Telehealth Program Helps Manage Diabetes in Pregnancy
When Norristown resident Megan Eggleston developed gestational diabetes while pregnant in 2018, and again in 2021, it was quite a challenge to do several insulin injections every day while caring for her children. She also had to manage multiple finger sticks daily to test her blood sugar and make sure it was staying under control.
But reporting her results and staying in close touch with her care team at Einstein Medical Center Montgomery was easy thanks to Einstein’s Diabetes in Pregnancy Management Program.
Pregnant patients in the program either have type 1 or type 2 diabetes before pregnancy or develop gestational diabetes during pregnancy.
“They record their blood sugar numbers using a phone app and send results to the team once or twice a week,” says Leanne Lawrence, RD, LDN, a dietitian specially trained in diabetes. “Or they can use a paper log sheet, take a photo of it, and send it by text or email.”
Visits with the care team often take place on a digital platform such as Doximity or Zoom from the comfort of the patient’s home or workplace.
Early Use of Telehealth
Einstein’s Diabetes in Pregnancy Management Program through telehealth began in 2017, years before telehealth came into widespread use during the pandemic.
“The team was amazing and the program was incredibly easy and convenient with so much of the communication through text messages,” says Eggleston. “With my two young kids, it would have been really stressful to arrange childcare if I had to go into the office for my appointments.”
“Results show that when access to care is made easy and barriers are removed, patients are much more likely to follow through with care, which results in improved health outcomes,” says Adeeb Khalifeh, MD, a maternal-ftal medicine specialist (high-risk obstetrician), who oversees the program.
“Continually monitoring their blood sugar enables them to play an active role in their care and know how they’re doing every step of the way,” he says.
Eggleston, who also has a 5-year-old boy, Carter, is thankful for the two healthy girls she delivered while participating in the program – Sawyer in 2018 and Amelia in November 2021.
Any pregnancy involving diabetes is considered high-risk, whether a patient has type 1 or type 2 diabetes before pregnancy or develops gestational diabetes during pregnancy.
Referral to the Program
About 100 patients from Einstein Medical Center Philadelphia and Einstein Medical Center Montgomery are in the Diabetes in Pregnancy Management Program at any given time. Patients are referred to the program by their obstetrician (OB) or nurse-midwife, whom they continue to see for their regular prenatal care. The OB and the diabetes team work together to prepare a care plan and share all the patient information, including test results.
The diabetes team is made up of maternal-fetal medicine specialists, a nurse practitioner and diabetic educator, and a dietitian. Of the patients enrolled at any given time, 80% have gestational diabetes and 20% have type 1 or type 2 diabetes.
Gestational diabetes is diabetes that is diagnosed for the first time during pregnancy. As with other types of diabetes, gestational diabetes affects how our cells use sugar (glucose). Insulin is a hormone that allows the body’s cells to use glucose for energy. Gestational diabetes develops during pregnancy because of insulin resistance, which is caused by other hormones produced during pregnancy that can make insulin less effective.
Gestational diabetes causes high blood sugar that has to be closely monitored and managed to ensure a healthy pregnancy and baby. The good news is that the condition can be controlled by making lifestyle changes such as eating healthy foods, exercising, and if needed, taking insulin or other medication.
Risks of Gestational Diabetes
Diabetes that is not well controlled causes the baby’s blood sugar to be high. As a result, the baby grows extra-large. This can result in the need for a Cesarean section (C-section), an operation to deliver the baby through the mother’s belly, which requires a longer recovery than a vaginal delivery.
Poorly controlled diabetes of any type also can increase the risk of high blood pressure, which can lead to a potentially dangerous condition called preeclampsia.
People with diabetes managed with insulin or other diabetes medications can sometimes develop low blood sugar, causing weakness, confusion, headaches or irregular heartbeat. It can be avoided if blood sugar is closely monitored and regulated.
How the Program Works
A patient who is referred to the Diabetes in Pregnancy Management Program has a telehealth visit with the maternal-fetal medicine specialist, the diabetes educator and the dietitian. The diabetes educator and dietitian offer nutrition tips for diabetes and explain what blood glucose values are and how they affect pregnancy, how to use a glucose monitor, how and when to do finger sticks, and how to record and report the results.
The risks for mother and baby when blood sugars are not controlled are discussed, with the emphasis on maintaining a healthy diet and the role of medications in case they need to be used. The overall care plan may include monthly ultrasounds to check the baby’s growth and weight and non-stress tests to monitor the baby’s heartbeat.
The aim of the program is to bring blood glucose numbers down through diet and exercise. If that doesn’t work sufficiently, then medications may be prescribed. Oral medications such as metformin are prescribed first, although some patients may need to move on to insulin injections for better control.
The team reviews the weekly blood-sugar logs and contacts the patient promptly if there are concerns.. Patients have a weekly visit with one of the team members but can reach out with questions or concerns or request a telehealth visit at any time.
Communication happens through telehealth, texting or phone calls. Reminders to send in the blood-sugar logs are sent out weekly.
Between six weeks and three months after giving birth, patients are screened to see if they have type 2 diabetes or a condition called pre-diabetes. After delivery, the pancreas is usually able to make enough insulin to keep blood sugars normal. However, about 45 to 65% of patients will have gestational diabetes again in a later pregnancy.
Fifty percent of patients who have gestational diabetes will develop type 2 diabetes later in life. That’s why it’s so important to have routine glucose screenings, eat a healthy diet and exercise regularly throughout their life, to help prevent diabetes.
For more information about the Diabetes in Pregnancy Management Program, call 215-456-7406.
Photo: Diabetes in Pregnancy Management Program team, left to right: Jessica Acevedo, CRNP, WHNP; Leanne Lawrence, RD, LPN; and Adeeb Khalifeh, MD.