Computerized and telemetric management of diabetic pregnancy in Cambridge

In order to optimize the quality of our care, we have used the Ames Memory Glucometer in our computerized management of 17 insulin-dependent diabetic pregnancies. Patients measured their own blood glucose levels on 4.5 +/- 1.2 (SD) occasions per day, and six of them transmitted their blood glucose measurements telemetrically from home into a hospital-based computer on a total of 42 occasions. We achieved near-optimal blood glucose levels and normal HbA1 levels throughout most of these 17 pregnancies. Average blood glucose levels were 6.4 +/- 0.9 mmol/l in the first, 5.9 +/- 1.2 mmol/l in the second, 5.4 +/- 1.0 mmol/l in the third trimester. Corresponding values for HbA1 were 8.0 +/- 1.5%, 6.5 +/- 0.8%, and 6.2 +/- 0.4%. Average insulin requirement doubled during pregnancy, but fell to 74% of the pre-pregnancy dosage by one week after delivery. The average gestational age at delivery was 38.9 +/- 1.3 weeks, and we had no perinatal deaths. Two of the babies were macrosomic, even though their mothers had good diabetic control. Four patients were delivered by Caesarean section. However we achieved a vaginal delivery in 93% of those in whom it was planned. Our computerized system of managing diabetic pregnancies was efficient, safe, and popular with our patients.