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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (5): 645-652    DOI: 10.31083/j.ceog.2020.05.2212
Original Research Previous articles | Next articles
Impact of clinical pharmacist intervention on blood glucose control and perinatal outcomes in gestational diabetes mellitus through a diabetes management system
C. Ji1, L.J. Sun2, L.T. Li1, J. Ma1, W.H. Ge1, *(), X. Zhao3, *()
1Department of Pharmacy, Affiliated Drum Tower Hospital, Medical School of Nanjing University, No.321 Zhongshan Road, Nanjing, P.R. China
2Department of Endocrinology, Sir Run Run Hospital, Nanjing Medical University, No.109 Longmian Road, Nanjing, P.R. China
3The Pharmaceutical college of Inner Mongolia medical university, No.5 XinHua Street, Hohhot, P.R. China
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Abstract  

Background: Very few studies have assessed the role of a clinical pharmacist in women with gestational diabetes mellitus (GDM). To improve pharmaceutical care, we explored a method to improve the control of blood glucose and perinatal outcomes in females with GDM through the application of a diabetes management system. Methods: A randomized controlled trial was conducted from October 2017 to October 2018 for 200 outpatients with GDM. In the study, a diabetes management system with pharmaceutical care was used for the intervention group. The clinical outcomes of all patients were recorded at the end of delivery. Results: From one sample of 200 patients, 169 finished the research. Compared with the control group, patients in the intervention group manifested greater reductions in fasting plasma glucose (5.22 ± 0.37 vs. 6.05 ± 1.06 mmol/L; P = 0.018), 2 h postprandial plasma glucose (6.66 ± 0.57 vs. 9.69 ± 1.58 mmol/L; P = 0.00), and glycated hemoglobin A1c corrected values (1.02 ± 0.12 vs. 1.16 ± 0.22; P = 0.023). Moreover, the rate of polyhydramnios was significantly lower in the intervention group than in the control group (0% vs. 10.59%; P = 0.003) as well as significantly fewer macrosomia in the intervention group (7.14% vs. 18.82%; P = 0.038). Conclusions: Using a diabetes management system, clinical pharmacists can improve the control of blood glucose and perinatal results in GDM females. With a diabetes management system, the comprehensive management of GDM is a new model for pharmaceutical care in the future.
Key words:  Clinical pharmacist      Diabetes management system      Gestational diabetes mellitus      Blood glucose control      Perinatal outcome     
Submitted:  06 July 2020      Accepted:  31 August 2020      Published:  15 October 2020     
Fund: 2018YX010/Nanjing Pharmaceutical Association, Changzhou Four Hospital
*Corresponding Author(s):  W.H. Ge,X. Zhao     E-mail:  6221230@sina.com;amy-zhaoxue@126.com
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C. Ji, L.J. Sun, L.T. Li, J. Ma, W.H. Ge, X. Zhao. Impact of clinical pharmacist intervention on blood glucose control and perinatal outcomes in gestational diabetes mellitus through a diabetes management system. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 645-652.

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https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.05.2212     OR     https://ceog.imrpress.com/EN/Y2020/V47/I5/645

Figure1.  — (a) Diabetes management system. The DMS was divided into seven main module functions, specifically for system login, newly diagnosed information, inspection information, evaluation system, follow-up system, data management and retrieval statistics. (b) Flowchart of study patients. Total up to 200 pregnant women were enlisted and randomized, and 169 (85 in the control group and 84 in the treatment group) finished this research and were covered in the comparative analysis.

Table 1  — Baseline characteristics.
Variable Control（n = 85） Intervention (n = 84) P value
Age, yrs 29.98 ± 3.81 30.05 ± 3.49 0.883
Gravidity 1.92 ± 0.98 1.83 ± 0.83 0.548
Parity 0.34 ± 0.57 0.24 ± 0.43 0.185
BMI, kg/m2 23.34 ± 4.34 23.54 ± 3.95 0.752
HbA1c corrected value 1.01 ± 0.18 1.02 ± 0.16 0.893
SBP 121.18 ± 11.98 120.33 ± 12.27 0.652
DBP 73.48 ± 10.41 74.21 ± 10.64 0.652
Table 2  — Changes in outcome parameters at the start and end of the study in control and intervention groups.
Outcome Intervention (n = 84) Control (n = 85) p value between groups
Baseline Final p value Baseline Final p value
FPG (mmol/L) 6.12 ± 1.04 5.22 ± 0.37 0.02a 6.26 ± 1.26 6.05 ± 1.06 0.241 0.018a
2h PPG (mmol/L) 10.15 ± 1.89 6.66 ± 0.57 0.00a 10.34 ± 2.23 9.69 ± 1.58 0.03a 0.00a
HbA1c corrected 1.02 ± 0.16 1.02 ± 0.12 0.932 1.01 ± 0.18 1.16 ± 0.22 0.02a 0.023a
SBP (mmHg) 120.33 ± 12.27 134.21 ± 10.75 0.034a 121.18 ± 11.98 135.57 ± 13.89 0.036a 0.674
DBP (mmHg) 74.21 ± 10.64 93.86 ± 10.04 0.025a 73.48 ± 10.41 95.67 ± 11.23 0.026a 0.552
Table 3  — Changes in blood lipid levels in control and intervention groups.
Outcome Intervention (n = 84) Control (n = 85) P value
TC (mmol/L) 5.38 ± 1.16 5.62 ± 1.42 0.023a
TG (mmol/L) 3.30 ± 2.37 3.86 ± 2.99 0.018a
LDL-C (mmol/L) 2.28 ± 0.71 2.45 ± 0.95 0.196
HDL-C (mmol/L) 1.72 ± 0.36 1.55 ± 0.44 0.01a
Table 4  — Changes in fetal abdominal circumference in the B ultrasound.
Normal Above tde range Below tde range
Control（n = 85） 56 (65.88%) 28 (32.94%) 1 (1.18%)
Intervention（n = 84） 76 (90.48%) 6 (7.14%) 2 (2.38%)
P value < 0.01a < 0.01a
Figure 2.  — Mean change in HbA1c values during study duration. Mean change in HbA1c values were dramatically higher in the control group than in the intervention group. * Shows statistical significance.

Table 5  — Clinical outcomes among the infants and their mothers in control and intervention groups.
Outcome Intervention
(n = 84)		 Control
(n = 85)		 P value
Women
Gestational weight gain1 0.77 ± 0.39 0.94 ± 0.48 0.015a
Gestational weight gain2 1.18 ± 0.64 1.45 ± 0.87 0.021a
Premature delivery 1/84 (1.19%) 3/85 (3.53%) 0.076
Gestational age at delivery (weeks) 38.46 ± 1.77 37.83 ± 2.11 0.1
Cesarean delivery 42/84 (50%) 55/85 (64.7%) 0.054
Polyhydramnios 0/84 (0%) 9/85 (10.59%) 0.003a
Infants
Fetal malformation 6/84 (7.14%) 5/85 (5.88%) 0.766
Macrosomia 6/84 (7.14%) 16/85 (18.82%) 0.038a
Intrauterine fetal death 0/84 (0%) 2/85 (2.35%) 0.497
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