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Can Nurse-Based Management Screening Ensure Adequate Outcomes in Patients With Gestational Diabetes? A Comparison of 2 Organizational Models

Nollino, Laura, MD; Marcon, Maria Lisa, PgDip; Kiwanuka, Edward, MD, PhD; Merlotto-Cazziola, Michela, RN; Sambataro, Maria, MD; Sambado, Luisa, PhD; Trevisiol, Enrica, PHARMD; Scantamburlo, Antonella, PgDip; Mauri, Alessandra, PSYCH; Busato, Enrico, MD; Pirolo, Roberta, PHARMD; Boaretto, Massimo, MD; Turolla, Licia, MD; Faronato, Pietro Paolo, MD; Cadamuro-Morgante, Marco, MD; Migot, Roberta, PSYCH; Paccagnella, Agostino, MD

doi: 10.1097/QMH.0000000000000202
Quality Improvement
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SDC

Background: Gestational diabetes mellitus (GDM) is an impaired glucose tolerance with onset or first recognition during pregnancy. The purpose of this study is to evaluate the clinical outcomes of a blood glucose monitoring protocol implemented by nurses and dietitians in a diabetes team to the previously established protocol of direct monitoring of GDM patients by a diabetologist.

Methods: Two groups of patients were formed: The first group was based on a traditional protocol (P1: 230 patients) with patients' blood glucose constantly checked by a diabetologist. In the second structured group (P2: 220 patients) patients were referred to a diabetologist only if they required insulin therapy.

Results: The number of medical visits (P2: 1.28 ± 0.70 vs P1: 3.27 ± 1.44; P < .001) and the percentage of patients with hypoglycemia (P2: 6.8% vs P1: 15.2%; P < .006) were found to be lower in group P2 than in group P1. In both groups, a direct relationship was found between a parental history of diabetes and the risk of GDM (odds ratio [OR]: P1 = 2.2 [1.17-4.12]; P2 = 2.5 [1.26-5.12]). In group P1, it was observed that hyperweight gain in patients who were already overweight before becoming pregnant significantly increased the risk of macrosomia (OR: 3.11 [1.39-25.7]), whereas this was not detected in patients in group P2. In group P2, a correlation was found between macrosomia and insulin therapy (OR: 0.066 vs 0.34). In group P1 and group P2, a correlation was observed between insulin therapy and a family history of diabetes (OR: 2.20 vs 2.27), and a body mass index of greater than 30 kg/m2 in group P2 (OR: 3.0 vs 1.47).

Conclusions: The data we collected show that creating a structured protocol for GDM management reduces the number of medical visits required by patients without increasing the risk of hypoglycemia, macrosomia, or hyperweight gain during pregnancy.

Endocrinological, Metabolic and Nutrition Unit, Department of Specialized Medicine, Local Health Authority (ULSS 2), Treviso, Italy (Drs Nollino, Kiwanuka, Sambataro, Sambado, Trevisiol, and Paccagnella and Mss Marcon, Merlotto-Cazziola, and Scantamburlo); Inpatient Psychological Service, Local Health Authority (ULSS 2), Treviso, Italy (Mss Mauri and Migot); Obstetrics and Gynecology Unit, Maternal Department, Local Health Authority (ULSS 2), Treviso, Italy (Dr Busato); Local Pharmacy Service, Local Health Authority (ULSS 2), Treviso, Italy (Drs Trevisiol and Pirolo); Internal Medicine Unit, Department of Medicine, Local Health Authority (ULSS 1), Belluno, Italy (Dr Boaretto); Medical Genetics Unit, Local Health Authority (ULSS 2), Treviso, Italy (Dr Turolla); and General Management, Local Health Authority (ULSS 2), Treviso, Italy (Mr Faronato and Dr Cadamuro-Morgante).

Correspondence: Maria Lisa Marcon, PgDip, UOC Malattie Endocrine, del Metabolismo e della Nutrizione, Ospedale Cá Foncello, 31100 Treviso, Italy (marialisa.marcon@aulss2.veneto.it).

The author acknowledge the following: Barbara Almoto, MD, Maria Rosaria Amoriello, RN, Eros Bagolin, MD, Carla Baruffi, MD, Lisa Campagnol, RN, Paolo Cenerelli, PgDip, Tania Ciani, RN, Tiziana Citro, MD, Lorena Fornaro, PgDip, Marta Giometto, MD, Daniela Lessi, RN, Mayla Longo, PgDip, Samuela Michieletto, PgDip, Mauro Rigato, PhD, Maria Teresa Semenzin, PgDip, Cristian Tonon, RN, and Zora Zuricich, RN (Endocrinological, Metabolic and Nutrition team, Department of Specialized Medicine, Local Health Authority [ULSS 2], Treviso, Italy); Valentina Sosero, PSYCH (Inpatient Psychological Service, Local Health Authority [ULSS 2], Treviso, Italy); Mery Bottarel, OB/GYN tech, and Maria Maddalena Serra, MD (Obstetrics and Gynecology Unit, Maternal Department, Local Health Authority [ULSS 2], Treviso, Italy); Alessandra Bettiol, PHARMD, and Alessandro Chinellato, PHARMD (Local Pharmacy Service, Local Health Authority [ULSS 2], Treviso, Italy); Boaretto Massimo (Internal Medicine Unit, Department of Medicine, Local Health Authority (ULSS 1), Belluno, Italy); Turolla Licia (Medical Genetics Unit, Local Health Authority (ULSS 2), Treviso, Italy); and Marco Cadamuro-Morgante (General Management, Local Health Authority (ULSS 2), Treviso, Italy).

The authors' contributions are as follows: L.N., M.L.M., M.S., A.M., and A.P. designed protocol and developed the methodology, directed and coordinated the research, and provided conceptual and technical guidance for all aspects of the project. L.N., M.L.M., M.M.C., A.S., E.B., and R.M. recruited patients and collected data and have prepared databases to compare the data and finally they analyzed data and results. E.K., E.B., R.P., M.B., and L.T. interpreted data and critically revisited results and conclusions. P.P.F. and M.C.M. approved the project.

The data sets used and analyzed during the current study are available from the corresponding author on reasonable request.

The authors declare that they have no competing interests.

The authors declare no conflicts of interest.

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