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Case study: Better monitoring and fewer hospital visits for women who develop diabetes during pregnancy

Overview summary

An innovative digital health system developed by researchers and engineers working with frontline clinicians is helping women who develop diabetes during pregnancy to better manage their condition and make fewer hospital visits. Oxford AHSN played a key role in establishing the proof of concept, spreading the pilot from a single hospital to multiple sites across a region of 3.3 million people.

Feedback from testing with almost 2,000 women demonstrated the system to be safe, robust and user-friendly, bringing many benefits for patients and services alike. There were improvements in reliability, convenience and efficiency. It showed better glucose control and a reduction in clinic visits by eligible women of approximately 25%, freeing up hospital capacity and improving efficiency. One unit estimated the time saving as an hour each day.

The product has now secured an industry partner opening-up possibilities for accelerated spread and commercialisation across the UK and beyond.

Challenge/problem identified

Gestational diabetes mellitus (GDm) affects about one in ten pregnancies, approximately 100,000 women across England every year – and numbers are rising. It can lead to complications for mother and baby. Careful monitoring of blood glucose levels is vital for successful management. Conventional treatment involves a combination of paper diaries (completed up to six times a day) and fortnightly check-ups in hospital where medication and diet are adjusted if necessary. These hospital visits are time-consuming and can be stressful for women in the latter stages of pregnancy. It can also be difficult for hospital staff to respond as quickly as they would like to changes in patients’ condition. Patients can inadvertently introduce errors through manual recording of results.

Actions taken

gestational diabetes monitoring deviceAn obstetrician wanted to improve remote monitoring and reduce the number of hospital visits made by women with gestational diabetes. She worked with the Institute of Biomedical Engineering at the University of Oxford, supported by the NIHR Oxford Biomedical Research Centre, to develop a digital health solution known as GDm-Health. It uses a smartphone app to track blood glucose levels, and enable swift communication between pregnant women with gestational diabetes and specialist midwives. Data is transferred simply and securely in real time, enabling instant review and feedback.

Clinicians and patients have been closely involved in the development of GDm-Health. Initially, it was only available on android phones loaned out by maternity units. Based on feedback this was extended to iOS products, with patients able to download the app to their own devices.

GDm-Health was initially piloted in one hospital. Input from the Oxford AHSN enabled wider testing at three more NHS trusts.

Impact/outcomes

By March 2017 almost 2,000 women had taken part in the regional pilot. Feedback demonstrated improvements in reliability, convenience and efficiency. It showed better glucose control and a reduction in clinic visits by eligible women of approximately 25%, freeing up hospital capacity and improving efficiency. One unit estimated the time saving as an hour each day.

With gestational diabetes affecting around 6,000 women each year in the Oxford AHSN region, adoption by all maternity services in the region could lead to thousands fewer hospital visits and savings of hundreds of thousands of pounds.

The GDm-Health system enables monitoring of blood glucose readings in line with the NICE Diabetes in Pregnancy Guideline, 2015.

Recorded benefits include:

  • accurate, real-time readings from patients, transferred electronically
  • flexibility for patients to add supplementary diet information
  • recording medication doses at each episode
  • staff alerted if no readings coming through or readings out of range, making it easier to prioritise workload.
  • Patient-friendly – especially with patients who are not good with other technology such as emails or who have literacy/numeracy problems.

The GDm-health device won the Best Digital Initiative award in the Quality in Care Diabetes Award 2014.

An evaluation of GDm-Health was included in an independent evaluation of digital health apps carried out by the York Health Economics Consortium in 2016 (see page 4).

The Oxford AHSN helped the innovation find an industry partner (Drayson Technologies) in February 2017 to further test, develop, spread and commercialise the GDm-Health system. Read more here.

Supporting quotes

“It was handy to know that I was in constant touch with somebody and that I would get a message if there was something to worry about. We live about an hour away so having fewer appointments as a result of using this kit helped a lot.”Vanessa Galli-Wara, gestational diabetes patient

“Previously we would receive an email from the patient, then précis their readings, record those readings manually on paper records and then respond by email to the patient with medication/dose recommendations. This was laborious and allowed for transcribing errors. Oxford AHSN adapted the database to our needs so we collect additional info on each patient at delivery and download it at the end of the year for audit purposes. This now takes approximately one day instead of six weeks. We would find it almost impossible to manage without the system now.” – Rachel Crowley, Diabetes specialist midwife, Royal Berkshire Hospital, Reading

“We have combined world-class engineering and clinical research with feedback from frontline NHS staff to create products that deliver real benefits to patients.” – Prof Lionel Tarassenko, Head of Engineering Science at the University of Oxford

“These products have shown in clinical trials that they improve patient health outcomes and reduce costs for the NHS. We are delighted to … complete clinical evaluation and deploy these products more broadly across the NHS.” – Lord Paul Drayson, Chairman and Chief Executive of Drayson Technologies 

Plans for the future

Having secured an industry partner (Drayson Technologies) in February 2017, the focus in 2017/18 will be on further testing, development, spread and commercialisation across a wider area.

National clinical or policy priorities addressed

  • Care and Quality
  • Funding and Efficiency
  • Health and Well Being
  • Driving Economic Growth

Start and end dates

2014-ongoing

Contact

Lauren Davis, Clinical Innovation Adoption Project Manager, Oxford AHSN

Lauren.davis@oxfordahsn.org   07917 837822

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