Using technology to support care in gestational diabetes mellitus: Quantitative outcomes of an exploratory randomised control trial of adjunct telemedicine for gestational diabetes mellitus (TeleGDM)

Rasekaba, Tshepo; Furler, John; Young, Doris; Liew, Danny; Gray, Kathleen; Blackberry, Irene; Lim, Wen Kwang

doi:10.1016/j.diabres.2018.05.049

Cited by 39 publications

(92 citation statements)

References 31 publications

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“…2,16,22 However, some data of other studies remain conflicting with regard to the reduction in medical visits with THCa, a result that could be partly explained by the heterogeneity of the THCa system and protocols used in the literature. 23 The literature also reports comparable glycemic control and rates of maternal-fetal complications in patients followed by THCa, which is similar to the findings in this study. [14][15][16]24 An innovative aspect of this project is that THCa was integrated within traditional care, as the responsibility for All values in boldface are considered significant.…”

Section: Discussionsupporting

confidence: 90%

Demonstrated Cost-Effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management

Lemelin

Paré

Bernard

et al. 2020

Diabetes Technology & Therapeutics

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Background: Prevalence of gestational diabetes mellitus (GDM) has increased steadily in recent years. Pregnant women with GDM are at risk for obstetrical and neonatal complications and require close multidisciplinary follow-up, which implies a significant use of hospital resources. Methods: A prospective noninferiority and controlled clinical trial was designed. The telehomecare (THCa) initiative is a clinical remote patient management project in women with GDM. The main objective was to evaluate the cost-effectiveness of THCa by assessing the direct costs, including the related reduction in medical visits. Secondary outcomes were to evaluate the impact of THCa on diabetes control, GDM-related complications, and patient satisfaction. Results: A total of 161 women were assigned to either an intervention group provided with a THCa system for transmission and online analysis of capillary glucose data (n = 80) or a control group receiving usual care in the clinic (n = 81). A decrease in medical visits by 56% (P < 0.001) in the THCa group was observed. There was no difference between the two groups in diabetes control or maternal and fetal complications. However, results showed a 10-fold increase in nursing interventions in THCa group (mainly by phone calls and e-mails). Satisfaction with care was high. Direct cost analysis revealed savings of 16% in patients followed by THCa compared with the control group. Conclusion: THCa monitoring significantly decreases medical visits and direct costs in GDM women without compromising pregnancy outcomes, quality of care, or patient satisfaction. THCa was shown to be costeffective despite placing an additional burden on nursing time.

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Section: Discussionsupporting

confidence: 90%

Demonstrated Cost-Effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management

Lemelin

Paré

Bernard

et al. 2020

Diabetes Technology & Therapeutics

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“…For instance, some studies have revealed the efficacy of telemedicine systems in monitoring glucose, improving pregnancy outcomes in women with GDM, and enhancing the quality of life of pregnant women with diabetes [ 44 , 48 , 63 , 65 ]. These findings are in line with the results of other studies [ 4 , 82 , 83 ]. Nevertheless, Homko et al [ 43 ] and Rasekaba et al [ 82 ] found no association between a telemedicine system and pregnancy outcome improvement.…”

Section: Discussionsupporting

confidence: 93%

“…These findings are in line with the results of other studies [ 4 , 82 , 83 ]. Nevertheless, Homko et al [ 43 ] and Rasekaba et al [ 82 ] found no association between a telemedicine system and pregnancy outcome improvement.…”

Section: Discussionsupporting

confidence: 93%

The use of mobile health interventions for gestational diabetes mellitus: a descriptive literature review

et al. 2021

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This study attempted to review the evidence for or against the effectiveness of mobile health (m-health) interventions on health outcomes improvement and/or gestational diabetes mellitus (GDM) management. PubMed, Web of Science, Scopus, and Embase databases were searched from 2000 to 10 July 2018 to find studies investigating the effect of m-health on GDM management. After removing duplications, a total of 27 articles met our defined inclusion criteria. m-health interventions were implemented by smartphone, without referring to its type, in 26% (7/27) of selected studies, short message service (SMS) in 14.9% (4/27), mobile-based applications in 33.3% (9/27), telemedicine-based on smartphones in 18.5% (5/27), and SMS reminder system in 7.1% (2/27). Most of the included studies (n=23) supported the effectiveness of m-health interventions on GDM management and 14.3% (n=4) reported no association between m-health interventions and pregnancy outcomes. Based on our findings, m-health interventions could enhance GDM patients' pregnancy outcomes. A majority of the included studies suggested positive outcomes. M-health can be one of the most prominent technologies for the management of GDM.

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“…The pooled effect of 20 trials [ [3,6,7,18,19,21,22,32,33,35,36,38,39,[41][42][43][45][46][47][48] revealed a significant advantage in the TM group compared with the standard care group in regard to the change in FBG [MD = -0.52, 95% CI = (− 0.81, − 0.24), P < 0.01] (Fig. 3b).…”

Section: Glycaemic Controlmentioning

confidence: 99%

Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

Xie

Dai

Qin

et al. 2020

BMC Pregnancy Childbirth

126

103

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Background: Gestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM. Methods: We searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively. (Continued on next page)Results: A total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = − 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable. Conclusions: Compared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.

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Using technology to support care in gestational diabetes mellitus: Quantitative outcomes of an exploratory randomised control trial of adjunct telemedicine for gestational diabetes mellitus (TeleGDM)

Cited by 39 publications

References 31 publications

Demonstrated Cost-Effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management

Demonstrated Cost-Effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management

The use of mobile health interventions for gestational diabetes mellitus: a descriptive literature review

Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

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