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How Mobile Devices Help in Managing Gestational Diabetes

May 29, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Mia Flowers, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy

Clinical dietitians and mobile apps play a crucial role in personalizing treatment for patients with gestational diabetes 

Gestational diabetes mellitus (GDM) is worldwide known complication with increasing healthcare costs. The risks associated with GDM can be harmful to the fetus and the woman carrying the baby. Some of the difficulties that could arise with GDM may include hypoglycemia of the neonate, the necessity of cesarean delivery, fetal macrosomia, or dystocia of the shoulder. Modifiable factors that may perpetuate GDM are identified as obesity before pregnancy, insufficient nutrition, and inactivity. In contrast, factors out of the patients control could include advanced age, Asian, Black, Hispanic, or Native American descent, history of prediabetes or GDM, familial diabetes mellitus, genetic predisposition, and pregnancy history of twins or low birth weights. Past research has found women are almost eight times more likely to progress to type 2 diabetes after a case of GDM than those who have normal blood sugar readings during pregnancy. The mother’s blood glucose can affect the babys birth weight and lead to overcompensation in the baby via hyperinsulinemia. Thus, gaining glycemic control is critical for patients with GDM.  Medical nutrition therapy (MNT) could provide greater blood glucose control in cases of GDM, in turn preventing cesarean sections, inadequate nutrition, low birth weights, and ketosis. MNT is the first step to treating GDM in pregnant women, according to the Korean Diabetes Association. Cellular devices such as smartphones may aid in the improvement of managing GDM via mAPP or mobile-application-based healthcare. This study takes a closer look at the effects of personalized nutrition interventions for women with GDM.  

 

In this case series study, four patients with GDM diagnosed within 24 to 28 weeks of gestation were observed. Data collected comprised dietary habits, baseline laboratory values followed up between 32 to 36 weeks of pregnancy and again after giving birth. The mAPP provided a simple method for health care providers to communicate with the mothers diagnosed with GDM. Monitoring parameters on the app included glucometer readings via Bluetooth connection to obtain blood glucose levels, dietary intake, physical activity, and intake of home medications. Once the patients entered the data, the information was configured to a server through a wireless network. Registered dieticians performed baseline nutritional assessments, which entailed collecting the history of the patients eating habits and food consumption within the last 24 hours to personalize dietary education for each patient. The patients meal plans were based on whether they received insulin. Insulin users were provided a food exchange table, and those with prescription insulin were advised to count and restrict their carbohydrate intake. The dietician followed up with each patient by tailoring messages on the app at least twice a month until the mothers gave birth. Information on how to manage GDM was provided weekly and comprised of education on cutting carbs, snack replacements, dietary supplements like fish oil and calcium, the intake of beverages, how to prevent constipation, and a guide on eating out. Between weeks 32 to 36, a three-day food journal was logged and assessed for each individuals status in terms of diet, exercise, and glycemic control. After giving birth, the dietician administered tips on preventing the development of type 2 diabetes and how to manage diet and weight postpartum with nutritional care.   

The findings of this study showed no significant changes in the carb-fat-protein ratio. After delivery, a decline in protein intake for the majority of the subjects and iron intake remained the same. Calcium intake decreased throughout the pregnancies. 700 milligrams per day was the recommended nutrient intake for these patients with GDM. However, this recommendation was only met at baseline. Glycemic control was demonstrated with an average hgbA1c of 5.4% to 5.5% from baseline to delivery. Postprandial blood glucose readings were better in comparison to those at baseline. The results of this case study strengthen the argument that close monitoring of dietary intake can promote glycemic control and prevent the development of type 2 diabetes in mothers experiencing gestational diabetes. Limitations of this study include the number of patients, the ethnicity of the patients, and lack of statistical analysis. Future studies could involve other patients of different origins, a larger population, reports of birth weights or any additional complications surrounding birth, and followup months after the delivery to strengthen the importance of the utility of the mobile app. Overall, the inclusion of registered dieticians improved glycemic control and dietary intake for patients with GDM.  

Practice Pearls: 

  • A nutrition management program for patients with gestational diabetes mellitus using an app on mobile devices successfully regulated carbohydrate intake and improved blood glucose.  
  • Future management of GDM should emphasize obtaining glycemic control and upholding optimum nutritional status.  
  • Moving forward, registered dietitians should be involved in the development and structuring of mAPP-based nutrition care programs and services. 

 

Seo Y, Kim EM, Choi JS, Park CY. Using a Mobile-based Nutritional Intervention Application Improves Glycemic Control but Reduces the Intake of Some Nutrients in Patients with Gestational Diabetes Mellitus: A Case Series Study. Clin Nutr Res. 2020 Jan;9 

 

Mia Flowers, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy