Abstract 190: Outcomes of doctor-nurse educator teamwork in managing diabetes in pregnancy

Background: The Diabetes Nurse Educators (DNE) maintain the link of communication between the doctor and the patient, beyond consultation hours. Digital services including video consultation (VC) and communication platforms like Whatsapp (WA) are useful tools for patients to connect with the medical team. This is particularly relevant in a dynamic condition like Gestational/Pre-gestational Diabetes (GDM/Pre-GDM). We analysed the glycemic and obstetric outcomes of GDM/PreGDM patients who were enrolled in the remote monitoring program with the DNE. Methods: Our Diabetes clinic has 3 DNE who are involved in remote monitoring of Diabetes. Once the doctor finishes the consultation, the patient and DNE exchange information on the clinical details and glucose checking pattern and frequency either in person or via WA. The patient then updates the nurse either daily/once in 3 days/ weekly based on the clinical requirement on WA and the nurse updates the physician at regular intervals and suitable adjustments to medication regimen is made. Patient is seen by the physician atleast twice each trimester either in the clinic or by VC with additional visits if recommended. We retrospectively analysed the glucose monitoring charts from June 2017 onwards and collected 82 patient charts with adequate information. Various data points including patient age, diagnosis and their medication regimen, glucose parameters and final pregnancy outcome were collected. Results: The mean (SD) age of the patients was 32 (4) years with the mean (SD) gestational age of presentation was 20 (9) weeks (range 4-33w) and almost equal numbers of GDM (n=40) and pre-GDM (n=42). The mean (SD) duration of follow up was 15.6 (10) weeks (range 2-51) with an average of 21 remote encounters with DNE for every patient. The medications required at the final follow up included Metformin only (n=8; 10%), Metformin+Basal insulin (n=4; 5%), Metformin+Prandial insulin (n=17; 21%), Prandial insulin only (n=5; 6%), Basal Only (1%) and 56% on Basal Bolus regimen. Basal insulin was changed from Detemir to NPH insulin in 8 patients (10%) and Metformin was stopped in 8 patients (10%) for concerns of IUGR or Oligoamnios. The average dose of Metformin used was 972 mg (range 500 to 2000). The mean (SD) total daily dose of insulin was 48 (40) units (range 4-164). A total of 24,790 capillary glucose values were analysed with a median of 227 readings per patient (range 45-866). A high fasting glucose values (>95) was noted in 1836 (7.4%), high post-breakfast glucose values (>140 in 1 hour or 120 in 2 hours) noted in 1924 (7.7%), high post-lunch glucose values in 1349 (5.4%) and high post-dinner glucose values in 1492 (6%). Moderate Hypoglycemia (Glucose < 70) was noted in 162 (0.65%) values and severe hypoglycemia (Glucose < 55) in 48 (0.2%) values. Majority of patients underwent LSCS (77%) with 92% undergoing term delivery and the mean (SD) birthweight of the newborn was 2.8 (0.5) kg. Conclusions: The Doctor-DNE team along with WA communication can help effectively manage GDM/ pre-GDM with extremely low rates of hypoglycemia (<1%) and keeping fasting and post meal hyperglycaemic rates <8%.