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41: A randomized control trial on the effect of introducing a daily smartphone based feedback system between GDM patients and physicians- on patient compliance, glycemic control, satisfaction, and pregnancy outcome

      Objective

      To study the impact of introducing a smartphone-based daily communication platform between gestational diabetes mellitus (GDM) patients and their physicians, on patients compliance, glycemic control, satisfaction, and pregnancy outcome.

      Study Design

      This is a prospective, single-center, randomized controlled trial. Newly diagnosed GDM patients presenting to our multidisciplinary diabetes-in-pregnancy clinic were randomized to: (1) routine bi-weekly prenatal clinic care (control group) or (2) an additional daily detailed feedback on their compliance and glycemic control from the clinic team via an application installed on their smartphone (smartphone group). The primary outcome was patient compliance defined as the actual blood glucose measurements/instructed measurements X100. The secondary outcomes included diabetes-control parameters, pregnancy, and neonatal outcomes. The study was adequately powered to detect a 20% difference in patient compliance, based on a preliminary phase that demonstrated 70% baseline compliance to glucose measurements.

      Results

      A total of 120 newly diagnosed GDM patients were randomized. The two groups did not differ in terms of age, parity, education, BMI, family history, maternal diseases, OGTT values, and HbA1C at randomization. The smartphone group demonstrated higher level of compliance (82% vs. 67%, p<0.001), lower mean blood glucose (104.7 ± 9.1 mg/dl vs. 112.6 ± 8.6 mg/dl, p<0.001), lower rates of off-target measurements both fasting (7.6% vs. 14.3%, p<0.001) and post-prandial (4.7% vs. 8.3%, p<0.001), and a lower rate of pregnancies requiring insulin treatment (11.6% vs. 28.3%, p=0.038). The rates of macrosomia, neonatal hypoglycemia, shoulder dystocia and other delivery and neonatal complications did not differ between the groups. Patients in the smartphone group reported excellent satisfaction from the use of the application and from their overall prenatal care.

      Conclusion

      Introduction of a smartphone-based daily feedback and communication platform between GDM patients and the multidisciplinary diabetes-in-pregnancy clinic team, improved patient compliance, glycemic control, and the rate of insulin treatment.
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