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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...
*
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