Gestational diabetes, which typically occurs toward the end of pregnancy, affects 3 to 5 percent of all women in the United States, and is more common in African-American, Latino, American Indian and Asian Indian populations. To keep blood sugars under control, critical for a healthy pregnancy, frequent monitoring is required so that adjustments to diet and medication can be made promptly.
Can telemedicine, primarily via the Internet, make this process easier and more effective? And, more importantly, can the use of telemedicine in managing gestational diabetes help prevent excessive growth of the fetus? These questions form the crux of a new project led by Carol Homko, R.N., Ph.D., C.D.E., assistant research professor at Temple University School of Medicine, and supported by a project grant from the National Institutes of Health.
Through a randomized trial, one group of women will be monitored the conventional way, a significant part of which involves keeping a log book of blood sugar levels and diet, and one group will be monitored through the phone and the Internet.
"When gestational diabetes gets out of control, the health of both mom and baby are threatened. My focus in this project is the major consequence of gestational diabetes-excessive growth of the fetus. Many problems can stem from being a big baby, especially a higher risk of diabetes," said Homko, who hopes to reduce the incidence of big birth weights by 10 percent through telemedicine.
"In previous studies with heart patients, another group requiring constant monitoring, we found that frequent contact via the phone and Internet was not only effective in controlling the disease but also embraced by the patient," explained Homko. "Patients loved being in touch with their physician online. And the physicians were able to react more quickly to signs of trouble-for example, a rise in blood pressure or weight."
For any patient, old or young, sick or healthy, frequent hospital or doctor's office visits to monitor a medical condition or disease are difficult and time-consuming.
"I spend a large part of my day on the phone because of the amount of monitoring and interaction needed with patients. It wouldn't be practical for my patients to come to the hospital all of the time," said Homko. "My job is to figure out how to adjust medication, insulin and diet, according to their blood sugar levels and other symptoms."
On the website for this project, patients regularly enter their blood sugar levels and insulin doses. Homko monitors the information and e-mails responses. The website will soon have automated messages, such as reminders to patients to send in their numbers, in addition to a section for education. Physicians can go to the site and screen patients' most recent lab results, ultrasounds, medications, pregnancy history and medical history.
It's believed that telemedicine will lead to better control of blood sugars and therefore a better pregnancy and birth. Valerie Whiteman, M.D., assistant professor of obstetrics and gynecology, is the project co-investigator.