Telemedicine in the treatment of diabetic pregnancy

Abstract Good diabetic patient control requires that treatment be continuously adapted to the patient's behaviour and the control achieved, in order to get the glucose level within a predetermined target range. Several approaches have been documented. Self‐monitoring of blood glucose (SMBG) has become a major element in the care of individuals with diabetes mellitus. In managing the pregnant diabetic patient it must be considered that two patients are being treated: the mother and the fetus. It appears that the strict maintenance of euglycaemia before conception and during the prenatal period may favourably influence perinatal mortality and morbidity. Assuming that easy access to diabetes care providers would allow patients to make appropriate adjustments to their management and thus improve their metabolic control, a controlled trial comparing customary management with continuous diabetes care providing access to patients' self‐monitored glucose data, was undertaken in diabetic pregnancy. In the study, two groups were compared. The Dianet group (7 diabetic pregnant women) used a Diva System: they stored their data in blood glucose meters (ROMEO) with memory to store and transmit data when inserted into JULIET, and this data was directly carried through a telephone modem (JULIET + BOXTEL) to our service every week, and they came to the clinic every two weeks. The control group (10 pregnant diabetic women) recorded their data in a diary and came to the diabetes clinic every week. The use of the telphone modem (DIANET system) stimulated both the patient and the diabetes specialist to keep closer control of blood glucose levels. This might be especially useful in the treatment of diabetes in pregnancy because the patients are usually highly motivated to achieve better metabolic control, as was shown by (a) faster optimisation of blood glucose profiles, (b) better pre‐breakfast and pre‐lunch blood glucose concentration, (c) fewer hypoglycaemic episodes, in the DIANET versus the control group.