An Internet-Based Program for Managing Diabetes in Pregnancy

1. An Internet-Based Program for Managing Diabetes in Pregnancy  Pamela Angelus, RN, MSN Farzaneh Sabi, MD Rita Driggers, MD Cherrel Christian, RN, CDE Seong K. Mun, Ph.D. Betty Levine, MS

2. Diabetes in Pregnancy 7% of pregnancies complicated by diabetes Fetal and maternal complications of diabetes in pregnancy fetal death large for gestational age birth trauma hypoglycemia hypertensive disorders Early identification and careful management helps reduce risks to the mother and her infant Approximately…………………………… A number of ……………………………. However, with Identification and frequent ……….and is the case at NNMCApproximately…………………………… A number of ……………………………. However, with Identification and frequent ……….and is the case at NNMC

3. Project Objectives Introduce the MyCareTeam™ system into existing prenatal services at the National Naval Medical Center Determine if the MyCareTeam™ system improves diabetes management in this group of pregnant women

4. Eligibility Criteria Pregnant patients with Type 1, 2 or Gestational Diabetes < 32 weeks gestation at time of enrollment > 18 years of age Access to standard telephone line or PC Read and write English Absence of medical or psychological co-morbidity that would interfere with ability to use MCT™ This slide lists:This slide lists:

5. Implementation Plan MCT™ training at enrollment with “Tech Support” BG data uploaded 1-2 times per week via Acculink Modem connected to standard telephone line or direct-connection to PC Unlimited access to “Diabetes in Pregnancy” on-line learning materials Website monitored by Study Nurse/CDE with support from NNMC residents, clinic nurse and dietician

6. Implementation Plan - continued Subjects surveyed twice during the study 4 weeks after enrollment 35 - 38 weeks gestation, or within 7-10 days after delivery Study completed at time of delivery or after second survey completed February 2005 – February 2007 42 subjects enrolled 45 infants delivered (3 sets of twins)

7. Objective 1 Results Introduce the MyCareTeam™ system into existing prenatal services at the National Naval Medical Center Was the “Technology” available and did it perform as planned? NNMC restricted access to computers and the Internet Equipment modem and glucose meter errors ISIS Center server and network issues programming errors < 1% downtime Caused the website to be unavailable < 1% during the two years Interesting observation. Arranged direct connect Caused the website to be unavailable < 1% during the two years Interesting observation. Arranged direct connect

8. Objective 1 Results - continued Participants 96% used a home computer to access MCT™ many lacked standard telephone line Did participants like communicating with their Providers using MCT™? Those reporting a positive experience with using MCT™, also reported that they liked using it to communicate with their providers (p<.02) Did participants learn about diabetes from MCT™? Liked learning about diabetes (p<.001) During the survey, women complained that providers didn’t respond quickly enough During the survey, women complained that providers didn’t respond quickly enough

9. Objective 2 Results Determine if the MyCareTeam™ system improves diabetes management in this group of pregnant women Evaluation based on maternal and fetal variables and blood glucose data Compared frequency of: Glucose data – UPLOADS System – LOGINS Light Users (< 1 time/week) Heavy Users (> 1 time/week)

10. Maternal Variables No significant differences between the Light and Heavy Users based on Frequency of UPLOADS and LOGINS for the these variables. Maternal age Diabetes type Pre-eclampsia (hypertensive disorders of pregnancy) Cesarean section rate Duration of participation

11. Fetal Variables By Frequency of UPLOADS This is a comparison of: This is a comparison of:

12. Fetal Variables By Frequency of LOGINS This is a comparison ofThis is a comparison of

13. Mean Fasting and 2-Hour Post-Prandial BG Levels By Frequency of UPLOADS

14. Mean Fasting and 2-Hour Post-Prandial BG Levels By Frequency of LOGINS Fasting < 95Fasting < 95

15. Discussion Small group of participants Patients are already closely monitored with frequent blood testing and clinic visits High-functioning groups will probably find the resources necessary for a positive outcome with or without a Web-based management program Lower mean GA could account for lack of LGA infants While we didn’t get the results we expected…….While we didn’t get the results we expected…….

16. Comments and Reactions Especially helpful with the demanding prenatal schedule of diabetes visits – “I liked this system because it saved me from having to go to an appointment every week.” Allowed provider to continue care during patient’s relocation to new “duty station”. Past participants are referring women to the study. Helpful for patients who falsify their BG data Dyslexic patients

17. Acknowledgements Thank you United States Army Medical Research and Materiel Command for their support under contract #W81XWH-04-2-0002 Roche Diagnostics Partners at NNMC – Dianne Bloom, RN, MSN and Susan Stone, RN, MSN Alan Neustadtl, PhD and Jim Grigsby, PhD for their statistical support