December 7, 2017

Telemedicine simplifies gestational diabetes treatment

When 32-year-old Dana Shaw was diagnosed with gestational diabetes mellitus (GDM) during her pregnancy with her first child, she was happy to learn she could meet with a physician about the condition through video conferencing rather than taking time off from work for an appointment.

Dana Shaw, RN, and her husband, Dallas, welcomed a baby girl, Rion, in August. After she was diagnosed with gestational diabetes mellitus, Dana met with Shubhada Jagasia, MD, MMHC, through video conferencing to manage her health during pregnancy. (photo by Katie Mosley)

When 32-year-old Dana Shaw was diagnosed with gestational diabetes mellitus (GDM) during her pregnancy with her first child, she was happy to learn she could meet with a physician about the condition through video conferencing rather than taking time off from work for an appointment.

Typically, pregnant women are screened for GDM at 24-28 weeks of pregnancy, and when her screening indicated GDM, Shaw was referred by her Vanderbilt nurse-midwife to Shubhada Jagasia, MD, MMHC, professor of Medicine, who leads the Gestational Diabetes Clinic at Vanderbilt Eskind Diabetes Center.

After an initial visit to the clinic for an evaluation, Jagasia offered Shaw the option of doing future visits by using a video conferencing app. Shaw is a nurse in the Pediatric Hematology/Oncology Clinic at Monroe Carell Jr. Children’s Hospital at Vanderbilt, and this option meant less time away from her patients.

“It was helpful that I could just take 10 minutes, go to the break room and have what was essentially an office visit instead of having to try to figure out when I could go back to see her,” Shaw said. “It was just like a regular appointment. I sent a week’s worth of blood sugar readings through the messaging system of My Health at Vanderbilt. During the virtual visit, we went over my readings, and she let me know I was doing well.”

GDM occurs in an estimated 10-14 percent of pregnancies. Genetic predisposition, along with pregnancy weight gain and placental hormones decrease the body’s sensitivity to the insulin a woman is able to produce causing blood sugar (glucose) to elevate.

Though some women require medication or insulin injections, most GDM cases can be managed through exercise and dietary changes, and GDM usually goes away after delivery. Gestational diabetes can cause multiple complications for the mother and her baby, including significant blood pressure elevation in the mother called preeclampsia and increased body weight in the baby, possibly requiring a surgical delivery. The long-term health of both mother and child can be positively impacted by strict blood glucose control during pregnancy.

Currently, the virtual GDM option is only available to individuals covered by the Vanderbilt Employee Health Plan offered by Aetna, but Jagasia and Vanderbilt Telehealth are optimistic that the program will expand as more insurance providers realize the value of telemedicine.

“It’s quite encouraging that our employee health plan is an early adopter of reimbursement for direct-to-patient telemedicine,” said Amber Humphrey, MBA, assistant director of Vanderbilt Telehealth. “The support of the employee health plan allows Vanderbilt University Medical Center (VUMC) to demonstrate telemedicine’s efficacy, cost-savings and patient satisfaction to other payers.”

Jagasia established the Gestational Diabetes Clinic in 2000, and the clinic is one of a group of programs that has received national recognition from the American Diabetes Association. The clinic receives referrals from obstetricians and midwives at Vanderbilt, as well as from other local practices.

Given the early success, Jagasia has also begun offering thyroid disease evaluations during pregnancy in the same manner as the GDM telemedicine appointments, as well as expanding this type of care to certain patients with diabetes. This is especially beneficial for patients that live further away from the Eskind Diabetes Center.

“There is definitely a trend in healthcare to move toward telemedicine, as opposed to more traditional, face-to-face visits,” Jagasia said. “The advantages are timely, easy and cost-effective access to patients without a reduction in the quality of clinical care. Another major advantage is reduced time away from work. Providing this service to patients with medical conditions that are compatible to virtual management is key to its success.”

“Gestational diabetes is typically a disease of the late second or early third trimester of pregnancy, making it a short-lived disease. I see the patient soon after diagnosis for a face-to-face visit, which helps me establish rapport. During this visit I thoroughly examine and educate the patient about treatment options and when necessary provide insulin education as well. Given the nature of the diagnosis and treatment, subsequent care can be conducted virtually. I am always able to convert this into a face-to-face visit, if required.”

The telemedicine program for women with GDM began in July, and patient response has been overwhelmingly positive, Jagasia said.

A recent survey of patients by VUMC shows more than 90 percent of responders are interested in using more telemedicine services.

“I think once people experience the quality and convenience of telemedicine for the appropriate medical conditions, there will be very few who will want to go back to the previous model of care,” she said.

Michelle Griffith, MD, assistant professor of Medicine, oversees the Vanderbilt Diabetes Telemedicine Program, and is working with other providers to develop telemedicine models in their practice.

“Dr. Jagasia is the first person in the Department of Medicine to use telemedicine clinically to provide direct-to-patient care,” Griffith said. “It’s not necessarily suitable for every medical condition. We use our best clinical judgment to make sure we’re always providing the best service to patients. For things where you spend time talking to the patient and looking at labs to make decisions, telemedicine is really ideal to get that access to them more easily. It really helps us meet the patient where they are.”

Following a trouble-free pregnancy, Shaw and her husband, Dallas Shaw, welcomed a baby girl, Rion, to the family in August. Everyone’s healthy and doing well, Shaw said.