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

Lemelin, Annie; Paré, Guy; Bernard, Sophie; Godbout, Ariane

doi:10.1089/dia.2019.0259

Cited by 33 publications

(87 citation statements)

References 25 publications

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“…Digital treatment approaches are an innovative alternative to conventional GDM therapies, particularly due to social distancing, quarantine, and the risk of infection for pregnant women. Interest in telemedicine is increasing because of benefits such as the lack of need for physical presence as well as cost and time benefits [ 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review

Eberle¹,

Stichling²

2021

JMIR Pediatr Parent

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Background In 2019, a new coronavirus emerged in China, and the disease caused by the virus (COVID-19) was rapidly classified as a pandemic. Pregnant women with gestational diabetes mellitus (GDM) are considered to be at risk for severe COVID-19. In the context of the pandemic, there are serious concerns regarding adverse effects on maternal and neonatal outcomes for women with GDM. Effective treatments for patients with GDM are therefore particularly important. Due to contact restrictions and infection risks, digital approaches such as telemedicine are suitable alternatives. Objective This systematic review aims to summarize currently available evidence on maternal and offspring outcomes of pregnant women with GDM and COVID-19 and to examine telemedical interventions to improve maternal glycemic control during the COVID-19 pandemic. Methods Publications were systematically identified by searching the Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published up to March 2021. We sorted the COVID-19 studies by outcome and divided the telemedical intervention studies into web-based and app-based groups. We analyzed case reports (COVID-19) and both randomized and nonrandomized controlled clinical trials (telemedicine). To determine the change in glycated hemoglobin A1c (HbA1c), we pooled appropriate studies and calculated the differences in means, with 95% CIs, for the intervention and control groups at the end of the interventions. Results Regarding COVID-19 studies, we identified 11 case reports, 3 letters, 1 case series, and 1 retrospective single-center study. In total, 41 patients with GDM and COVID-19 were analyzed. The maternal and neonatal outcomes were extremely heterogeneous. We identified adverse outcomes for mother and child through the interaction of GDM and COVID-19, such as cesarean deliveries and low Apgar scores. Furthermore, we selected 9 telemedicine-related articles: 6 were randomized controlled trials, 2 were clinical controlled trials, and 1 was a quasi-experimental design. In total, we analyzed 480 patients with GDM in the intervention groups and 494 in the control groups. Regarding the quality of the 9 telemedical studies, 4 were rated as strong, 4 as moderate, and 1 as weak. Telemedical interventions can contribute to favorable impacts on HbA1c and fasting blood glucose values in the context of the COVID-19 pandemic. Meta-analysis revealed a mean difference in HbA1c of –0.19% (95% CI 0.34% to 0.03%) for all telemedical interventions, –0.138% (95% CI –0.24% to –0.04%) for the web-based interventions, and –0.305% (96% CI –0.88% to 0.27%) for the app-based interventions. Conclusions Telemedicine is an effective approach in the context of COVID-19 and GDM because it enables social distancing and represents optimal care of patients with GDM, especially with regard to glycemic control, which is very important in view of the identified adverse maternal and neonatal outcomes. Further research is needed.

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Section: Discussionmentioning

confidence: 99%

Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review

Eberle¹,

Stichling²

2021

JMIR Pediatr Parent

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“…Almost all studies (83.3%) reported that the number of face-to-face clinic visits decreased explicitly. Pérez-Ferre et al [ 10 , 13 ] (HQ), Lemelin et al [ 16 ] (low quality [LQ]), and Caballero-Ruiz et al [ 17 ] (MQ) outlined large significant reductions ranging between 56.00% and 88.56% ( P =.002 [ 10 ], P <.03 [ 13 ], P <.001 [ 16 ], and P <.01 [ 17 ]). Pérez-Ferre et al [ 13 ] reported an even greater reduction in insulin-treated patients (62% overall and 82% in insulin-treated patients; P <.03).…”

Section: Resultsmentioning

confidence: 99%

“…Caesarean section rate (7 studies). Three (42.86%) MQ and LQ studies demonstrated positive tendencies in favor of the intervention group, but overall no significant effects were found [13,[15][16][17]19,20]: Rasekaba et al 2015 [8] Preterm delivery (<37 weeks; 4 studies). In 2 of 4 MQ studies, the number of preterm deliveries in the intervention group was distinctively lower (0% in the intervention group vs 8% in the control group; no P value reported [14]; 5.6% in the intervention group vs 13.2% in the control group; P=.30 [19]).…”

Section: Maternal Complications In Childbirthmentioning

confidence: 97%

“…The reported cases of GDM have drastically increased worldwide [2]. According to the International Diabetes Federation in 2019, the prevalence of GDM ranged from 7.5% in Middle East and North Africa, 9.6% in Africa, 12.5% in Western Pacific countries, 13.5% in South and Central America, 16.3% in Europe, and 20.8% in North America and the Caribbean to 27.0% in South-East Asia, excluding countries with no estimates [3].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Telemetric Interventions on Maternal and Fetal or Neonatal Outcomes in Gestational Diabetes: Systematic Meta-Review

Eberle¹,

Stichling²

2021

JMIR Diabetes

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Background In 2019, 1 of 6 births was affected by gestational diabetes mellitus (GDM) globally. GDM results in adverse maternal, fetal, and neonatal outcomes in the short and long term, such as pregnancy and birth complications, type 2 diabetes, metabolic syndrome, and cardiovascular disease. In the context of “transgenerational programming,” diabetes mellitus during pregnancy can contribute to “programming” errors and long-term consequences for the child. Therefore, early therapy strategies are required to improve the clinical management of GDM. The interest in digital therapy approaches, such as telemetry, has increased because they are promising, innovative, and sustainable. Objective This study aimed to assess the current evidence regarding the clinical effectiveness of telemetric interventions in the management of GDM, addressing maternal glycemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth, as well as fetal and neonatal outcomes. Methods Medline via PubMed, Web of Science Core Collection, Embase, Cochrane Library, and CINAHL databases were systematically searched from January 2008 to April 2020. We included randomized controlled trials, systematic reviews, meta-analyses, and clinical trials in English and German. Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews” and “Effective Public Health Practice Project.” Results Our search identified 1116 unique studies. Finally, we included 11 suitable studies (including a total of 563 patients and 2779 patient cases): 4 systematic reviews or meta-analyses (1 of high quality and 3 of moderate quality), 6 randomized controlled trials (2 of high quality and 4 of moderate quality), and 1 low-quality nonrandomized controlled trial. We classified 4 “asynchronous interventions” and 3 “asynchronous and real-time interventions.” Our findings indicate that telemetric therapy clearly improves glycemic control and effectively reduces glycated hemoglobin A1c levels. Furthermore, in 1 study, telemetry proved to be a significant predictor for a better glycemic control (hazard ratio=1.71, 95% CI 1.11-2.65; P=.02), significantly fewer insulin titrations were required (P=.04), and glycemic control was achieved earlier. Telemetric therapy significantly reduced scheduled and unscheduled clinic visits effectively, and women were highly satisfied with the treatment (P<.05). From fetal and neonatal short-term outcomes, some improving tendencies in favor of telemetry were determined. No long-term outcomes were detected. Conclusions Telemetric interventions clearly improved glycemic control, notably glycated hemoglobin A1c levels, and reduced scheduled and unscheduled clinic visits effectively, which reinforces this digital approach in the treatment of GDM.

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“…Traditional blood glucose testing usually evaluates blood glucose levels 2 hours after mealtimes and fasting blood glucose levels. However, it is difficult to dynamically monitor the blood glucose status of patients throughout the day, especially for the detection of reactive hypoglycemia at night (11,12). The ISGMS is a new method of blood glucose monitoring where the patient wears an ISGMS sensor and blood glucose levels can be monitored every 5-10 minutes and recorded through the computer.…”

Section: Discussionmentioning

confidence: 99%

The effects of the instantaneous scanning glucose monitoring system on hypoglycemia, weight gain, and health behaviors in patients with gestational diabetes: a randomised trial

Zhang¹,

Jiang²,

Wang³

2021

Ann Palliat Med

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Background: Gestational diabetes (GDM) can cause adverse effects on parturient and newborns, and effective control of blood sugar levels in the parturient is essential for good prognosis. Continuous dynamic blood glucose monitoring can effectively improve the final pregnancy outcome of patients with GDM.Methods: A total of 110 GDM patients admitted to our hospital from April 2019 to April 2020 were selected and divided into 2 groups according to the random number table method, with 55 participants in each group. In the control group, fingertip blood glucose monitoring was used, and in the ISGMS group the ISGMS was used in combination with fingertip blood glucose monitoring. The incidence of hypoglycemia, the qualified rate of weight gain at the end of pregnancy, compliance with blood glucose monitoring, and health behavior patterns were compared between the 2 groups.Results: Patients who used the ISGSM showed a lower incidence of hypoglycemia (P<0.05), a greater qualified rate of weight gain at the end of pregnancy (P<0.05), had higher blood glucose monitoring compliance (P<0.05), and demonstrated better health behaviors (P<0.05) compared to the control group after 2 weeks of intervention. Conclusion:The application of the ISGMS in patients with GDM improved the compliance of blood glucose monitoring, improved health behaviors, reasonably controlled weight gain, and avoided hypoglycemia.

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

Cited by 33 publications

References 25 publications

Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review

Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review

Effects of Telemetric Interventions on Maternal and Fetal or Neonatal Outcomes in Gestational Diabetes: Systematic Meta-Review

The effects of the instantaneous scanning glucose monitoring system on hypoglycemia, weight gain, and health behaviors in patients with gestational diabetes: a randomised trial

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