Mobile apps a preferable GDM management tool among busy soon-to-be moms

For working expectant moms with gestational diabetes mellitus (GDM) who need additional support to control their blood sugar, a GDM management smartphone app is the way to go, according to a Singapore study.

“In general, smartphone apps are considered to be patient-centric interventions,” the investigators said. [Diabetes 2017;2:e25]

They added that women surveyed in the study believe that a such an app can help them overcome their common difficulties in self-management of GDM, improve lifestyle behaviours, and acquire reliable information on their condition and understand trends in glucose control.

A total of 216 women (median age, 32 years; 47.6 percent Chinese; 53.9 percent overweight/obese; 73.9 percent employed; 69.4 percent university graduates) with GDM participated in the survey. In addition, the investigators conducted semistructured interviews with 15 women and with eight healthcare providers managing GDM patients. All participants were recruited from specialized clinics at the National University Hospital Singapore (NUHS).

In the survey, 210 women controlled their diet, 103 were physically active, and 21 used insulin to regulate blood sugar. Most (n=185) were able to perform finger prick blood testing at the recommended times. While 97.7 percent of women received a high score for perceived GDM control, most (72.3 percent) of them still expressed a worry that they would not be able to control the same condition in future pregnancies. [JMIR Form Res 2020;4:e14486]

Working women, in particular, faced barriers to GDM management, including lack of reminders for sugar monitoring, issues related to diet control, and insufficient time for exercise. They had difficulty performing the required seven blood sugar readings for one weekday and one weekend day each week, in accordance to the clinical practice guidelines of the Ministry of Health, largely because they forgot to take the test. This was confirmed by healthcare providers who reported that working women experienced more barriers to managing GDM than nonworking women.

In terms of support for GDM management, 194 women were receiving GDM-related information from a physician, nurse, or trained counsellor at the GDM clinic, while 131 did from websites. The interviews revealed that women were most likely to rely on healthcare providers to guide them with medical advice and used the internet to obtain additional information.

Indeed, healthcare providers said that support from physicians, nurse educators, and dietitians was available in the usual clinic setting, with the patients being followed up biweekly. Some providers mentioned that they offered additional reading resources, while others pointed out the need to regulate the quality of supplementary material, especially those sourced from the internet.

Most of the interview participants thought a mobile app would be a practical approach to obtaining additional support for GDM management, given that smartphones are now commonplace. They pointed out that an app should prove more effective for recording blood glucose readings daily as opposed to a paper and pen or a computer. Other desirable intervention features identified by the women themselves included more information on GDM, diet and exercise options, blood sugar testing alerts, a platform to illustrate or understand sugar level trends, and a means to communicate with healthcare providers.

“To date, few studies have been conducted to understand the usability and acceptance of smartphone apps among women with GDM. Neither of these reported studies assessed the perception and contribution of potential users before developing their programs,” the investigators noted. “Having user input—both women with GDM and healthcare providers who treat women with GDM—is vital for the successful implementation of such interventions as it increases user acceptability and intervention sustainability.” [Diabetes Res Clin Pract 2015;110:1-9; J Med Internet Res 2016;18:e290; Healthcare 2015;3:310-323; BMC Pregnancy Childbirth 2016;16:277]

The investigators concluded that a carefully planned randomized control trial is useful for assessing the effectiveness and cost-effectiveness of a smartphone app—which is able to integrate testing, education, and communication—to minimize adverse maternal and foetal outcomes of GDM while reducing the use of healthcare resources in Singapore.