Smartphone Apps for Surveillance of Gestational Diabetes: Scoping Review

Abstract

Background Developments and evolutions in the information and communication technology sector have provided a solid foundation for the emergence of mobile health (mHealth) in recent years. The cornerstone to management of gestational diabetes mellitus (GDM) is the self-management of glycemic indices, dietary intake, and lifestyle adaptations. Given this, it is readily adaptable to incorporation of remote monitoring strategies involving mHealth solutions. Objective We sought to examine and assess the available smartphone apps which enable self-monitoring and remote surveillance of GDM with a particular emphasis on the generation of individualized patient feedback. Methods Five databases were searched systematically for any studies evaluating mHealth-supported smartphone solutions for GDM management from study inception until January 2022. The studies were screened and assessed for eligibility of inclusion by 2 independent reviewers. Ultimately, 17 studies were included involving 1871 patients across 11 different countries. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) conceptual framework was adhered to for data extraction and categorization purposes. Results All studies analyzed as part of this review facilitated direct uploading of data from the handheld glucometer to the downloaded patient-facing smartphone app. Glycemic data were captured by all studies and were reassuringly found to be either improved or noninferior to extant models of hospital-based care. Feedback was delivered in either an automated fashion through in-app communication from the health care team or facilitated through bidirectional communication with the app and hospital portal. Although resource utilization and cost-effective analyses were reported in some studies, the results were disparate and require more robust analysis. Where patient and staff satisfaction levels were evaluated, the response was overwhelmingly positive for mHealth smartphone–delivered care strategies. Emergency cesarean section rates were reduced; however, elective cesarean sections were comparatively increased among studies where the mode of delivery was assessed. Most reviewed studies did not identify any differences in maternal, perinatal, or neonatal health when app-based care was compared with usual in-person review. Conclusions This comprehensive scoping review highlights the feasibility, reliability, and acceptability of app-assisted health care for the management of GDM. Although further exploration of the economic benefit is required prior to implementation in a real-world clinical setting, the prospect of smartphone-assisted health care for GDM is hugely promising

A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes

“…The Apps support women with automatic transfer of blood glucose values from a glucometer to their smartphone and onwards to the supporting healthcare team, and some provided varying tailored lifestyle information on diet, PA, breastfeeding and GDM [ 30 , 31 ]. Similar to + Stay-Active feedback, studies have described that these smartphone apps are appealing to women with overwhelmingly positive feedback [ 32 ]. Whilst positive results have been reported in improved compliance of blood glucose monitoring [ 33 , 34 ], significantly lower blood glucose measurement and lower rate of insulin needed [ 34 ]; smartphone-based apps alone have not been clearly shown to improve pregnancy outcomes [ 35 ].…”

“…Nevertheless, during our study support was considerable with motivational inteviews, regular telephone follow ups and over 900 text messages sent; the effectiveness on clinical outcomes will need to be balanced with intervention and implementation costs. More robust resource utilization and cost-effective analysis within GDM App studies is required [ 32 ] and needs to be consider in future work.…”

Designing and Developing a Mobile App for Management and Treatment of Gestational Diabetes in Nepal: User-Centered Design Study

“…To date, there are only a few published randomized controlled trials that have evaluated mobile app–based solutions for GDM management [ 63 - 68 ]. Two recent reviews [ 69 , 70 ] on app-based interventions for GDM concluded that most existing studies were of moderate quality and were underpowered to detect effects on perinatal outcomes but, overall, indicated improved glycemic control in the mobile intervention groups compared to standard care alone. However, most existing app-based interventions for GDM management focus on remote blood glucose monitoring, with manual feedback from health care providers [ 24 , 69 , 70 ], which can be resource intensive and burdensome for both providers and participants, thus limiting the potential for widespread dissemination and impact, particularly in low-resource settings, such as Nepal.…”

“…Two recent reviews [ 69 , 70 ] on app-based interventions for GDM concluded that most existing studies were of moderate quality and were underpowered to detect effects on perinatal outcomes but, overall, indicated improved glycemic control in the mobile intervention groups compared to standard care alone. However, most existing app-based interventions for GDM management focus on remote blood glucose monitoring, with manual feedback from health care providers [ 24 , 69 , 70 ], which can be resource intensive and burdensome for both providers and participants, thus limiting the potential for widespread dissemination and impact, particularly in low-resource settings, such as Nepal. Additionally, despite evidence showing that lifestyle and T2D interventions based on behavior change theory are more effective [ 71 - 73 ], we found only 2 studies [ 67 , 68 ] that incorporated relevant theories in their mobile intervention for GDM.…”

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

“…Telemedicine can be categorized, on one hand, by implemented activities (i.e., televisits, teleconsultations, and tele-healthcare cooperation), and on the other, by activity purposes, which can be summarized as follows: Remote monitoring: A variety of medical-health activities with the purpose of monitoring a patient’s health status, via the implementation of routine medical tests, the communication of medical results to healthcare professionals, and the potential transmission of automated responses [ 7 , 8 , 9 ]. The collection and sharing of clinical data, which aims to disseminate clinical information that is less sensitive to time between healthcare professionals and/or between doctors and patients, and which currently often involves a delay between the transmission, the receipt of, and the response to the content that was shared [ 10 , 11 ].…”