title: Telemedicine for Gestational Diabetes Mellitus (TeleGDM): A Mixed-Method Study Protocol of Effects of a Web-Based GDM Support System on Health Service Utilization, Maternal and Fetal Outcomes, Costs, and User Experience.
abstract: BACKGROUND
  Women with insulin-treated gestational diabetes mellitus (GDM) require close monitoring and support to manage their diabetes. Recent changes to the diagnostic criteria have implications for service provision stemming from increased prevalence, suggesting an increased burden on health services in the future. Telemedicine may augment usual care and mitigate service burdens without compromising clinical outcomes but evidence in GDM is limited.
  
  
  OBJECTIVE
  The Telemedicine for Gestational Diabetes Mellitus (TeleGDM) trial aims to explore the use of telemedicine in supporting care and management of women with GDM treated with insulin.
  
  
  METHODS
  The TeleGDM is a mixed-methods study comprising an exploratory randomized controlled trial (RCT) and a qualitative evaluation using semistructured interviews. It involves women with insulin-treated GDM who are up to 35 weeks gestation. Participating patients (n=100) are recruited face-to-face in outpatient GDM clinics at an outer metropolitan tertiary hospital with a culturally diverse catchment and a regional tertiary hospital. The second group of participants (n=8) comprises Credentialed Diabetes Educator Registered Nurses involved in routine care of the women with GDM at the participating clinics. The RCT involves use of a Web-based patient-controlled personal health record for GDM data sharing between patients and clinicians compared to usual care. Outcomes include service utilization, maternal and fetal outcomes (eg, glycemic control, 2nd and 3rd trimester fetal size, type of delivery, baby birth weight), diabetes self-efficacy, satisfaction, and costs. Semistructured interviews will be used to examine user experiences and acceptability of telemedicine.
  
  
  RESULTS
  The trial recruitment is currently underway. Results are expected by the end of 2016 and will be reported in a follow-up paper.
  
  
  CONCLUSIONS
  Innovative use of technology in supporting usual care delivery in women with GDM may facilitate timely access to GDM monitoring data and mitigate care burdens without compromising maternal and fetal outcomes. The intervention may potentially reduce health service utilization.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000934640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366740 (Archived by WebCite® at http://www.webcitation.org/6jRiqzjSv).
authors: Department of General Practice, The University of Melbourne, Carlton, Australia. tshepo.rasekaba@unimelb.edu.au.
authors: Tshepo Mokuedi
authors: http://orcid.org/0000-0001-8714-0409
authors: TM
authors: Rasekaba
authors: Kwang
authors: http://orcid.org/0000-0003-4559-2276
authors: K
authors: Lim
authors: Irene
authors: http://orcid.org/0000-0003-4482-4936
authors: I
authors: Blackberry
authors: Kathleen
authors: http://orcid.org/0000-0003-1616-2170
authors: K
authors: Gray
authors: John
authors: http://orcid.org/0000-0003-0339-5848
authors: J
authors: Furler
keywords: Internet; electronic personal health record; gestational diabetes; telemedicine