Final PresentationPreventing Type 2 diabetes onset among expectant mothers with gestational diabetes mellitus (GDM)

Kris, Emily, Kathi, & Yukiha

What’s the issue

● Approximately 7 out of 100 pregnant women develop GDM (CDC, 2014)● Many health complications for GDM mother and baby.

o Increased risk of: preterm delivery increased likelihood of needing emergency caesarean section excessive birth weight (babies >9lbs) babies have a higher risk of developing obesity and type 2

diabetes later in life maternal high blood pressure GD in future pregnancies mothers developing type 2 diabetes

Risk Factors

Women at risk of gestational diabetes mellitus (GDM)● Meet one or more of the following risk factors:

o Older than 25 years of ageo Family or personal health history of diabeteso High blood pressureo Previously delivered a baby weighing >9 lbs, or had an unexplained

stillbirtho BMI >30o From a higher risk ethnic group - Hispanic American, African

American, Native American, Southeast Asian, or Pacific Islander

Pilot Population Pregnant women with GDM living in Rhode Island (11.7%, CDC, 2014)

GoalsPrevent onset of type 2 diabetes (prenatal to postpartum)

Activity goals● Healthy, pregnant women in our population get at least 150 minutes per week of

moderate-intensity aerobic activity (e.g. brisk walking) during and after pregnancy (target

approximately 30 minutes a day)

Food Intake Goals● Track daily food intake

Glucose tracking goals● Track blood glucose levels according to the frequency recommended by their healthcare

providers

Our Audience

Tech in use...

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Pilot Details

Duration: 9 months● 24-28 weeks of gestation (screening for GDM) + 6 months post-partum

Management○ Partnerships between tertiary institutions and healthcare providers

■ already going to see doctor (aids compliance; prevent loss-to-follow-up)

○ Nurses/PAs as part of the research team■ Nurse part of research team

● know data, collect data, and integrate into care:○ decrease likelihood of ethical dilemma

Pilot Details

Marketing and Recruitment● Recruit via healthcare providers

○ Between 24 and 28 weeks of pregnancy○ Diagnosed with GDM○ Living in Rhode Island○ Age: not teenagers; 18 to 35 years old

● Marketing via Facebook ads, prenatal care classes, doctors’ offices

Pilot Details

Budget and opportunities for funding● Pay for PI, nurse● Cost of watches + apps● Pay for primary investigator, nurse● Cost of watches + apps● Project assistant● NIH - PA-14-180 mHealth Tools for Individuals with Chronic

Conditions to Promote Effective Patient-Provider Communication, Adherence to Treatment and Self-Management (R01)

Risks & Limitations

● Limited sample size● Maintaining compliance; loss-to-follow-up ● Closed entry into study ● Patient information obtained by anyone involved in the study must be

reviewed by the clinic, as they are ethically responsible for the patient’s well being

● Potential risk of the effect of wearable device on fetus, as this is yet unstudied

● Participation in the study cannot guarantee prevention of the development of type II diabetes after delivery

Expected Outcomes

● May lower rates of type 2 diabetes onset● May begin and maintain healthy physical activity pattern● Begin and maintain healthy blood glucose● Maintaining healthy diet

● Survey the pilot about their perceived compliance, ability to follow, and success in managing glucose levels

● Results could enable future studies● Results would enable investigators to pursue additional funding

The Next Steps

Evidence-Based Guidelines

From the National Institute of Child Health and Human Development:● Know blood sugar level and keep it under control● Eat a healthy diet, as recommended by healthcare provider● Regular, moderate physical activity● Maintain a healthy weight gain● Keep daily records of diet, physical activity, and glucose levels● Adhere to insulin and/or other medication prescriptions● Test urine for ketones, as per healthcare provider recommendations● Blood pressure checks, as recommended

Evidence-Based Guidelines

From the American Congress of Obstetricians and Gynecologists:

“Complete postpartum screening following a diagnosis of GDM”:● at the 38 week prenatal appointment,● at the birth hospital discharge visit● at the post-op visit following an operative delivery

Theoretical Frameworks

Health Belief Model

● Perceived benefits: More stable glucose levels; Increased exercise (data

visualized); Peer group of fellow recruits

● Perceived barriers: Limited access to safe walking/exercise areas; Unfamiliarity with

tech and monitoring glucose levels (host trainings and weekly check-ins by research

team)

● Perceived severity/susceptibility: Information from doctor about current symptoms

and potential prenatal/postpartum consequences for mother and fetus

● Self-efficacy: Real-time feedback and access to data trends; Each time you input

data, you’ve performed desired action (self reinforcement to increase self-efficacy)

● Cues to action: Push notifications; Text based reminders from research teams

Theoretical Frameworks

Social Support Theory

● Emotional: Peer group correspondence

● Instrumental: Feedback from apps; Reminders from research teams

● Informational: from HCP and research team

● Appraisal: Data visualization