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Poster Session 2

(384) Digital Intervention and Hybrid Care Improves Adherence to Gestational Diabetes Surveillance - Prospective Pilot Study

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

MA

Michal Axelrod, MD, MPH (she/her/hers)

Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel

Coauthor(s)

EG

Ester Galler, CNM

Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel
HL

Hila Lahav Ezra, MD

Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel
ON

Omer Nir, MD

Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel
GB

Galia Barkai, MD

Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel
KO

Keren Ofir, MD

Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel
ES

Eyal Sivan, MD

Physician
Sheba Medical Center, Tel-Hashomer
Ramat-Gan, Israel, Israel
SM

Shali Mazaki-Tovi, MD

Physician
Chaim Sheba Medical center, Tel HaShomer
Ramat Gan, HaMerkaz, Israel
AT

Abraham Tsur, MD

Director of the Women's Health Innovation Center, Deputy Chief Transformation Officer
Sheba Medical Center
Ramat-Gan, HaMerkaz, Israel

Objective:

Assessing adherence to glycemic control surveillance among women with gestational diabetes (GDM) using a digital intervention.

Study Design:

We assessed the adherence to the use of a digital intervention as part of a four-week prospective clinical study investigating hybrid remote and in-clinic visits for 19 women with GDM starting at 32-34 weeks of gestation. Virtual visits consisted of comprehensive maternal care as well as remote fetal monitoring and ultrasound assessment of amniotic fluid deepest vertical pocket. A digital intervention was used to enhance the engagement of patients with daily documentation of glucose levels (Datos Ltd. platform), from study recruitment date until birth. Our primary metric for adherence was the percent of fasting glucose measurements documented. In addition, obstetric and neonatal outcomes of the study participants were compared with a control group of 452 GDM patients followed in the same MFM clinic during the preceding year.

Results:

Adherence to recording fasting glucose values was 92.23% during the four-week hybrid in-clinic and remote care study and declined to 61.81% following the study period until birth (P=0.001). None of the participants required induction of labor due to glycemic imbalance. In addition, we compared the clinical outcomes of the study participants with the above-mentioned control group. In the study group there were 0/19 (0%) cases of macrosomia, high-grade perineal tears, shoulder dystocia, neonatal hypoglycemia, or respiratory distress syndrome. In comparison, in the control group, there were 47 cases of hypoglycemia and 18 cases of macrosomia. Overall, a total of 65/452 in the control group experienced complications (14.2%; P=0.059).

Conclusion:

Digital Intervention improves adherence to glucose levels documentation. Engagement is highest when paired with hybrid care consisting of alternating in-clinic and remote visits. Additional larger studies are required to assess the potential contribution of this intervention to reduce GDM related complications.