(1164) Single site pilot clinical investigation of a novel app-assisted self-management programme for gestational diabetes

Incorporation of information and communication technology into healthcare management has provided novel solutions to combat operational and financial challenges through the development of telemedicine pathways. Gestational diabetes (GDM) is a perfectly suited condition on which to model such strategies, through the potential for remote surveillance of self-monitored glycemia. We sought to evaluate the impact of a smartphone app-assisted self-management program for GDM on a range of maternal and neonatal outcomes.


Study Design:

A bespoke smartphone app linked to a secure hospital portal was developed. Bluetooth-enabled glucometers and a secure link to the patient-facing app were provided. Glycemic indices, perinatal outcome and service usage were assessed and compared with a matched historical control cohort of GDM patients who underwent GDM clinic-based surveillance of glycemic control.  Continuous data were assessed using independent samples t-test and categorical data were assessed using Chi squared and Fischer’s exact tests.


Results:

169 women engaged with app-assisted care and their data were compared with 162 patients from a historical cohort. App-use was associated with a 2-point reduction in the mean fasting blood glucose(BG) level(p=0.022 ), a 5-point reduction in mean postprandial BG level(p < 0.001) and fewer instances of above threshold BG values. Maternal and neonatal outcome data were similar between the groups however, rates of caesarean delivery were lower among app users. Among app-assisted care patients, fewer clinical encounters and shorter postnatal hospital stays were observed (p < 0.012;p < 0.0045). Cost-effective analysis significantly favoured an app-based approach.


Conclusion:

App-assisted care achieved optimised glycaemic control for 80% of participants, with significant reductions in both mean fasting and postprandial BG levels. Translation of this telemedicine solution into clinical practice has a beneficial impact on the number of patients requiring treatment intensification, resulting in a significant reduction in health economic metrics.