Gestational Diabetes is a temporary condition diagnosed at 24-28 weeks gestation, where the body is unable to maintain normal blood glucose levels due to insulin resistance during pregnancy. This condition is associated with obesity and is increasing in prevalence in western society and developing countries. In Asian countries prevalence of up to 17% has been reported. Although blood glucose control generally returns to normal levels following delivery of the baby, adverse clinical outcomes are common including delivery complications, infant complications often associated with high birth weight and increased risk of development of Type 2 diabetes for the mother within 5-10 years.
A recent Bangladeshi pilot clinical study (96 patients) by Professor Ashraf demonstrated a reduced number of mothers suffering pregnancy complications, reduced foetal weight (so reduced obstructed labour) and fewer babies requiring resuscitation (0 versus 12 in control group). The study design involved hospital admission and included an educational package to give patients control in dietary and exercise habits and instructions on the benefits of blood glucose sampling to reduce the symptoms of the disease. These results were encouraging but the increased clinical workload has economic costs preventing expansion to multiple centres across Bangladesh and India.
Adoption of telemedicine is proposed to have benefits in diabetes care in pregnancy and provides a potential solution which requires validation in Bangladesh. Mobile telephone apps are already available in western society to track dietary habits (eg MyFitnessPal) and activity (eg Strava, Apple health, Fitbit). Recent advances in diabetic blood glucose monitoring have also increased patient knowledge of their blood glucose levels via tools such as dexcom.
Development of the next generation of smartphone technology could provide knowledge to improve diabetes blood glucose control. To maximise patient benefit we will develop artificial intelligence (AI) to provide an interactive patient experience, modifying advice to GDM patients based on individual symptoms and knowledge base. Current UK packages such as the NHS endorsed OurPath, provides education and motivational advice to those investing to improve their health but without specialisation to enhance diabetes care. Our project will collect information from the clinicians to establish how to obtain successful outcomes, develop AI and pilot the technology in patients. This will automate labour intensive elements of the GDM patient service previously provided by Professor Ashraf’s team.