Can Nurse-Based Management Screening Ensure Adequate Outcomes in Patients With Gestational Diabetes? A Comparison of 2 Organizational Models. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Nollino, Laura; Marcon, Maria Lisa; Kiwanuka, Edward; Merlotto-Cazziola, Michela; Sambataro, Maria; Sambado, Luisa; Trevisiol, Enrica; Scantamburlo, Antonella; Mauri, Alessandra; Busato, Enrico; Pirolo, Roberta; Boaretto, Massimo; Turolla, Licia; Faronato, Pietro Paolo; Cadamuro-Morgante, Marco; Migot, Roberta; Paccagnella, Agostino
• Is Part Of: Quality management in health care. Volume 28:Issue 1(2019)
• Publication Date: 2019-01
• Subjects: diabetes -- gestational -- nutrition -- obesity -- organization; Medical care -- Quality control -- Periodicals; Total quality management -- Periodicals; Health services administration -- Periodicals; 362.1068
• DOI: 10.1097/QMH.0000000000000202
• Languages: English
• ISSNs: 1063-8628

Abstract

Abstract : Background: Gestational diabetes mellitus (GDM) is an impaired glucose tolerance with onset or first recognition during pregnancy. The purpose of this study is to evaluate the clinical outcomes of a blood glucose monitoring protocol implemented by nurses and dietitians in a diabetes team to the previously established protocol of direct monitoring of GDM patients by a diabetologist. Methods: Two groups of patients were formed: The first group was based on a traditional protocol (P1: 230 patients) with patients' blood glucose constantly checked by a diabetologist. In the second structured group (P2: 220 patients) patients were referred to a diabetologist only if they required insulin therapy. Results: The number of medical visits (P2: 1.28 ± 0.70 vs P1: 3.27 ± 1.44; P < .001) and the percentage of patients with hypoglycemia (P2: 6.8% vs P1: 15.2%; P < .006) were found to be lower in group P2 than in group P1. In both groups, a direct relationship was found between a parental history of diabetes and the risk of GDM (odds ratio [OR]: P1 = 2.2 [1.17-4.12]; P2 = 2.5 [1.26-5.12]). In group P1, it was observed that hyperweight gain in patients who were already overweight before becoming pregnant significantly increased the risk of macrosomia (OR: 3.11 [1.39-25.7]), whereas this was not detected in patients in group P2. In group P2, a correlation was found between macrosomia and insulin therapy (OR: 0.066 vs 0.34). In group P1 and group P2, a correlation was observed between insulin therapy and a family history of diabetes (OR: 2.20 vs 2.27), and a body mass index of greater than 30 kg/m 2 in group P2 (OR: 3.0 vs 1.47). Conclusions: The data we collected show that creating a structured protocol for GDM management reduces the number of medical visits required by patients without increasing the risk of hypoglycemia, macrosomia, or hyperweight gain during pregnancy.