As rates of obesity and type 2 diabetes rise around the world, gestational diabetes mellitus (GDM) is becoming increasingly common. GDM is a condition where blood glucose levels in pregnancy are too high, which has potentially serious consequences for both mother and baby, most commonly with the baby growing too large resulting in birth trauma. Keeping maternal blood glucose levels within the normal range can largely prevent complications of GDM. This is achieved through diet and exercise, often requiring the addition of medications such as insulin or metformin. More women with GDM has led to increasingly overcrowded outpatient clinics, with many women coming only for review of their blood glucose results.
GDm-Health is an interactive remote blood glucose monitoring system developed in response to increasing numbers of women with GDM in the UK. The aim was to develop a digital solution to help women better monitor and control their blood glucose levels at home with less frequent outpatient appointments. The technology uses a Bluetooth enabled blood glucose meter to automatically transmit readings to a smartphone application and secure website. A midwife then reviews the results and can contact the women via SMS or phone call if any changes are required.
Preliminary results from a service development cohort of 50 women were extremely encouraging. Women found the system convenient to use, appreciating the extra support from the health care team without the need for long waits in the outpatient department. For the success of any mHealth application, It is vital that users be involved at all stages in the development process. An example of this from our initiative was modification of the technology to improve bilateral communication with the introduction of a function for patients to signal to the midwife that they would like a phone call. Seemingly small additions like this can help improve compliance.
A randomized controlled trial evaluating whether the system can actually improve clinical outcomes with the system is currently underway. If we can demonstrate that this technology can improve clinical outcomes as well as patient satisfaction, the next challenge will be effective scale up, both within the UK and abroad.
While the uptake of smartphones isn’t a challenge to scale-up in our case given the setting, scaling faces several other challenges. Firstly, the security and confidentiality of the patient’s data must be paramount. Currently all information is hosted on a secure NHS server, however if the system were to be used elsewhere this would have to be negotiated. The second major consideration is the ongoing costs of the system. Blood glucose test strips compatible with the system are expensive, limiting enthusiasm for uptake. Additionally, the cost of data transmission via 3G networks must also be considered.
And yet the key rate-limiting step to scale-up in many settings is likely to be gaining support of the health professionals required for the system to work. A phone itself does not save lives. It is the people using it and their experience and ability to effectively communicate advice through the technology.
It is hoped that working with hospitals in our region, industry partners and learning from experiences abroad these issues will be able to be overcome and outcomes for women with GDM improved.
Do you have an opinion on the role mHealth can play to improve maternal health? What do you see as the biggest advantages of mHealth? The limitations? If you are interested in submitting a blog post for our ongoing guest blog series on mHealth for Maternal Health, please email MHTF Research Assistant Yogeeta Manglani at firstname.lastname@example.org.