Gestational diabetes mellitus (GDM) diagnosis brings expectant mothers additional burdens regarding glucose monitoring. Remote monitoring can reduce unnecessary appointments, or treatment delays, but may not be appropriate for all users. Identifying factors associated with lower engagement with such platforms enables treating teams to direct work flows and accommodate for standard and low-engagement users.
56 women with GDM were linked to the NetHealth application for remote blood glucose monitoring enabling results to be automatically uploaded and immediately visible to the treating team. Users were stratified into categories of standard (> 75% daily readings available), or low-engagement (< 75% daily readings available). Demographics, medical history and birth outcomes were collected.
Overall, 75% of the cohort achieved standard glucose monitoring. Low-engagement users completed a mean of 51% of required tests and were less responsive to direct messaging (33% returned messages vs 57%).
Associated factors in the low-engagement group included (1) lower rates of family or friend support (53% vs. 74%), (2) lower rates of employment (53% vs. 90%), (3) higher rates of pre-existing anxiety and/or depression (47% vs. 24%), (4) previous diagnosis of postnatal depression (27% vs. 5%), and (5) current or previous concerns regarding family safety (33% vs. 0%). Babies born to low-engagement users had higher admission rates to the special care nursery (seven with respiratory distress, five with jaundice, and one with neonatal hypoglycaemia).
This cohort demonstrates that glucose remote monitoring remains a challenge for some expectant mothers. Awareness of these factors associated with low-engagement with remote monitoring platforms should encourage clinicians to have open and informed discussions with women about their preferred method of team interactions. Low-engagement with remote monitoring platforms can also be considered a signal for increased complications after delivery.