Advanced technology aims to prevent excess weight gain and manage gestational diabetes in pregnant women

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SMART-GDM clinical trial by the NUH aims to test the efficacy of a Smartphone App in Managing Gestational Diabetes in Pregnant Women

Glucometer device by Janacare, called “Aina” Photo Credit: Jana Care

Gestational diabetes (GDM) is a type of diabetes that is first recognized and develops during pregnancy- generally the second half of the pregnancy. Singapore has one of the highest and increasing rates of GDM in the world, affecting 20-30% of pregnant women i.e. almost 1 in 4 pregnant women. GDM poses a significant impact on the women and their babies’ health.

“Unrecognized or poorly controlled GDM can lead to a host of problems for the baby and even death of the baby inside the womb. Mothers with GDM are also at increased risk of developing high blood pressure and a condition called pre-eclampsia during pregnancy. Significantly, GDM is not a problem that ends at delivery. There is a long-term aspect to GDM because women who have had it have a seven-fold increased risk of developing type 2 diabetes in the future compared with those who did not have GDM,” says Dr. Claudia Chi, Consultant with NUH Department of Obstetrics & Gynaecology and a Co-investigator of the SMART-GDM study.

Now, a smart way to help pregnant women with gestational diabetes (GDM) manage their condition better is underway. A novel clinical trial, “SMART-GDM” by the National University Hospital (NUH) aims to test the efficacy of a smartphone app in preventing excessive weight gain among pregnant women with GDM.

The SMART- GDM involves the use of a new mobile application (HABITS-GDM), a newly-HSA-approved device that turns any smartphone into a glucometer (Aina device) and a blue-tooth enabled weighing scale. It also includes HABITS-GDM – a self-administered, smartphone coaching mobile application for self-management of GDM that was jointly developed by NUH, NUS Saw Swee Hock School of Public Health (SSHSPH) and Janacare.

Some of the ways the HABITS-GDM app helps in management of GDM are –

  • Short, personalized interactive lessons and daily tips to help mothers with GDM.
  • The app helps mothers understand the nutritional content and how their food intake is linked to their blood sugar levels. The nutritional content of most locally available foods are available in the app, customized to the local context.
  • With the help of the HSA-approved Aina Blood Glucose monitoring system, blood sugar readings can be taken regularly, and the readings are saved automatically in the HABITS-GDM app. Weekly reports are generated so that doctors can work with their patients to assess progress.

Dr. Claudia Chi, Consultant with NUH Department of Obstetrics & Gynaecology and a Co-investigator of the SMART-GDM study explains, “This app will give an overall picture and trend of GDM management. We will not be alarmed if there is only one high blood glucose reading, however, if it is persistently high readings, we will try to help the lady to optimize her glucose control – by helping her improve the dietary intake with the aid of the dietician, promoting her to have regular exercise that is suitable for her during pregnancy. However, if the readings are consistently high, it could signal the body’s need for help and that is when medical treatment may need to come in. This generally applies to only 10% of women affected with GDM.” Thus, the app promotes self-management of GDM and allays the anxiety which a pregnant woman may feel during pregnancy with GDM. 

Diet plays a very important role in the management of GDM. However, she clarifies that gestational diabetes doesn’t mean the woman has been on a poor diet.

“It is rather, a reflection of how the particular woman’s body works. During pregnancy, the pregnancy hormones act against insulin, and therefore, for every pregnant woman during pregnancy, their body has to produce enough insulin to overcome that and majority of women are able to do so. So, whatever they eat, their body can cope with it, and they will not have high sugar levels. However, in women with gestational diabetes, their body is not able to produce that extra amount of insulin that is required. Thus, when they eat something, they are more likely to have a tendency to have high sugar levels. Therefore, to compensate that (the absence of extra insulin) it becomes imperative to choose the right food to eat, which won’t spike your sugar levels. Thus, diet is a way of management of GDM. “

It is difficult for women with GDM to know what foods to choose, because foods can have variable effects on blood sugar levels depending on the specific variety, preparation and combination of foods consumed. This app links the meals women consume to their blood sugar levels after meals, providing them with personalized guidance on food choices,” saya Associate Professor Rob van Dam, Domain Leader, Epidemiology domain, SSHSPH.

The clinical trial started in September 2017 and aims to recruit 340 participants.

Dr Yew Tong Wei, site Principal Investigator of SMART-GDM clinical trial, and Consultant at NUH Division of Endocrinology shares, “If proven effective, the study will result in a unique clinical application for GDM that integrates lifestyle coaching with glucose monitoring. It will help patients manage their GDM in the comfort of their own home as they go about their daily lives. Clinical outcomes, in terms of the current pregnancy and the future metabolic health of both mothers and their offspring throughout the later phases of their lives, will hopefully be improved.”