Replacing all but essential face-to-face visits with virtual support for gestational diabetes care during the COVID pandemic maintains outcomes

ABSTRACT

Background: Gestational diabetes mellitus (GDM) is associated with increased perinatal complications. Our service historically saw patients with GDM monthly. Self-monitoring blood glucose (SMBG) levels were reviewed weekly via email. During COVID lockdown (23 March 2020-14 September 2020) we limited face-to-face contact and started using an App-based communication platform (GDm-HealthTM). Patients recorded SMBG on the App. Face-to-face contact was reduced to monthly scans or if insulin start was needed. Otherwise, contact was made via the app or telephone. We wanted to establish whether reduced face-to-face contact had impacted glucose control or postnatal outcomes. Methods: A retrospective analysis was performed comparing fasting glucose data and postnatal outcomes for women with the App (June 2020-31 December 2020) and standard care ( June 2019-31December 2019). Results: There were 62 women in the before App group (BA) and 61 in the with App group (WA). There was no significant difference in baseline characteristics. Results are shown as mean (SD). Treatment at 36 weeks gestation diet only BA 22 vs WA 26 (p=0.40);metformin only BA 16 vs WA 22 (p=0.28);insulin (+metformin) 24 vs 13 (p=0.06). Fasting glucose at 36 weeks BA 5.0 (1.1) vs WA 4.7 (0.3) mmol/L (p=0.12). Birth weight BA 3.4 (0.6) vs WA 3.3 (0.5) kg (p=0.43) and Z score 0.3 (1.1) vs 0.4 (0.9) (p=0.77). Mode of delivery vaginal BA 27 vs WA 14;instrumental BA 5 vs WA 7;caesarean section BA 30 vs WA 27 (p=0.78). Gestation at birth BA 40 vs WA 38 weeks (p=0.16). Conclusion: App-based communication is effective with outcomes matching standard face-to-face GDM care.