Background
Gestational diabetes mellitus (GDM) affects 11-15% of pregnancies. It poses challenges to limited hospital outpatient resources. Telemedicine has been shown to be a feasible and acceptable approach to GDM management; however studies in GDM are limited.
Aim
To evaluate the impact of telemedicine on GDM service utilisation, maternal and foetal outcomes, quality of life and service costs.
Methodology
Systematic literature review with a search of English papers on MEDLINE, EMBASE, PUBMED, CINAHL, the Cochrane Central Register of Controlled Trials and the World Health Organisation International Clinical Trials Registry. The search covered January 1999 to August 2013 and included RCTs of telemedicine (service provision, telemonitoring) using various ICT modalities. Effect sizes were summarised as standardised mean difference (SMD) and odds ratios.
Results
The search returned 689 publications and three met the inclusion criteria. Telemedicine interventions involved web-based system, web-based system+interactive voice, web-based+SMS. One study evaluated GDM clinic visits/patient (telemedicine vs. usual care): unscheduled visits SMD=-2.63(95%CI: -3.18, -2.08). Meta-analyses showed non-significant glycaemic control for telemedicine vs. usual care/control: HbA1c SMD=-0.18(95%CI: -0.50, 0.14); fasting and post-prandial BGL (breakfast, lunch, dinner) effect sizes from -0.14 to 0.14(95%CI: range: -0.50 to 0.47). Caesareans OR=1.40(95%CI: 0.53, 3.68), LGA OR=1.50(95%CI: 0.70, 3.22). One study reported significantly better quality on two domains of diabetes self-efficacy in favour of telemedicine. None of the studies evaluated costs.
Conclusion
Telemedicine for GDM is feasible and acceptable. It may reduce service utilisation, and clinical outcomes are comparable to usual care. Its advantage over usual care may lie in the ability to deliver support and monitoring remotely to ease face-to-face and unscheduled consultation burdens without compromising maternal and foetal outcomes. Further studies that also include cost evaluation are required.