Periodic Mobile Application (eMOM) With Self-Tracking of Glucose and Lifestyle Improves Treatment of Diet-Controlled Gestational Diabetes Without Human Guidance: A Randomized Controlled Trial.

BACKGROUND: Digitalization with minimal human resources could support self-management in women with gestational diabetes (GDM) and improve maternal and neonatal outcomes.

OBJECTIVE: To investigate whether a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes for women with diet-controlled gestational diabetes, without additional guidance from healthcare personnel.

STUDY DESIGN: Women with gestational diabetes were randomly assigned in a 1:1 ratio at weeks 24-28 to the intervention or the control arm. The Intervention arm received standard care and the periodic eMOM, while the control arm received only standard care. The Intervention arm used eMOM with a continuous glucose monitor, an activity tracker, and a food diary 1 week/ month until delivery. The primary outcome was the change in fasting plasma glucose from baseline to weeks 35-37. Secondary outcomes included capillary glucose, weight gain, nutrition, physical activity, pregnancy complications, and neonatal outcomes such as macrosomia.

RESULTS: In total, 148 women (76 in the intervention arm, 72 in the control arm; average age 34.1 ± 4.0 years; BMI 27.1 ± 5.0 kg/m2) were randomized. The Intervention arm showed a lower mean change in fasting plasma glucose compared to the control arm (difference: -0.15 mmol/L (-2.7 mg/mL); p = .022) and lower capillary fasting glucose levels (difference: -0.04 mmol/L (-0.7 mg/mL); p = .002). The Intervention arm also increased their intake of vegetables (difference: 11.8g/MJ; p = .043), decreased their sedentary behavior (difference: -27.3 min/day; p = .043), and increased light physical activity (difference: 22.8 min/day; p = .009) compared to the control arm. In addition, gestational weight gain was lower (difference: -1.3 kg; p =.015), and there were less newborns with macrosomia in the intervention arm (difference: -13.1 %; p = 0.036). Adherence to eMOM was high (daily use >90%), and the usage correlated with lower maternal fasting (p = .0006) and postprandial glucose levels (p = .017), weight gain (p = .028), intake of energy (p = .021) and carbohydrate (p = .003), and higher duration of the daily physical activity (p = .0006). There were no significant between-arm differences in terms of pregnancy complications.

CONCLUSION: Self-tracking of lifestyles and glucose without additional guidance improves self-management and the treatment of GDM, which also benefits newborns. The results of this study support the utilization of digital self-management and education tools in maternity care.