(609) Does integrating diabetic educators in pregnancy management program improve glycemic control?

To determine if integrating diabetic educators into pregnancy care improves glycemic control.

Study Design: A formalized diabetes in pregnancy program was developed in 2019 involving 2 diabetic educators supervised by MFM provider & secure electronic messaging. We hypothesize that integration of diabetes educators improves glycemic control, & tested this using a pre-post study design. Prior to establishment of the program (10/1/2018-9/30/2019; PRE), communication was via telephone messaging with the MFM provider. The POST period was a year after the program began (10/1/2021-9/30/2022). Variables of interest were volume of patients seen, # of ultrasounds per patient, demographics, medication initiation, percentage of time of logs in goal, delivery medication advice & documentation of compliance. This study was IRB exempt.

Results:

In the PRE period, 87 women were seen for diabetes vs. 271 in the POST. There were no significant differences in age (32 vs 33, P=0.88), race/ethnicity (58.6% vs 59.8%, Non-Hispanic white), gestational age (weeks) of diagnosis (28 vs 29, P-0.09) or public insurance status (17.2% vs 17.7 %, P=0.85). (Table) In the POST group, there were significantly more women who were pre-gestational diabetic (14.8% vs 4.6%, P=0.01) & on continuous glucose monitoring (0% vs 6.3%, P=0.017). There was no difference in medication initiation (50.6% vs 56.8%), but a significant shift from Glyburide to Insulin (Table). Average number of scans per patient was not different (2.5 vs 2.1, P=0.37), but more patients only had 1 scan POST (52% vs 34%, P< 0.01). There was better compliance in the POST group with more uploads of glucose logs (average 5 vs 7, P< 0.01), more glucose values in range (81.8% vs 90.9%, P< 0.01) & documented delivery recommendations (29.9% vs 95.3%, P< 0.01).  Documented reasons for non-compliance were stopping uploading logs, declining insulin & cancelling appointments.

Conclusion:

A formalized diabetes in pregnancy program improved glycemic control parameters & resulted in a 3-fold increase in number of patients seen without increasing number of scans per patient.