Monitoring Inner City Women with Gestational Diabetes via the Internet

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Monitoring Inner City Women with Gestational
Diabetes via the Internet

• Carol J. Homko, William P. Santamore, Valerie
  Whiteman, Margaret Bowers, Phillip Berger, Alfred
  A. Bove
• Department of Obstetrics Gynecology
• Telemedicine Research Center
• Temple University, Philadelphia, PA

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Gestational Diabetes Mellitus

• Carbohydrate intolerance of variable severity
  with onset or first recognition during pregnancy
• Occurs in 7 of all pregnancies
• Strong association between maternal glucose
  control and pregnancy outcomes

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Purpose

• To demonstrate the feasibility
• of monitoring glucose control
• in indigent women with GDM
• over the internet

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Study Design

• RCT Paper log books versus telemedicine system
• Intent to treat analysis
• Outcomes
• System use
• Maternal feelings of self-efficacy
• Birth weight and neonatal complications

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Diabetes Empowerment ScaleAnderson and
FunnellUniversity of Michigan

• Measure of psychosocial self-efficacy
• 28-items, 5-point Likert scale
• Three subscales
• Managing psychosocial aspects of diabetes
• Assessing dissatisfaction and readiness to change
• Setting and achieving goals

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Inclusion Criteria

• 18 45 years of age
• Documented diagnosis of GDM
• ? 33 weeks gestation

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Exclusion Criteria

• Multiple gestations
• Pre-existing diabetes

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Temple Telehealth System
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Additional Features

• Laboratory values
• Medications
• Education
• Bi-directional messaging
• E-mail reminders
• Usage logs

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Sample
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Education
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Total Family Income
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Mean Blood Glucose Control
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Pregnancy Outcomes
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Telemedicine Group

• 53 Computer/Internet access
• 22 (n7) never accessed system
• Lost phone service (n2)
• Left home (n2)
• Lost interest (n3)
• 21.8 16.9 sets of transmitted data
• 32 maintained additional logbook data

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Maternal Feeling of Self-Efficacy Diabetes
Empowerment Scale


P lt0.05
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Summary Conclusions

• Use of the system was limited
• No differences
• Blood glucose control
• Pregnancy outcomes
• Enhanced feelings of psychosocial
• self-efficacy

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Future Directions

• Difficulties/Barriers Encountered
• Hardware installation delays
• Computer speed
• Computer skills training
• Social factors
• Moving forward IVR system

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Temple Telemedicine Research Team
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