Management of postprandial hyperglycaemia and weight gain in women with gestational diabetes mellitus using a novel telemonitoring system

Abstract

Objectives: The purpose of this study was to investigate the effect of remotely delivered telemedicine dietary advice on monitoring of blood glucose levels and weight gain of women with gestational diabetes mellitus (GDM).

Methods: Women with GDM were recruited and randomly allocated into two groups: a Tele-GDM group that received a telemonitoring device, and a control group that was followed-up traditionally. A telemonitoring service calculated the ratio of reaching or exceeding the pregnancy weight gain target (according to pre-pregnancy weight), following Institute of Medicine guidelines for healthy pregnancy weight gain.

Results: The sample comprised 27 women in the Tele-GDM group and 30 in the control group. At the end of pregnancy, the Tele-GDM group showed significantly lower 2-hour postprandial glucose levels than the control group. Most women in the Tele-GDM group reached their recommended range of weight gain at the end of pregnancy. Additionally, the Tele-GDM group showed significantly lower weight gain than the control group.

Conclusions: Telemonitoring can facilitate close monitoring of women with GDM and motivate patients to adopt a healthy lifestyle.

Keywords: Gestational diabetes mellitus; gestational weight gain; hyperglycaemia; telediabetes; telemedicine; telemonitoring.

Figure 1.

Random allocation of women with gestational diabetes mellitus. GDM: gestational diabetes mellitus; DM: diabetes mellitus; BMI: body mass index.

Figure 2.

Compliance of patients with GDM in telemonitoring. Proactive communication graphs showing an alert system for the healthcare provider using an email (a), a questionnaire link (b), and a coaching message (c) to indicate the health status of the patient. Average number of monitoring episodes per week for participants in the telemedicine group for glucose (GLU) readings, weight (WT) and questionnaire (QUS) response. GDM: gestational diabetes mellitus.

Figure 3.

Results of laboratory investigations, including FPG, 2-hour PPG and glycated haemoglobin (HbA1c) are compared between the Tele-GDM and control groups. Values are expressed as mean ± standard error of the mean. Statistical significance was determined by unpaired t-tests (n =57); **P < 0.001.

Figure 4.

Improvement in weight gain during pregnancy in the Tele-GDM group. (a) The number of women from the Tele-GDM group categorised as reaching or exceeding the recommended weight either at the end-of-pregnancy or post-delivery period. (b) The average weight gain (in kilograms) during pregnancy in both groups is expressed as mean ± standard error of the mean. Statistical significance was determined using a chi-square test or an unpaired t-test (n = 57); *P < 0.05.