JMIR Publications

ABSTRACT

Background:

In 2019, one of six births was affected by gestational diabetes mellitus (GDM) globally. GDM results in adverse maternal, fetal and neonatal outcomes in the short- and long-term, such as pregnancy and birth complications, type 2 diabetes, metabolic syndrome and cardiovascular disease. In the context of “transgenerational programming”, diabetes mellitus during pregnancy can contribute to “programming” errors and long-term consequences for the child. Therefore, early therapy strategies are required to improve the clinical management of GDM. The interest in digital therapy approaches such as telemetry increases because they are promising, innovative, and sustainable.

Objective:

To assess the current evidence regarding the clinical effectiveness of telemetric interventions in the management of GDM addressing maternal glycemic control, scheduled and unscheduled visits, satisfaction, diabetes self-efficacy, compliance, maternal complications in pregnancy and childbirth as well as fetal and neonatal outcomes.

Methods:

MEDLINE via PubMed, Web of Science Core Collection, EMBASE, Cochrane Library, and CINAHL databases were systematically searched from January 2008 to April 2020. We included randomized controlled trials (RCTs), systematic reviews (SRs), meta-analyzes (MAs) and clinical trials (CTs) in Englisch and German. Study quality was assessed using “A MeaSurement Tool to Assess systematic Reviews" (AMSTAR 2) and "Effective Public Health Practice Project" (EPHPP). Interventions were categorized according communication channels to health care professionals: “real-time audio”, “real-time video”, “asynchronous”, and “asynchronous and real-time”.

Results:

Search identified n=1116 unique citations. Finally, we included n=11 suitable publications (n=563 patients and n=2779 patient cases): n=4 SRs/MAs (n=1 high, n=3 moderate quality), n=6 RCTs (n=2 high, n=4 moderate quality) and n=1 low quality non-randomized controlled trial. We classified n=4 “asynchronous interventions” and n=3 “asynchronous and real-time interventions”. The findings indicated that telemetric therapy clearly improved glycemic control and reduces HbA1c values effectively. Even more, in one study, telemetry proved to be a signficant predictor for a better glycemic control hazard ratio (HR)=1.71 (95% conficende interval (CI): 1.11 to 2.65; P=.015), significantly less insulin titrations were required and glycemic control was achieved significantly earlier. Telemetric therapy significantly reduced scheduled and unscheduled clinic visits effectively and women were highly satisfied. In fetal and neonatal short-term outcomes, some improving tendencies in favor of telemetry were determined. No long-term outcomes were detected.

Conclusions:

Telemetric interventions clearly improved glycemic control, notably HbA1c values, and reduced scheduled and unscheduled visits effectively, which reinforces this digital approach in the therapy of gestational diabetes mellitus.