Brief report
A Telemedicine system based on Internet and short message service as a new approach in the follow-up of patients with gestational diabetes

https://doi.org/10.1016/j.diabres.2009.12.002Get rights and content

Abstract

To evaluate the feasibility of a Telemedicine system based on Internet and short message service in the follow-up of patients with gestational diabetes. Compared to control group, Telemedicine group reduced 62% the number of unscheduled face-to-face visits, and 82.7% in the subgroup of insulin-treated patients, improving patient satisfaction, and achieving similar pregnancy and new born outcomes.

Introduction

Telemedicine-based systems have been increasingly developed in the last decades in order to facilitate the monitoring of diabetes [1], [2], [3], [4], [5], [6]. The main objective of these systems is to provide a tool to improve the quality of care through a closer communication between the patient and the professional. In the special situation of gestational diabetes (GDM), the patient requires a very tight glycaemic control during a short period of time that will be critical in reducing maternal and delivery complications and newborn outcomes.

The objective of this pilot study is to assess the feasibility of a Telemedicine system in the treatment of patients with GDM compared to traditional face-to-face visits.

Section snippets

Patients

A prospective randomised interventional study with two parallel groups was designed. All women diagnosed as having GDM according to Carpenter–Coustan criteria before 28 weeks of gestation and referred to San Carlos University Hospital (HCSC) from June to December 2007 were invited to participate in the study, 100 signed written informed consent and 97 completed the study. The study was approved by the Ethical Committee of our institution

Women were instructed as regards nutritional habits and

Results

All women achieved HbA1c values <5.8% during pregnancy. The Telemedicine group transferred a median of 94 (34–127; Q1–Q3) values per patients of SMBG. Five patients (10.2%) were not able to transmit any data. The professional posted a median of 5 (3–9) text messages per patient (Table 1). There was some kind of fault in the data transmission of 10 patients (20.4%), which forced the health professional to use the telephone to contact the patient. The major defects detected were caused by the use

Discussion

The present study shows that the Telemedicine system based on mobile technology and the Internet applied to the monitoring of GDM is feasible in clinical practice. A significant reduction in the number of visits was reported, mainly in the insulin-treated patients. This means a significant saving of time. A trend toward an earlier insulinitation in the Telemedicine group was observed, but did not reach a significant difference in the week starting insulin treatment. The use of the Telemedicine

Conclusions

We conclude that this Telemedicine system can be a useful tool in the treatment of diabetic patients, as long as a complement to conventional face-to-face monitoring, especially in cases requiring a tighter glycaemic control, or with difficulties to access to the medical centre. An improvement of the overall system quality and a more accurate and longer training period prior to the use, would be desirable to reduce technical problems.

Conflict of interest

The authors declare that they have no conflicts of interest.

Acknowledgement

This work was supported by grants from Fundacion para Estudios Metabolicos.

Data from the manuscript have been partially presented at 2nd International Conference on Advanced Technologies & Treatments for Diabetes, Athens, Greece, February 25–28, 2009 (abstract no. 261).

References (10)

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    These initiatives allow for 2-way communication with women monitoring and transmitting their BG results in real time to health-care providers for feedback. Studies have demonstrated 38.0% (340) to 82.7% (341) reduction in face-to-face medical visits and decreased insulin use (340) in pregnant women using telehomecare in conjunction with conventional care, without an increase in maternal or perinatal complications. While 4 studies of GDM women (total n=272) have demonstrated comparable glycemic control and pregnancy outcomes (342–345), other studies with type 1 diabetes (346–348) and GDM (348) have shown improved glycemic control and pregnancy outcomes in the group using web-based programs compared to standard care.

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