Balancing convenience and care in Gestational Diabetes management: A retrospective evaluation of a three-part evolving model of care using remote patient monitoring in the Geelong region. — ASN Events
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Balancing convenience and care in Gestational Diabetes management: A retrospective evaluation of a three-part evolving model of care using remote patient monitoring in the Geelong region. (#131)

Kate van Berkel 1 , Kabir Ahmad 2 , Alexandra Stokes 1 , Anna Anderson 3 , Esha Kathpal 3
  1. Dietetics Department, Barwon Health, Geelong, Victoria, Australia
  2. Research Development Unit, Barwon Health, Geelong, Victoria, Australia
  3. Endocrinology, Barwon Health, Geelong, Victoria, Australia

Background: 
Barwon Health Diabetes Referral Centre (DRC) piloted a quality improvement project to reshape gestational diabetes mellitus (GDM) care using Remote Patient Monitoring (RPM). RPM provides medical nutrition therapy (MNT) via more frequent, shorter and responsive contacts rather than pre-scheduled appointments.  

Traditional care at Barwon Health (Model of Care 1, MOC 1) consisted of pre-booked appointments with Credentialled Diabetes Educators (CDE) and dietitians. In May 2024, Model of Care 2 (MOC 2) implemented a dietitian-led RPM service using the NetHealth program, with patient group education. From December 2024, Model of Care 3 (MOC 3) added a Complex GDM clinic for high-risk patients requiring in-person support, including interpreter services or complex mental health care, with a dietitian as well as CDE support for insulin therapy if required. Guidelines recommend at least three dietitian visits to reduce pharmacotherapy and provide adequate MNT education.

Aim: 
This retrospective study evaluated whether dietitian-led RPM achieves outcomes comparable to traditional care. 

Methods: 
A comparative cohort study analysed the most recent 100 births per model with data collected before ADIPS 2025 diagnostic changes. Data included demographics (maternal age, postcode, Indigenous status), clinician contacts, GDM treatment (diet or insulin), and birth outcomes (large for gestational age [LGA], macrosomia, shoulder dystocia, neonatal hypoglycaemia, birthweight, gestational age, mode of birth). Data were analysed using Stata 18; categorical variables were compared with chi-square tests, continuous variables with Kruskal–Wallis tests (p < 0.05). 

Results: 
Demographics were similar across MOC. Birth outcomes did not differ significantly, except for gestation (38.5, 38.6, 38.9 weeks; p = 0.048). GDM treatment varied: diet management (31.9%, 37.1%, 30.9%), insulin for fasting only (33.3%, 17.8%, 48.9%), insulin post meals only (22.2%, 66.7%, 11.1%), insulin for fasting and post meals (47%, 23.5%, 29.4%) (p = 0.016). Dietitian contacts increased significantly in RPM models (median contacts: MOC 1 = 1.09, MOC 2 = 5.55, MOC 3 = 7.77). 

Conclusions: 
Dietitian-led RPM provided GDM care comparable to traditional models in terms of birth outcomes, while enabling more responsive MNT and reducing mealtime insulin requirements. When combined with in-person support for complex cases, RPM achieved the best outcomes.