Telemedicine for managing diabetes in pregnancy

“The goal of telemedicine is to improve patient access to care,” said presenter Noelia Zork, MD, an assistant clinical professor of ob-gyn and maternal-fetal medicine at Columbia University Irving Medical Center in New York, New York.

At the Medical Center, the number of patient video visits in the ob-gyn department drastically increased from eight between March 9 and March 13, 2020, to 892 between March 30 and April 3, 2020.

“Prior to COVID-19, we were performing 3 to 5 video obstetric visits per month, with only 3 out of 40 clinical faculty offering obstetrical care through video,” Zork told Contemporary OB/GYN®.

To become eligible to practice telemedicine at Columbia University, providers needed to complete a 15-minute online training program. In order to secure provider participation, recommendations for a virtual prenatal care schedule and peer support were found to be helpful.

Zork was co-author of a survey conducted at Columbia University during COVID-19 that found the majority of providers believed telehealth was convenient for patients and their practice, and that 89% planned to continue using the technology after the pandemic. However, 78% felt the most common barrier to care was patient difficulty in accessing and using the technology.

Virtual diabetes management at Columbia University consists of diabetes self-management education (DSME) video visits with a certified diabetes educator (CDE), educational materials emailed to patients, a video consult with maternal-fetal medicine and a video consult with a registered dietician. Additionally, blood glucose levels are logged on paper logs or a variety of phone applications and then emailed to a dedicated email address on a weekly basis for review. Care recommendations also are transmitted via email or phone.

Data collection problems arose during the pandemic, however, such as patient inability to log on paper because there was no access to a printer at work, or less frequent in-person appointments to be given blank logs.

“Logs also became difficult to interpret quickly and easily,” Zork said.

Cell-phone reporting is one successful method to improve patient and provider convenience with logging and interpreting glucose levels.

Published in 2015, a Hawaiian study among pregnant women with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (GD) found that nearly 70% of patients preferred cell-phone reporting compared to only about 25% who favored voicemail. The majority of patients also appreciated weekly text message reminders.

“Most patients at Columbia University have downloaded the MyChart app onto their smartphone to conduct their video visits,” Zork said. “Different institutions with the Epic patient portal also allow patients to enter glucose values into MyChart.”

Despite the advantages of a cell phone for monitoring diabetes, not all patients have cell phones, and there may be poor cell service/data plans. Certain mobile phone applications are also not user-friendly for patients who do not speak English. The technology can be overwhelming for those not accustomed to it. Moreover, no one actively monitors incoming data.

Remote patient monitoring (RPM) is a reporting system that does not require patient resources to monitor glucose. “RPM collects patient health data—continuously or intermittently—while the patient is at home and transmits the data to a provider in another location,” Zork said.

Data is sent wirelessly to a web-based cloud and monitored by trained nurses during the day, including trends in blood sugars. There are also established escalation pathways and protocols.

One systematic review and meta-analysis of RPM published in 2017 concluded there was a modest improvement in HbA1c in people with type 2 DM. The greatest impact was from phone calls, provider messaging and automated messages.

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Disclosure

Zork reports no relevant financial disclosures.

Reference

Zork N. Telemedicine for the management of diabetes in pregnancy during COVID-19 and beyond. American Diabetes Association Scientific Sessions 2021; June 28, 2021; virtual. Accessed June 28, 2021.