Medicaid-insured pregnant individuals who experience a high burden of unmet social needs. Multifaceted provider–patient-based approaches are needed to improve glycaemic control in this high-risk pregnant population. Mobile health (mHealth) applications (app), provider dashboards, continuous glucose monitoring (CGM) and addressing social needs have been independently associated with improved glycaemic control in non-pregnant individuals living with diabetes. The combined effect of these interventions on glycaemic control among pregnant individuals with T2D remains to be evaluated. Methods and analysis In a two-arm randomised controlled trial, we will examine the combined effects of a multicomponent provider–patient intervention, including a patient mHealth app, provider dashboard, CGM, a community health worker to address non-medical health-related social needs and team-based care versus the current standard of diabetes and prenatal care. We will recruit 124 Medicaid-insured pregnant individuals living with T2D, who are ≤20 weeks of gestation with poor glycaemic control measured as a haemoglobin A1c ≥ 6.5% assessed within 12 weeks of trial randomisation or within 12 weeks of enrolling in prenatal care from an integrated diabetes and prenatal care programme at a tertiary care academic health system located in the Midwestern USA. We will measure how many individuals achieve the primary outcome of glycaemic control measured as an A1c<6.5% by the time of delivery, and secondarily, adverse pregnancy outcomes; patient-reported outcomes (eg, health and technology engagement, literacy and comprehension; provider–patient communication; diabetes self-efficacy; distress, knowledge and beliefs; social needs referrals and utilisation; medication adherence) and CGM measures of glycaemic control (in the intervention group). Ethics and dissemination The Institutional Review Board at The Ohio State University approved this study (IRB: 2022H0399; date: 3 June 2023). We plan to submit manuscripts describing the user-designed methods and will submit the results of the trial for publication in peer-reviewed journals and presentations at international scientific meetings. Trial registration number NCT05662462

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Section: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multicomponent provider–patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study

Venkatesh,

Joseph,

Swoboda

et al. 2023

BMJ Open

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Gestational diabetes mellitus care re‐imagined: women's experiences of a major model of care change at a large metropolitan hospital

Butten,

Laurie,

Varnfield

et al. 2024

Practical Diabetes

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Background: A gestational diabetes mellitus (GDM) pregnancy has significant psychological, time and resource impacts. In 2020–21, a digitally‐supported radical GDM service redesign was undertaken at a Brisbane tertiary centre, producing substantial cost savings without compromising clinical outcomes.Aims: To describe women's experiences within this new model of care (MOC), specifically the app user experience (MOC) (post), compared with a traditional MOC (pre).Methods: The new MOC was evaluated using a pre–post study design. This MOC included a smartphone app‐to‐clinician blood glucose communication platform. A convenience sample of women were surveyed about care experiences and app use pre‐ and post‐implementation. An additional survey queried user app experience at four weeks’ postpartum.Results: Within the service, 34% (n=24) and 22% (n=48) of women were surveyed pre and post MOC introduction, respectively. Pre‐implementation, 50% (n=12) of women missed work to attend appointments and 75% spent 30–120 minutes at the hospital. Questions regarding understanding GDM, initial dietary changes and glucometer use received similar or slightly lower ratings, pre‐ to post‐implementation. Nearly a quarter of women in the app‐experiences survey (24.2%; n=177) showed high levels of satisfaction with care received (91.5%) and with the app for managing GDM (87.1%). Two experience themes that emerged were Enhanced GDM management and Usability issues.Conclusions: The new MOC reduced time impositions associated with attending appointments. Despite the removal of face‐to‐face visits in the new MOC, women still established a connection with their treating team and maintained their understanding of their GDM management. Copyright © 2024 John Wiley & Sons.

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