title: Development of a real-time smartphone solution for the management of women with or at high risk of gestational diabetes.
abstract: Gestational diabetes mellitus (GDM) is defined as new onset or recognition of glucose intolerance in pregnancy. Evidence supports tight blood glucose regulation to prevent adverse maternal and fetal outcomes. Finger-prick blood glucose (BG) testing with frequent clinic review remains the most common method of managing diabetes in pregnancy. The prevalence of GDM is rising globally, pressuring resource-limited services. We have developed an intuitive, interactive, reliable, and accurate management system to record BG measurements and deliver management of GDM remotely. Following an initial scoping phase, a prototype software application was developed using an Android smartphone with BG meter linkage via Bluetooth. A custom website was built for clinician review of the data transmitted by the smartphone. After system refinement, further evaluation was undertaken for usability and reliability in a 48-patient service development project. Women used the system for an average of 13.1 weeks. In all, 19 686 BG measures were transmitted, 98.6% of which had a meal tag. A total of 466 text messages were transmitted. A mean of 30 BG readings per woman per week were transmitted, and 85% of women submitted the minimum requirement of 18 readings per week. We have developed a novel, real-time, smartphone-based BG monitoring management system that allows clinician review of real-time patient-annotated BG results. Results indicate high usage and excellent compliance by women. Robust clinical, economic, and satisfaction evaluations are required. To address these requirements, we are currently conducting a randomized controlled pilot trial.
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK lucy.mackillop@ouh.nhs.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Mackillop
authors.affiliation: Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
authors.forename: Lise
authors.initials: L
authors.lastname: Loerup
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Bartlett
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
authors.affiliation: Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Gibson
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Hirst
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kenworthy
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Dev A
authors.initials: DA
authors.lastname: Kevat
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
authors.affiliation: Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D040421:Cell Phone; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D006801:Humans; D063731:Mobile Applications; D011247:Pregnancy; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*
keywords: complex intervention development; digital health; gestational diabetes; self monitoring