Pregestational Diabetes Intervention Pilot Study With Diabetes Self-Management Education and Support and...

Uncontrolled diabetes in pregnancy is associated with maternal and fetal complications. Individuals with pregestational diabetes require frequent glucose monitoring and insulin adjustments to meet glycemic targets. The purpose of the study was to provide improved management of diabetes during pregnancy and up to 6 weeks postpartum, improve patient understanding of diabetes and diabetes self-management, and develop a multidisciplinary obstetrics workflow model for women with diabetes that is both replicable and self-sustaining.

Fifty participants who were pregnant, diagnosed with type 1 or type 2 diabetes, and ≥18 years of age comprised two groups: a historical group who received traditional diabetes education and an intervention group who received traditional diabetes education enhanced with a cellular-enabled glucose meter, both alongside their prenatal medical appointments. In the intervention group, glucose levels were monitored daily via a cloud-based portal in addition to traditional weekly review, and outreach was initiated when glucose levels met thresholds. Diabetes medications were adjusted as needed in both groups. Practice, clinical, and glycemic data were extracted from the electronic medical record and cloud portal.

Neonatal hypoglycemia was reduced (P = 0.047) and more participants used continuous glucose monitoring (P = 0.01) in the intervention group. Communication by text and telephone occurred more frequently in the intervention group (P = 0.007 and P = 0.011, respectively). The intervention group also received more diabetes education (4.44 vs. 2.89 hours, P = 0.030). Differences in other clinical, practice, or glycemic outcomes did not differ significantly.

Enhanced care with a cellular-enabled glucose meter facilitated remote patient monitoring with accurate glucose data. The intervention group received more hours of diabetes education and more text and telephone contact. Review of glucose data via the cloud-based portal increased the identification of hypoglycemic and hyperglycemic events, informing delivery decisions. Delivery was earlier for the intervention group, yet rates of neonatal hypoglycemia were reduced.