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New gestational diabetes trial reduces the need for clinic appointments

Nurses at Fairfield Hospital in Sydney have trialled the use of an app that can help cut the number of clinical appointments needed for pregnant women with gestational diabetes (GDM).

Jenny Wright, diabetes clinical nurse consultant at Fairfield Hospital, found that since the implementation of the new World Health Organisation diagnostic criteria in 2016, Fairfield has had a 23–25 per cent increase in prevalence of GDM, with substantial burden on the hospital’s resources.

“We are having this increased high demand in our service and we don't have enough staff to cope with the work flow. So, in 2017, I got to looking for any other innovative way we can help us with these pregnant women with GDM,” Wright said.

“When I was doing a little search, I found a study from Oxford University in England, [where] they developed a similar model.”

The hospital uses the existing Accu-check technology and app, which they can pair with a patient’s blood glucose meter via Bluetooth. The pregnant women can then input and keep a track of all their levels on their smartphone.

“Then the clinician like myself, I can sit on my desk and monitor those sugar levels in real time,” Wright said.

Current standards of care will see an expectant mother with GDM have frequent clinic visits, normally 1-2 weekly.

The women in the Fairfield pilot trial had four weekly clinic reviews at an antenatal clinic until 36 weeks gestation and then weekly until delivery. If blood glucose levels were seen to be abnormal via the information on the app, clinicians were able to intervene and arrange clinic visit.

The trial reduced the burden on the health system significantly, but also on the expectant mothers.

“Some woman, if they are diagnosed diabetes a bit earlier in the second trimester or first trimester, that would significantly reduce that clinic visit a lot,” said Wright.

Wright found patient satisfaction rose with fewer clinic visits. The women who participated did not have to organise babysitters. Reduced travel and costs were also a big plus.

“One woman, she had her P-plates and the husband would not let her drive because he thought she wasn’t a good enough driver. So, every time they paid $50 for the cab for her to come to the clinic,” Wright said.

Importantly, the study found that using the app made no difference to pregnancy outcomes, including mode of delivery, admission to special care nursery, birthweight and neonatal hypoglycaemia.

The next step is a trial for non-English speakers, and Wright hopes that hospitals will adopt the idea as standard practice.

“I had a chat with a professor at the RPA at one stage because she's doing a [a trial]. And I've been contacted by the Lower Hunter hospital and they are adopting similar model of care, and I've been contacted by Western Australia. So apparently, we are one of the first hospitals in Australia to implement such a model of care, so we've become a resource clinic,” said Wright.

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