Effectiveness of clinical pharmacist-led smartphone application on medication adherence,insulin injection technique and glycemic control for women with gestational diabetes receiving multiple daily insulin injection: A randomized clinical trial |
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| Institution: | 1. First Affiliated Hospital of Shantou University Medical College, Department of Clinical Pharmacy, Shantou, China;2. First Affiliated Hospital of Shantou University Medical College, Department of Pediatrics, Shantou, China;3. First Affiliated Hospital of Shantou University Medical College, Department of Endocrinology, Shantou, China;4. First Affiliated Hospital of Shantou University Medical College, Obstetrical Department, Shantou, China;1. Centre of Research for Development (CORD), University of Kashmir, Srinagar, Jammu and Kashmir 190006, India;2. Department of Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir 190006, India;3. Department of Endocrinology, SKIMS, Srinagar, Jammu and Kashmir 190011, India;1. Department of Medicine, University of Hong Kong, Hong Kong;2. State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong;1. Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia;2. Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, USA;3. Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia;4. Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia;5. Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia;1. Çankiri Karatekin University Faculty of Health Nursing Department, Eski Devlet Hastanesi Yan?, Merkez/Çankiri, 18200, Turkey;2. Ankara Yildirim Beyazit University Faculty of Nursing Department, Esenbo?a Külliyesi Dumlup?nar Mahallesi Esenbo?a/Ankara, Turkey;1. Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;2. Endocrinology and Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;3. Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;4. Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;5. Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India |
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| Abstract: | AimTo investigate the efficacy of a clinical pharmacist-led smartphone application (app) on medication adherence, insulin injection technique (IIT) and diabetes-related outcomes among women with gestational diabetes mellitus (GDM) receiving insulin therapy.MethodIn all, 124 women were randomly (1:1 ratio) assigned to receive app intervention plus usual care (intervention) or usual care (control), and were followed up till 12 weeks postpartum. Interventions centralized on medication adherence and IIT. Primary outcome was medication adherence assessed by the 5-item Medication Adherence Report Scale. Secondary outcomes included IIT, insulin requirement, prepartal and puerperal glycemic control, hypoglycemia, and pregnancy and neonatal outcomes.ResultsA total of 119 patients completed the follow-up evaluation (58 intervention, 61 control). Significant more women with high medication adherence in the intervention group was observed (69.0% vs. 34.4%, p = 0.000). The other notable benefits (all p < 0.05) included patient percentage with appropriate IIT, lesser preprandial insulin dose, patient proportion with both qualified prepartal FPG and 2 hPG, and puerperal FPG or HbA1c, fewer hypoglycemia, and lower neonatal intensive care unit (NICU) admission rate. Cesarean delivery rate was higher among intervention cases (p < 0.05). Qualified prepartal glycemic control was related to high medication adherence and proper IIT. NICU admission was associated with complicated with gestational hypertension, deficient medication adherence and premature rupture of fetal membrane.ConclusionCombined with usual care, clinical pharmacist-led smartphone app might be a valid tool for GDM management. |
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| Keywords: | Smartphone application Clinical pharmacist Women with gestational diabetes mellitus Insulin therapy Medication adherence Insulin injection technique Glycemic control Pregnancy and neonatal outcomes |
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