Impact of Remote Monitoring Technologies for Assisting Patients With Gestational Diabetes Mellitus: A Systematic Review

Abstract

Introduction: In Chile, 1 in 8 pregnant women of middle socioeconomic level has gestational diabetes mellitus (GDM), and in general, 5–10% of women with GDM develop type 2 diabetes after giving birth. Recently, various technological tools have emerged to assist patients with GDM to meet glycemic goals and facilitate constant glucose monitoring, making these tasks more straightforward and comfortable.Objective: To evaluate the impact of remote monitoring technologies in assisting patients with GDM to achieve glycemic goals, and know the respective advantages and disadvantages when it comes to reducing risk during pregnancy, both for the mother and her child.Methods: A total of 188 articles were obtained with the keywords “gestational diabetes mellitus,” “GDM,” “gestational diabetes,” added to the evaluation levels associated with “glucose level,” “glycemia,” “glycemic index,” “blood sugar,” and the technological proposal to evaluate with “glucometerm” “mobile application,” “mobile applications,” “technological tools,” “telemedicine,” “technovigilance,” “wearable” published during the period 2016–2021, excluding postpartum studies, from three scientific databases: PUBMED, Scopus and Web of Science. These were managed in the Mendeley platform and classified using the PRISMA method.Results: A total of 28 articles were selected after elimination according to inclusion and exclusion criteria. The main measurement was glycemia and 4 medical devices were found (glucometer: conventional, with an infrared port, with Bluetooth, Smart type and continuous glucose monitor), which together with digital technology allow specific functions through 2 identified digital platforms (mobile applications and online systems). In four articles, the postprandial glucose was lower in the Tele-GDM groups than in the control group. Benefits such as improved glycemic control, increased satisfaction and acceptability, maternal confidence, decreased gestational weight gain, knowledge of GDM, and other relevant aspects were observed. There were also positive comments regarding the optimization of the medical team’s time.Conclusion: The present review offers the opportunity to know about the respective advantages and disadvantages of remote monitoring technologies when it comes to reducing risk during pregnancy. GDM centered technology may help to evaluate outcomes and tailor personalized solutions to contribute to women’s health. More studies are needed to know the impact on a healthcare system.

Effectiveness of a comprehensive telemedicine intervention replacing standard care in gestational diabetes: a randomized controlled trial

“…In the telemedicine group, we found a lower average postprandial glucose and a lower percentage of postprandial measurements above the target, which was also confirmed in previous studies [ 3 , 5 , 10 , 19 ]. However, it needs to be emphasized that in those studies, telemedicine tools were used as a complement and not as a replacement for standard care.…”

“…Many telemedicine tools were already tested with the aim to achieve swift glycemic control and optimal perinatal results [2]. Although available evidence suggests that telemedicine tools can be useful in GDM in general [3] and can give comparable or favorable outcomes regarding glycemic control or some adverse perinatal outcomes [4][5][6][7][8][9], the tools used are very diverse, applied in different clinical settings and within different organizations of care. Altogether, they seem useful [3,10,11].…”

“…Although available evidence suggests that telemedicine tools can be useful in GDM in general [3] and can give comparable or favorable outcomes regarding glycemic control or some adverse perinatal outcomes [4][5][6][7][8][9], the tools used are very diverse, applied in different clinical settings and within different organizations of care. Altogether, they seem useful [3,10,11]. However, in a subgroup analysis [10], more comprehensive patterns of telemedicine interventions, e.g., real-time monitoring + feedback + healthcare education + question answering, were more effective than the simple telemedicine interventions, e.g., real-time monitoring and feedback.…”

How Wearable Sensors Can Support the Research on Foetal and Pregnancy Outcomes: A Scoping Review

“…This research field, however, is in continuous expansion and requires a constant updating on newest devices, research pitfalls, and potential perspectives. Although several systematic reviews exist about the role of mobile health in antenatal care [ 8 , 9 , 10 ], none of them have focused on the use of wearable devices. Yet, there is also still controversy over the efficacy of interventions based on the use of wearable devices by mothers, probably due to methodological and clinical heterogeneity among studies [ 6 , 7 , 9 ].…”

“…Although several systematic reviews exist about the role of mobile health in antenatal care [ 8 , 9 , 10 ], none of them have focused on the use of wearable devices. Yet, there is also still controversy over the efficacy of interventions based on the use of wearable devices by mothers, probably due to methodological and clinical heterogeneity among studies [ 6 , 7 , 9 ]. A scoping review was therefore conducted in order to map the research conducted using wearable sensors during pregnancy.…”