Adherence to a Diabetes Care Regimen Following Text Message Intervention in Pregnant Women With Diabetes

As a part of routine care, pregnant women without known diabetes undergo screening and testing for gestational diabetes either with a two-hour glucose tolerance testing or a one-hour glucose challenge test followed by a three-hour glucose tolerance test in the event of failure of the one-hour test.

Women who have been given the diagnosis of gestational diabetes mellitus (GDM) by failing this diabetes testing and who meet the inclusion and exclusion criteria shall be approached and offered enrollment in the study. Women with known type 2 diabetes mellitus (T2DM) (pre-gestational diabetes) and women diagnosed elsewhere with GDM who meet the inclusion and exclusion criteria will be offered enrollment when they establish prenatal care. Patients who consent to participate in the study shall be randomized to either the intervention or the contact control group. For randomization purposes, an equal number of notecards will be made for the two groups. These will all be placed in sealed envelopes and shuffled. At the time of patient inclusion, an envelope will be selected by the consenting practitioner. If a patient declines receiving text messages but consents to have her medical record reviewed for adherence to her diabetes care regimen and glycemic control, she will be enrolled in the standard of care control group. A baseline hemoglobin A1c (HbA1c) is obtained.

Patients in all groups shall receive initial diabetes education and started on an individualized diabetic diet regimen. Patients with GDM who develop a requirement for either oral medication or insulin will remain in the same group to which they were initially randomized. An HbA1c level is obtained every one to three months during pregnancy as well as near the time of delivery.

Patients in the intervention group will receive reminders based on their individual disease treatment. A text message shall be sent one day (12 to 36 hours) before appointments to remind about the appointment and with instructions to bring glucose and food records to the appointment. If medication changes are made at the appointment, the patient will receive a text message reminder the day after her appointment to reinforce the regimen. Postpartum patients who had GDM will receive a text message reminder to complete their glucose tolerance test. A reminder will be sent at 2 weeks postpartum followed by a reminder at 6 weeks and 10 weeks postpartum if the testing is not completed. Women with T2DM will be reminded to bring glucose and food records to their postpartum visits. Participants will be contacted through Google Voice which is a Google system requiring a secure login and password.

Patients in the contact control group will be enrolled in the text4baby program with assistance from a healthcare provider. As the study will conclude upon the patient's postpartum visit, she will be offered the option of discontinuing messages, which otherwise would continue through the infant's first year of life.