Piloting the NetHealth model of care for remote glucose monitoring in gestational diabetes: glycaemic outcomes — ASN Events
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Piloting the NetHealth model of care for remote glucose monitoring in gestational diabetes: glycaemic outcomes (#128)

Alia N Tun Ismail 1 2 , Michael Do 1 2 , Rachel Hicks 3 , David Simmons 1 2 3
  1. Campbelltown Hospital, Campbelltown, NSW, Australia
  2. Macarthur Diabetes Service, Campbelltown Hospital, Campbelltown, NSW, Australia
  3. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

Background

Gestational diabetes mellitus (GDM) requires frequent glucose monitoring and timely treatment escalation to optimise perinatal outcomes. Digital health platforms may improve access to care and reduce the burden of appointments for patients and clinicians. We aimed to evaluate glycaemic outcomes in women enrolled in a pilot remote glucose monitoring program (NetHealth) via a GDM-specific smartphone app.

Methods

We conducted a retrospective cohort study of women with GDM diagnosed using Australasian Diabetes in Pregnancy Society (ADIPS) 2025 criteria enrolled in the NetHealth program at Campbelltown Hospital between 1st August 2025 and 28th February 2026. Participants uploaded capillary blood glucose (BGL) readings via a smartphone application, which were reviewed remotely to guide initiation and titration of pharmacotherapy.

Glycaemic target attainment was defined as ≥70% of BGL readings to reflect recommended time in range for continuous glucose monitoring. This was applied to pregnancy-specific BGL targets per American Diabetes Association (ADA) guidelines ( fasting BGL <5.3 mmol/L and 2-hour postprandial BGL <6.7 mmol/L), as well as ADIPS targets (fasting BGL <5.3 mmol/L and 2-hour postprandial BGL <7.0 mmol/L). Secondary analyses included fasting and postprandial target attainment and hypoglycaemia (defined as blood glucose <3.5mmol/L).

Results

A total of 329 women were enrolled in NetHealth during the study period, of whom 59.9% achieved ADA targets and 69.9% achieved ADIPS targets. The mean proportion of glucose readings within target overall 73.4% (ADA) and 78.1% (ADIPS). Fasting targets were achieved less frequently than postprandial targets (69.2% vs 75.1% (ADA); 69.2% vs 81.6% (ADIPS), both p<0.001). A total of 87 hypoglycaemic events occurred across 59,534 readings (0.15%) using a threshold of <3.5 mmol/L, with 13.1% of women experiencing at least one episode.

Conclusion

Remote glucose monitoring using the NetHealth model is a feasible approach to managing GDM. Glycaemic target attainment was higher using ADIPS criteria compared with ADA criteria, reflecting differences in postprandial thresholds. Fasting glycaemic control remained more difficult than postprandial control, highlighting the challenge of fasting hyperglycaemia specific to insulin resistance mechanisms in pregnancy. Hypoglycaemia rates were low. Further evaluation is required to assess perinatal outcomes and scalability of this model.