Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus.
BACKGROUND
Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the Internet.


METHODS
Women with GDM were randomized to either the Internet group (n = 32) or the control group (n = 25). Patients in the Internet group were provided with computers and/or Internet access if needed. A website was established for documentation of glucose values and communication between the patient and the health care team. Women in the control group maintained paper logbooks, which were reviewed at each prenatal visit. Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery.


RESULTS
Women in the Internet group accessed the system and sent on average 21.8 (+/- 16.9) sets of data. There was no difference between the two groups in regards either fasting or post-prandial blood glucose values, although more women in the Internet group received insulin therapy (31% vs. 4%; P <0.05). There were also no significant differences in pregnancy and neonatal outcomes between the two groups. Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study's end.


CONCLUSIONS
The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system. Although system use was not associated with improved pregnancy outcomes, women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy.
Homko
Carol J
CJ
Section of Cardiology, and Reproductive Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA. homkoc@temple.edu
Santamore
William P
WP
Whiteman
Valerie
V
Bower
Margaret
M
Berger
Phillip
P
Geifman-Holtzman
Osnat
O
Bove
Alfred A
AA
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000706:statistics & numerical data*; D003625:Data Collection / Q000379:methods; D016640:Diabetes, Gestational / Q000097:blood / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome; D011584:Psychology; D020377:Self Efficacy; D017216:Telemedicine / Q000379:methods*
D001786:Blood Glucose