Reminder Systems to Increase Compliance With Glucose Logging in Gestational Diabetes: A Systematic Review & Meta-analysis

Objective: We sought to evaluate the effectiveness of reminder systems in improving patient compliance with blood glucose monitoring in gestational diabetes in a meta-analysis of randomized controlled trials. Data sources: Scopus, PubMed, CINAHL and the Cochrane Library were searched from inception through October 2021. Study eligibility criteria: Randomized control trials (RCTs) that examined reminder-based systems (i.e. technology assisted or phone based) to prompt pregnant patients with gestational diabetes to monitor glucose levels (compliance) versus traditional management without reminder systems were included. Studies were excluded if they examined only qualitative outcomes, examined patients with pre-existing diabetes or those in which the control group included another intervention rather than standard care. Study appraisal and synthesis method: Primary outcome was patient compliance, defined as the number of glucose values provided by the patient divided by the number of instructed glucose values. Secondary outcomes were maternal mean blood glucose values, 2 hour glucose tolerance test results postpartum, cesarean section rate, neonatal intensive care admission and rates of large for gestational age or macrosomia. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI). Results: Seven RCTs including 863 patients were included in our review. Reminder systems were associated with a statistically significant increase in patient compliance in blood glucose monitoring (83.5% versus 68.2%, MD 15.87%, 95% CI 10.94 to 20.8). Reminder systems were associated with a significant decrease mean blood glucose values (Mean difference -5.63, 95% CI -8.1 to -3.15) and in the rate of delivery by cesarean section (RR 0.66, 95% CI 0.49 to 0.88). Other outcomes including neonatal intensive care unit admissions, fetal macrosomia, large for gestational age infants, and two-hour glucose tolerance tests results postpartum were not significant between the two groups. Conclusion: The use of reminder systems for patients with gestational diabetes increases patient compliance with blood glucose monitoring, decreases mean blood glucose values and is associated with a decreased risk of cesarean section.