Laurie Josephine G, Wilkinson Shelley A, Griffin Alison, McIntyre Harold D
Department of Obstetric Medicine, Mater Health Services, The University of Queensland, Brisbane, Queensland, Australia.
School of Human Movement and Nutrition Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2023 Oct;63(5):681-688. doi: 10.1111/ajo.13691. Epub 2023 Apr 26.
The rapidly rising prevalence of gestational diabetes mellitus (GDM) poses major challenges to the efficient, timely and sustainable provision of diabetes care.
To assess whether the implementation of a novel, digital model of care would provide improved efficiency without compromising clinical outcomes in a cohort of women with GDM.
A digital model of care was developed, implemented and evaluated using a prospective pre-post study design in 2020-21 at a quaternary centre. We introduced six culturally and linguistically tailored educational videos, home delivery of equipment and prescriptions, and a smartphone app-to-clinician portal for glycaemic review and management. Outcomes were prospectively recorded by an electronic medical record. Associations between model of care and maternal and neonatal characteristics and birth outcomes were examined for all women and separately by treatment received (diet, metformin, insulin).
Comparing pre-implementation (n = 598) and post-implementation (n = 337) groups, maternal (onset, mode of birth) and neonatal (birthweight, large for gestational age (LGA), nursery admission) clinical outcomes confirmed that the novel model of care was similar to standard, traditional care. Minor birthweight variation was noted when separated by treatment type (diet, metformin, insulin).
This pragmatic service redesign demonstrates reassuring clinical outcomes in a culturally diverse GDM cohort. Despite the lack of randomisation, this intervention has potential generalisability for GDM care and important key learnings for service redesign in the digital era.
妊娠期糖尿病（GDM）患病率迅速上升，给高效、及时且可持续地提供糖尿病护理带来了重大挑战。
评估一种新型数字护理模式的实施是否能在不影响GDM女性队列临床结局的情况下提高效率。
在一家四级医疗中心于2020 - 21年采用前瞻性前后对照研究设计，开发、实施并评估了一种数字护理模式。我们引入了六部经过文化和语言定制的教育视频、设备及处方的上门配送，以及一个用于血糖评估和管理的智能手机应用程序与临床医生门户。结局通过电子病历进行前瞻性记录。对所有女性以及根据所接受的治疗（饮食、二甲双胍、胰岛素）分别检查护理模式与母婴特征及分娩结局之间的关联。
比较实施前（n = 598）和实施后（n = 337）两组，母婴（发病时间、分娩方式）和新生儿（出生体重、大于胎龄儿（LGA）、入住新生儿重症监护室）的临床结局证实，这种新型护理模式与标准的传统护理相似。按治疗类型（饮食、二甲双胍、胰岛素）分开时，注意到出生体重有轻微差异。
这种务实的服务重新设计在文化多元的GDM队列中显示出令人放心的临床结局。尽管缺乏随机分组，但该干预措施对GDM护理具有潜在的推广性，并且为数字时代的服务重新设计提供了重要的关键经验教训。
