Wednesday, December 27, 2006

Online Diabetes Monitoring, Follow-Up for Gestational Diabetes

Via Diabetes Today:
Internet Helps People with Diabetes Monitor Blood Sugar
Patients load self-testing results to a website monitored by physicians, nurses, and a dietician, who respond as needed. A recent study found lower average blood sugar levels and fluctuations in the internet group compared to those who weren't uploading levels and receiving responses. I'm guessing it's not so much "The Internet" that was important in improving the patients' levels, but the fact that they had more frequent contact with clinicians via the online system compared to the group that made regular office visits only. It's not clear whether the patients also had better long term outcomes with regards to common diabetes-related complications - this was essentially a study of lab values. Still, good use of technology, if clinicians have the staff/time/$ to do this for more patients.
Citation for the study: Cho JH, Chang SA, Kwon HS, Choi YH, Ko SH, Moon SD, Yoo SJ, Song KH, Son HS, Kim HS, Lee WC, Cha BY, Son HY, Yoon KH. Long-Term Effect of the Internet-Based Glucose Monitoring System on HbA1c Reduction and Glucose Stability: A 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care. 2006 Dec;29(12):2625-2631. Read the abstract

Follow-up Often Lacking After Gestational Diabetes
"According to a report in the current issue of the journal Obstetrics and Gynecology, only 45 percent women in the study group underwent postpartum glucose testing, which is recommended by the American Diabetes Association and the American College of Obstetricians and Gynecologists. More than one third of those tested (36 percent) had persistent abnormal glucose levels, Dr. Michelle A. Russell, from the Department of Veterans Affairs Medical Center in White River Junction, Vermont, and colleagues report."
Citation for the study: Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol. 2006 Dec;108(6):1456-62. Read the abstract
This article is in the same issue of Obstetrics & Gynecology that has the piece about young pregnant women fearing that they were infertile. Hoo, there's a lot of good stuff in this issue. A couple of findings from the full article:
  • "Women who returned to the hospital-based clinic were twice as likely be tested as were women seen in the hospital-affiliated community clinics"
  • The rate of testing was 3 times higher in women who attended the postpartum visit. This is sort of a no-brainer - if women don't go for follow-up, they won't get the recommended follow-up testing.
  • No relationship was found between the women's actual risk of diabetes and the likelihood that they got the postpartum test.
  • "The rate of testing in Hispanic women was 52% higher than in non-Hispanic white women. None of the other demographic factors were significantly associated with testing."
    These results are difficult to interpret because they are affected by both providers who may or may not perform the recommended test, and women who may or may not complete the recommended follow-up, or mention to community providers their history of gestational diabetes. Nonetheless, it seems that women are not receiving the proper follow-up for gestational diabetes a lot of the time.
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