Use of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus: A pilot study

An Evidence-Based Framework for Creating Inclusive and Personalized mHealth Solutions-Designing a Solution for Medicaid-Eligible Pregnant Individuals With Uncontrolled Type 2 Diabetes

Mobile health (mHealth) apps can be an evidence-based approach to improve health behavior and outcomes. Prior literature has highlighted the need for more research on mHealth personalization, including in diabetes and pregnancy. Critical gaps exist on the impact of personalization of mHealth apps on patient engagement, and in turn, health behaviors and outcomes. Evidence regarding how personalization, engagement, and health outcomes could be aligned when designing mHealth for underserved populations is much needed, given the historical oversights with mHealth design in these populations. This viewpoint is motivated by our experience from designing a personalized mHealth solution focused on Medicaid-enrolled pregnant individuals with uncontrolled type 2 diabetes, many of whom also experience a high burden of social needs. We describe fundamental components of designing mHealth solutions that are both inclusive and personalized, forming the basis of an evidence-based framework for future mHealth design in other disease states with similar contexts.

Effectiveness of Smartphone-Based Lifestyle Interventions on Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Gestational diabetes mellitus (GDM) is a condition that causes poor glucose tolerance during pregnancy and usually resolves after birth. Having GDM impacts the mother and baby. Smartphone-based lifestyle interventions may offer innovative solutions.

Aim

To examine the effects of smartphone-based lifestyle interventions on compliance, Hemoglobin A1c (HbA1c), maternal outcomes, infant outcomes, psychological status, satisfaction, and cost effectiveness among women with GDM.

Methods

Randomized controlled trials (RCTs) of smartphone-based lifestyle interventions for women with GDM aged over 18 years were included. A systematic search of PubMed, Embase, Web of Science, CINAHL, and Cochrane Library for articles published from January 2007 to March 2022 and updated on 12 October 2022. Data were extracted independently by two researchers, and the risk of bias in individual trials was rated using the Cochrane risk-of-bias tool (RoB 2). Meta-analysis was conducted by using RevMan 5.3.

Results

Ten studies were included involving 1626 participants. The mean ages of the women were 32.42 ±4.68 years. Eight out of 10 studies were conducted in developed countries. Meta-analysis found that smartphone-based lifestyle interventions statistically improved compliance [SMD = 7.36, 95% CI = (4.05 to 10.68), P < 0.0001] and decreased the incidences of neonatal intensive care unit (NICU) admission [RR = 0.64, 95% CI = (0.47,0.86), P = 0.003], compared with controls. However, intervention effects on HbA1c, maternal outcomes, neonatal hypoglycemia, and infant birth weight were non significant. Moreover, the satisfaction of intervention is high in this review. Contrastingly, no significant effects were observed for psychological status and cost-effectiveness.

Conclusion

Smartphone-based lifestyle interventions may improve patient compliance and reduce NICU admissions. These findings may aid in developing future intervention strategies, help elucidate future research directions, and guide clinical practice for women with GDM. Future high-quality RCTs must be further studied at larger scales to examine smartphone-based lifestyle interventions' long-term effects and cost-effectiveness.