Highlights
- •Clinical pharmacist-led app significantly promoted GDM women’s medication compliance.
- •Clinical pharmacist-led app improved GDM women’s insulin injection technique.
- •Clinical pharmacist-led app reduced their insulin requirement during pregnancy.
- •Well antepartum and puerperal glycemic control were observed after app intervention.
- •App usage was related to a 22.9% reduction in Neonatal Intensive Care Unit admission.
Abstract
Aim
To investigate the efficacy of a clinical pharmacist-led smartphone application (app)
on medication adherence, insulin injection technique (IIT) and diabetes-related outcomes
among women with gestational diabetes mellitus (GDM) receiving insulin therapy.
Method
In all, 124 women were randomly (1:1 ratio) assigned to receive app intervention plus
usual care (intervention) or usual care (control), and were followed up till 12 weeks
postpartum. Interventions centralized on medication adherence and IIT. Primary outcome
was medication adherence assessed by the 5-item Medication Adherence Report Scale.
Secondary outcomes included IIT, insulin requirement, prepartal and puerperal glycemic
control, hypoglycemia, and pregnancy and neonatal outcomes.
Results
A total of 119 patients completed the follow-up evaluation (58 intervention, 61 control).
Significant more women with high medication adherence in the intervention group was
observed (69.0% vs. 34.4%, p = 0.000). The other notable benefits (all p < 0.05) included
patient percentage with appropriate IIT, lesser preprandial insulin dose, patient
proportion with both qualified prepartal FPG and 2 hPG, and puerperal FPG or HbA1c,
fewer hypoglycemia, and lower neonatal intensive care unit (NICU) admission rate.
Cesarean delivery rate was higher among intervention cases (p < 0.05). Qualified prepartal
glycemic control was related to high medication adherence and proper IIT. NICU admission
was associated with complicated with gestational hypertension, deficient medication
adherence and premature rupture of fetal membrane.
Conclusion
Combined with usual care, clinical pharmacist-led smartphone app might be a valid
tool for GDM management.
Keywords
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Article info
Publication history
Published online: February 12, 2022
Accepted:
February 6,
2022
Received in revised form:
February 4,
2022
Received:
November 1,
2021
Identification
Copyright
© 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
