Gestational diabetes mellitus (GDM) complicates about 5% of all pregnancies with African-American and Hispanic women disproportionately affected. Poor maternal blood glucose control is associated with an increased risk for macrosomia (high birth weight), and other adverse pregnancy outcomes. Macrosomic fetuses have higher perinatal and neonatal mortality and morbidity rates than average-sized newborns, and are more likely to require admission to a neonatal intensive care nursery as a result of traumatic birth injuries. The mother faces an increased risk of prolonged labor, operative delivery and prolonged hospital admission. Therefore, the mainstay of therapy is to normalize blood glucose levels using intensive treatment regimens, which include frequent self-monitoring of blood glucose levels, nutrition therapy, and insulin therapy to maintain glycemia. Although frequent medical surveillance represents the best approach to minimizing morbidity, such approaches are labor intensive, expensive, and inconsistent; and are often unavailable to underserved patients, who are more typically managed by periodic clinic visits with little or no interim communication. Further, underserved populations often manifest personal, cultural and/or language barriers that impact blood glucose control and adherence. A disconnect exists between the availability of comprehensive management regimens and their effective utilization-a real chasm according to the Institute of Medicine. Our objective is to test an innovative approach to address this chasm and the goals of Healthy People 2010. Accordingly, our Center of Excellence will apply new technologies (Telemonitoring utilizing a multi- lingual, Interactive Voice Response (IVR)-enabled telephone system) to facilitate diabetes control, and thereby improve pregnancy outcomes. Our hypothesis is that Telemonitoring will improve maternal glycemia, thereby reducing infant birth weights in underserved women with GDM. Using a step care design, women will be randomized into standard of care or Telemonitoring. In the Telemonitoring group, women will receive the standard of care and will also transmit their blood glucose/fetal movement information daily to their health care providers. Primary outcome will be maternal blood glucose control. Other outcomes will include infant birth weight, neonatal hypoglycemia, metabolic abnormalities and admission to the Neonatal Intensive Care Unit. We expect that Telemonitoring will improve maternal glucose control and lead to reductions in birth weight. ? ? ?
| Homko, Carol J; Deeb, Larry C; Rohrbacher, Kimberly et al. (2012) Impact of a telemedicine system with automated reminders on outcomes in women with gestational diabetes mellitus. Diabetes Technol Ther 14:624-9 |
