Specialist commentator comments
Comments on this technology were invited from specialist commentators working in the relevant fields and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
Three specialist commentator responses were received. One specialist commentator was involved in developing GDm‑Health and uses the app for all new patients with gestational diabetes. The other 2 commentators were not familiar with GDm‑Health, but 1 was aware of a similar technology.
One commentator considered GDm‑Health to be a natural progression in the use of telehealth in this field. Similar technologies are used in the NHS for people with type 1 diabetes, but not consistently for those with gestational diabetes. An advantage of GDm‑Health is that it allows information to be passed back to the clinician remotely, unlike other systems.
The second commentator described GDm‑Health it as being extremely innovative and a major improvement on the previous paper-based system used in their centre. This commentator stated that other telehealth systems are available, but reported that that they cannot be used as a communication tool to advise the patient on diet or medication. With GDm‑Health, the data can be viewed and midwives can communicate with the patient, and keep a communication record in 1 place. GDm‑Health also facilitates data collection for the whole patient population, allowing clinical audit and improvement.
The third commentator stated that GDm‑Health is a very innovative way for people to take control of their own blood glucose management.
One commentator considered that GDm‑Health would potentially improve patients' quality of life because of a reduced need for clinic appointments. However, they raised concerns that remote advice does not allow healthcare professionals to explore any surrounding issues (such as diet and exercise).
The second commentator stated that GDm‑Health allows the transfer of patients' blood glucose data without them having to either send emails, contact midwives by phone or show their readings at the clinic. This commentator stated the system can be used to positively encourage patients with good levels of compliance by sending messages of reassurance, which provides reinforcement for some patients to adhere to dietary modification and avoid medication. They continued that using GDm‑Health reduces the need for hospital visits. The system is beneficial for patients who have difficulty using email or phone and for some people who may struggle to record and communicate their blood glucose readings. If there are no measurements, or the measurements are higher than targets, the system alerts and prompts the midwife to contact the patient to provide the information or treatment that they need. Patients who have difficulty reading and writing have no problem with this system. It allows deviations from normal measurements to be identified and responded to very quickly.
A third commentator stated that many people work during pregnancy, so using GDm‑Health would give them control of their own monitoring needs. This commentator noted that the population of people with gestational diabetes is increasing.
All 3 specialist commentators indicated that 1 of the main system benefits would be the possibility of reducing the number of clinic visits needed for people with gestational diabetes.
One specialist commentator reported that assuming an obstetric review is not needed every 2 weeks, glucose levels could be monitored and changes to treatment recommended remotely. This would free up clinic appointments for more complicated patients. This commentator highlighted that the time taken by healthcare professionals to interpret the remotely observed readings and then make suggested changes should be taken into account.
The second commentator stated that using GDm‑Health has shown major time savings for diabetes midwives. They explained that the GDm‑Health system includes a secure database of patient information that cannot be altered by either patient or staff, and therefore provides greater security from a governance point of view. There is also the facility to download information for audit data, allowing performance management and improvement.
The third commentator highlighted the need for the clinic to have access to the software that supports the app and highlighted potential difficulties in implementing the system, specifically in terms of costs of implementation and ongoing maintenance.
All 3 commentators thought that some training would be needed for both users and healthcare professionals.
One commentator considered that GDm‑Health system would be limited to patients with gestational diabetes (that is, it would not be suitable for patients with pre-existing diabetes). The same commentator considered that clinical outcomes were unlikely to be affected, but that use of GDm‑Health would provide an acceptable alternative to more frequent face-to-face clinic visits for patients.
In contrast, the second commentator used GDm‑Health for all pregnant patients with diabetes (including type 1 and type 2), because the database facilitates better information gathering so that all patients have the same standard of care. This commentator felt that it is refreshing to have a system developed by professionals who understand both patient and professional needs.
None of the commentators was aware of any safety or security issues with GDm‑Health, but 1 stated there would need to be safety measures in place to ensure that people with abnormal readings are followed up in a timely manner.