Cellular-Enabled Glucometers and Maternal Glucose Control: A Quality Improvement Initiative

• Published in: Journal of diabetes science and technology Vol. 14; no. 1; pp. 77 - 82
• Main Authors: Wernimont, Sarah A., Sheng, Jessica S., Fleener, Diedre, Summers, Karen M., Syrop, Craig, Andrews, Janet I.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2020
• Subjects: Adult; Blood Glucose - analysis; Blood Glucose Self-Monitoring; Diabetes, Gestational - blood; Diabetes, Gestational - drug therapy; Female; Glycated Hemoglobin - analysis; Glycemic Control; Humans; Insulin - therapeutic use; Original; Pregnancy; Quality Improvement; Telemedicine; telemedicine; glucometer; cellular-enabled glucometer; diabetes; pregnancy; quality
• ISSN: 1932-2968; 1932-2968; 1932-3107
• DOI: 10.1177/1932296819856360

Background: Management of diabetes in pregnancy is burdensome due to self-glucose monitoring, recording, and reporting demands. Cellular-enabled glucometers provide real-time transmission of glucose values independent of internet access and cell phone data plans. We describe a quality improvement (QI) intervention that introduced cellular-enabled glucometers for use during pregnancies complicated by diabetes. Methods: Our aim was to improve maternal glucose control in a cohort of insulin-requiring pregnant women enrolled in a telemedicine diabetes program. During initial establishment of a QI program, women were offered cellular-enabled glucometers but could elect to keep their standard meter. The primary outcome evaluated was glycosylated hemoglobin A1c (HbA1c) at delivery. Results: Baseline characteristics including initial HbA1c were similar between women using a standard glucometer (n = 45) and those using a cellular-enabled glucometer (n = 72). Women who used a cellular-enabled glucometer had a lower HbA1c at delivery compared to those using a standard glucometer (5.8% vs 6.3%, P = .03). This improvement was particularly notable for women with poor glucose control (defined as HbA1c >6.5%) at initial obstetric visit. Women with poor glucose control who used a cellular-enabled glucose monitor had significantly lower HbA1c at delivery (6.0% vs 6.8%, P = .03) and greater change from initial visit compared to those using a standard glucometer (−2.6% vs −1.4%, P = .02). No statistically significant differences were detected in tracked neonatal outcomes. Conclusion: For pregnancies complicated by insulin-requiring diabetes, use of cellular-enabled glucometers as part of a perinatal diabetes program improves glucose control at delivery with timely transmission of accurate values throughout gestation.