The Emerging Role of Telemedicine in Managing Glycemic Control and Psychobehavioral Aspects of Pregnancy Complicated by Diabetes

Abstract

There is a gradual decline in concern of specialists who follow up the care of pregnant women with diabetes. In addition, due to the dwindling economic resources allocated to health services, access to specialized healthcare facilities is becoming more difficult. Telemedicine, or medicine practiced at a distance, is inserted in this context with applications differing for type of interaction (real-time or deferred, i.e., videoconferencing versus store-and-forward data transmission), type of monitoring (automatic versus requesting cooperation from the patient), and type of devices used (web connections and use of mobile phones or smartphones). Telemedicine can cope with the current lack of ability to ensure these patients frequent direct contact with their caregivers. This approach may have an impact not only on the classical maternal-fetal outcome, but also on some underestimated aspects of patients with diabetes in pregnancy, in this case their quality of life, the perception of “diabetes self-efficacy,” and the glycemic variability. In this paper, we will analyze the current evidence regarding the use of telemedicine in pregnancies complicated by diabetes, trying to highlight the main limitations of these studies and possible strategies to overcome them in order to improve the effectiveness of future clinical interventions with these medical applications.

Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review

“…In this regard, the major aim is to educate patients on healthier lifestyle habits (healthy diet and physical activity domains) [38, 39] and to facilitate the process of illness acceptance [40] after a diagnosis of GDM.…”

“…Further research should be conducted to test the effect of integrative programs on QoL focusing on pharmacological care mixed up with advanced practices based on information and communication technologies (e.g., telemedicine and/or games for health) [ 36 , 37 ]. In this regard, the major aim is to educate patients on healthier lifestyle habits (healthy diet and physical activity domains) [ 38 , 39 ] and to facilitate the process of illness acceptance [ 40 ] after a diagnosis of GDM.…”

Efficacy of Internet-Based Self-Monitoring Interventions on Maternal and Neonatal Outcomes in Perinatal Diabetic Women: A Systematic Review and Meta-Analysis

“…Four reviews focused on the use of technologies to evaluate healthy pregnant women in terms of maternal outcomes [ 27 ], women with complicated pregnancies in terms of cost effectiveness [ 28 ], a mixed group of patients (with type 1 DM and GDM) in terms of maternal-neonatal outcomes [ 29 ], and patients with GDM in terms of maternal outcomes [ 30 ]. These studies reported mixed results, did not include ongoing studies without outcomes [ 27 ], lacked systematic searching strategies [ 28 , 29 ], and evaluated limited studies (n=3) [ 30 ]. None of the studies focused on Internet-based self-monitoring approaches.…”

Implementation and Impact of a Maternal–Fetal Medicine Telemedicine Program

“…Much of the research associated with MFM telemedicine programs has been devoted to specific condition management over the course of the pregnancy. [8][9][10][11][12][13][14] In general, there are good levels of acceptance of telemedicine interventions and usage among women. 10,15 However, limited information is available on outcomes associated with MFM care delivered via teleconsult centers compared with an in-person visit.…”