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

Abstract

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 intensive medical nutrition therapy (MNT) via shorter, 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, supported by 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 analyzed 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 analyzed 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 models. Birth outcomes did not differ significantly, though gestation was longer in MOC 2 and 3 (38.5, 38.6, 38.9 weeks; p = 0.048). GDM treatment varied: diet management (31.9%, 37.1%, 30.9%), insulin for fasting (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 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.