Smartphone app shown to be effective in helping women control diabetes during pregnancy

Gestational diabetes mellitus affects one in five pregnant women in Singapore. Having elevated blood sugar levels can cause complications for both mother and the baby.
Gestational diabetes mellitus affects one in five pregnant women in Singapore. Having elevated blood sugar levels can cause complications for both mother and the baby.ST PHOTO: NEO XIAOBIN

SINGAPORE - A smartphone app designed for women with gestational diabetes mellitus (GDM) has proven effective in helping the women control their blood sugar levels and prevent GDM-related complications in their babies.

This was found in a 14-month clinical trial conducted by researchers from the National University Hospital on 340 pregnant women in Singapore.

GDM affects one in five pregnant women in Singapore. Having elevated blood sugar levels can cause complications for both mother and the baby.

In most cases, the condition develops from the middle to the end of pregnancy, and resolves after the women give birth.

The app, Habits-GDM, incorporates a coaching programme that guides users on diet and exercise. It also helps them track their blood sugar levels and weight, and a chat function connects them to healthcare professionals.

The use of this app by the pregnant women with GDM - in addition to usual care - has helped to lower their average blood sugar readings.

Overall, neonatal complications were also significantly lower among those who used the app. Only 38.1 per cent of their babies developed complications, while 53.7 per cent of babies in the control group whose mothers did not used the app suffered complications.

Generally, having a healthy diet and regular exercise is sufficient to control GDM. Currently, patients work with a dietitian on an individualised healthy eating plan and are also taught how to monitor their own blood sugar levels at home as well as note down their readings. Medication may be given if these interventions fail.

However, face-to-face consultations and lifestyle intervention programmes are often resource intensive and not delivered in a timely manner, as patient support and feedback typically surface only during consultations. The manual recording of readings may also be inaccurate and incomplete. Patients may also be overwhelmed with information and not know how to contact the nurse or doctor if needed.

These challenges led to the creation of Habits-GDM.

NUH partnered medical technology firm Jana Care to co-develop the app, which incorporates a coaching programme designed to equip women with GDM with the means to independently manage and monitor their own condition.

The programme also takes into consideration the nutritional requirements and exercise restrictions during pregnancy, as well as the need to prevent excessive gestational weight gain.

Users get access to 12 interactive lessons and tools to monitor their diet, self-monitoring of blood sugar, physical activity and weight.

This content was co-developed by endocrinologists, obstetricians, diabetes educators and dietitians in NUH. Participants could go through the lessons, which were in bite-sized modules, at their own pace and revisit them whenever they desired.

Habits-GDM also contains a database of common foods in Singapore. Trial participants were also cued via automated messages to record their diet, and the app also had a manual chat function where the healthcare team could be reached and had to respond within 24 hours.

Ms Joyce Ke, 38, who had GDM during her first and second pregnancies, said: "During my first pregnancy, I had to remind myself to track the blood sugar level manually, which was very troublesome. I had to be very conscious all the time, and set reminders on my phone to note it down on pen and paper.

"My second pregnancy was during the trial period and it was much more convenient to use a smartphone-enabled app. I liked the lessons as well, which I can easily access on the go. I could also use the chatbot and pose questions to the healthcare team, which was very helpful."

Dr Yew Tong Wei, a consultant at the division of endocrinology in NUH and also the principal investigator of the study, said: "The app does not only make monitoring of blood sugar, food, physical activity and weight gain during pregnancy more convenient, it allows care and support for better self-management to be delivered remotely through telemedicine. This can be timely and effective, as we have seen during this times of Covid-19.

"While the mobile app cannot entirely replace healthcare professional, as the medical needs of each individual are unique, the technology-enabled coaching channel can empower the patient in self-care and monitoring, and cut down on frequent hospital visits."

GDM is associated with higher risks of pre-term birth, cesarean section, and high blood pressure that develops in pregnancy.

Babies may also grow larger than average for their gestational age and may have low sugar levels after birth, causing them to require additional care in the neonatal unit. Women with GDM are more likely to develop diabetes later in life.