STORK: Collaborative Online Monitoring of Pregnancies Complicated with Gestational Diabetes Mellitus

Abstract

Background: A novel digital platform, named STORK, was developed in the COVID-19 pandemic when clinic visits were restricted. A study of its clinical use during the pandemic was conducted. The study aims to advance the state of the art in monitoring and care of pregnancies complicated with gestational diabetes mellitus (GDM) via online collaboration between patients and care providers. Methods: This study involved 31 pregnant women diagnosed with GDM and 5 physicians. Statistical comparisons were made in clinic-visit frequency and adverse outcomes between the STORK group and a historical control group of 32 women, compatible in size, demographics, anthropometrics and medical history. Results: The average number of submitted patient measurements per day was 3.6±0.4. The average number of clinic visits was 2.9±0.7 for the STORK group vs. 4.1±1.1 for the control group (p<0.05). The number of neonatal macrosomia cases was 2 for the STORK group vs. 3 for the control group (p>0.05); no other adverse incidents. Conclusions: The patient compliance with the pilot use of STORK was high and the average number of prenatal visits was reduced. The results suggest the general feasibility to reduce the average number of clinic visits and cost, with enhanced monitoring, case-specific adaptation, assessment and care management via timely online collaboration.

Keywords: GDM; collaborative online monitoring; data-driven adaptive GDM therapies; gestational diabetes mellitus; mobile healthcare platform; sustainable quality healthcare.

Figure 1

Demonstration of STORK user interface on personal computers and mobile devices. (Top): Patient view. An automated summary of feedback in multiple charts and plots. The upper twopie charts show the rates of out-of-target-range measurements of glucose level and blood pressure. The lower two plots display dynamic variations over time in glucose level and blood pressure. (Bottom): Doctor view. A scrollable list for selection and retrieval of patient information. Each demo image has an insert of the mobile version on a smartphone at the bottom-right corner. See detailed STORK description in Section 2.1.

Figure 2

Blood glucose concentration (BGC) profiles of four patients with IDs 07, 19, 24 and 28. The profile for each patient is shown in four time sequences in red, green, blue and yellow (RGBY), their respective histograms and a box-and-whisker chart. The red time sequence and histogram are associated with daily fasting BGC measurements; the green, the daily nadir (minimum) of postprandial measurements; the blue, the daily mean of postprandial measurements; and the yellow, the daily maximum of postprandial measurements. Each histogram is also overlaid with an approximate continuous distribution curve. The box-and-whisker chart summarizes the mean locations and dispersions of the four time sequences. See more comments in Section 3.3 and Section 4.3.

Figure 3

The use of STORK in clinical practice is the first in Greece with online collaborative GDM monitoring. The STORK user interface is bilingual, in Greek and English. STORK has ready functionality for accommodating more languages. See more description of STORK in Section 2.1.

Figure 4

The ease of use is an important criterion for STORK design. The panel for patient submitting blood glucose measurements, for example, hasa pop-up calendar anda clock dial to ease the registration of timestamps, which the usersappreciated. Further ease of use is expected with the advance in automatic data transport between smart devices, see more comments in Section 4.