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Cited by 160Mobile Health and mHealth ApplicationsGestational Diabetes Research and ManagementDiabetes Management and Education

The impact of a daily smartphone-based feedback system among women with gestational diabetes on compliance, glycemic control, satisfaction, and pregnancy outcome: a randomized controlled trial

Miremberg, Hadas, Ben-Ari, Tal, Betzer, Tal, Raphaeli, Hagit, Gasnier, Rose, Barda, Giulia, Bar, Jacob, Weiner, Eran·2018·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2018.01.044
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Abstract

Background Patient compliance and tight glycemic control have been demonstrated to improve outcome in pregnancies complicated by gestational diabetes mellitus. The use of advanced technological tools, including smartphone-based platforms, to improve medical care and outcomes has been demonstrated in various fields of medicine, but only a few small studies were performed with gestational diabetes mellitus patients.Objective We aimed to study the impact of introducing a smartphone-based daily feedback and communication platform between gestational diabetes mellitus patients and their physicians, on patient compliance, glycemic control, pregnancy outcome, and patient satisfaction.Study design This is a prospective, single-center, randomized controlled trial. Newly diagnosed gestational diabetes mellitus patients presenting to our multidisciplinary diabetes-in-pregnancy clinic were randomized to: (1) routine biweekly prenatal clinic care (control group); or (2) additional daily detailed feedback on their compliance and glycemic control from the clinic team via an application installed on their smartphone (smartphone group). The primary outcome was patient compliance defined as the actual blood glucose measurements/instructed measurements ×100. The secondary outcomes included diabetes-control parameters, pregnancy, and neonatal outcomes. The study was adequately powered to detect a 20% difference in patient compliance, based on a preliminary phase that demonstrated 70% baseline compliance to glucose measurements.Results A total of 120 newly diagnosed gestational diabetes mellitus patients were analyzed. The 2 groups did not differ in terms of age, parity, education, body mass index, family history, maternal comorbidities, oral glucose tolerance test values, and hemoglobin A1C at randomization. The smartphone group demonstrated higher level of compliance (84 ± 0.16% vs 66 ± 0.28%, P < .001); lower mean blood glucose (105.1 ± 8.6 mg/dL vs 112.6 ± 7.4 mg/dL, P < .001); lower rates of off-target measurements both fasting (4.7 ± 0.4% vs 8.4 ± 0.6%, P < .001) and 1-hour postprandial (7.7 ± 0.8% vs 14.3 ± 0.8%, P < .001); and a lower rate of pregnancies requiring insulin treatment (13.3% vs 30.0%, P = .044). The rates of macrosomia, neonatal hypoglycemia, shoulder dystocia, and other delivery and neonatal complications did not differ between the groups. Patients in the smartphone group reported excellent satisfaction from the use of the application and from their overall prenatal care.Conclusion Introduction of a smartphone-based daily feedback and communication platform between gestational diabetes mellitus patients and the multidisciplinary diabetes-in-pregnancy clinic team improved patient compliance and glycemic control, and lowered the rate of insulin treatment.

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Crossref · 10.1016/j.ajog.2018.01.044

Cites

34 of 34 references verified0 citation errors · 0 not checkable

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  • Of the 27 papers, 4 focused on GDM, with 339 patients in the intervention groups and 343 in the control groups.

    “4 were focused on GDM (339 patients in the intervention groups and 343 patients in the control groups) [62-65]”

    From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [65]

  • Significant differences between groups favoring the app intervention groups were found for off-target fasting glucose measurements (P<.001).

    “Significant differences between groups favoring the app intervention groups were found for off-target fasting glucose measurements (P<.001 [62,65]), off-target 1-hour glucose measurements (P<.001 [65]), and off-target 2-hour glucose measurements (P<.001 [62]).”

    From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [65]

  • Significant differences between groups favoring the app intervention groups were found for off-target 1-hour glucose measurements (P<.001).

    “Significant differences between groups favoring the app intervention groups were found for off-target fasting glucose measurements (P<.001 [62,65]), off-target 1-hour glucose measurements (P<.001 [65]), and off-target 2-hour glucose measurements (P<.001 [62]).”

    From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [65]

  • Both GDM studies found significant differences between groups, favoring the app intervention groups, for patient compliance (P<.001).

    “Both studies found significant differences between the groups, favoring the app intervention groups (P<.001 [62,65]).”

    From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [65]

  • Two GDM studies (124 intervention, 120 control) included patient compliance, defined as the ratio between actual blood glucose measurements and instructed measurements ×100.

    “Two studies [62,65] (124 patients in the intervention groups and 120 patients in the control groups) included the outcome of patient compliance, defined as the ratio between actual blood glucose measurements and instructed measurements ×100.”

    From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [65]

Cites

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1 of the 35 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Dollberg, 2005, Birthweight standards in the live-born population in Israel, Isr Med Assoc J, 7, 311

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Authors
Miremberg, H., Ben-Ari, T., Betzer, T., Raphaeli, H., Gasnier, R., Barda, G., Bar, J., & Weiner, E.
Affiliations
Tel Aviv University (IL)
Corresponding author
Miremberg, Hadas
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2018-04
Volume
218
Issue
4
Pages
453.e1-453.e7
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2018.01.044
OpenAlex
W2792295467
Semantic Scholar
761197523391ee0ba3c082f2b21abf3e8d328d0f
Cited by
160
References
35
Citations by year
2026: 9 · 2025: 18 · 2024: 24 · 2023: 17 · 2022: 35 · 2021: 25 · 2020: 24 · 2019: 4 · 2018: 4
FWCI
21.74
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
gestational diabetes mellitus, medication adherence, glycemic control, blood glucose monitoring, patient-physician communication, pregnancy outcomes, neonatal outcomes, macrosomia, neonatal hypoglycemia, insulin requirement, patient satisfaction, mobile health intervention, women of reproductive age, HbA1c, postprandial blood glucose
MeSH terms
Smartphone, Adult, Blood Glucose, Feedback, Female, Humans, Hypoglycemic Agents, Insulin, Patient Care Team, Patient Compliance, Pregnancy, Pregnancy Outcome, Prospective Studies, Diabetes, Gestational, Patient Satisfaction, Postprandial Period, Mobile Applications

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