If you’ve got patients with gestational diabetes, you know that the majority of the management occurs outside of the office. You can have the best protocols for visits, run the labs, perform the ultrasounds, and provide patient education, but it’s what that patient is doing in the day-to-day that greatly influences the outcomes. Gestational diabetes (GDM) requires full buy-in from the patients.

You want nothing more than your patients with gestational diabetes to feel empowered to manage their blood sugars confidently. Are there proven ways to facilitate patient-driven participation in prenatal care? Fortunately, the answer is yes. 

Patient engagement is a hot topic of research. Most providers realize that overall satisfaction and outcomes are dependent on collaborative care. Today, we’re exploring some of the best ways to improve patient engagement in GDM.

1. Empathy

When talking with your patients, your reaction to concerns, struggles, and feelings matters. Your patients want to feel understood and validated. In one study involving health coaches, it was found that when coaches frequently used empathy, patients were more highly engaged in their goals.¹ The research team concluded that counseling has a great impact on engagement, thereby making the intervention effective.

You’re likely in a hurry with a schedule loaded with patients. So how do you show empathy during your brief visits? Rather than jumping straight to unsolicited advice, be curious about your patient. Let them know you’re listening by actively displaying verbal and non-verbal cues (i.e., nodding or affirming). Acknowledge their feelings and concerns and try to connect on a personal level. 

Another way to show that you are responsive to a patient’s needs is by considering their values and preferences when choosing a treatment plan.

2. Shared Decision-Making

Your patient has had consistent numbers above target and you need to initiate insulin. However, they feel ashamed and are hesitant to start. Employing shared decision-making with your patients may empower them to take those difficult next steps. There is a continuing conversation where they collaborate with you on a care plan. 

This starts at diagnosis. Having an honest conversation about how GDM progresses and occasionally requires insulin frames the treatment in a faultless and positive way. At every visit, you use your expertise to address any uncertainties and concerns without judgment so that if the time for insulin comes, your patient feels comfortable with the treatment. 

It’s not surprising that patients do better when their treatment aligns with their personal beliefs and goals. Involving your patients is a method of care that shows compassion and provides an opportunity to build trust.²

3. Trustworthy Support

It’s nearly impossible to follow the recommendations of someone you don’t trust. You want to be the go-to for your patients when they are seeking guidance for their GDM. When evaluating engagement, this review highlighted several factors that contributed to patient success, and one of those was information trustworthiness and support.³ 

Building trust with your patient requires clear communication (two-sided) and full transparency regarding their condition.⁴ When you take the time to listen to your patient’s concerns, you are building a foundation for an effective working relationship. 

Furthermore, offering convenient self-management tools can help reinforce this trust and empower your patients to engage in their treatment plans.

4. Convenience

Life is busy. However, this busyness can be amplified in the third trimester, especially with GDM. Increased visit frequency, ultrasounds, non-stress tests, fingersticks, glucose logging, food records, and regular physical activity can all be burdensome. A common barrier to adequate diabetes self-management is inconvenience. 

Research has shown that convenience is a facilitator that increases patient motivation and independence.⁵ Some strategies to enhance the convenience of GDM care include continuous glucose monitoring to eliminate fingersticks, offering flexible scheduling options, and providing easy access to diabetes education. 

Services like remote patient monitoring (RPM) and virtual appointments allow the patient to access GDM care in a convenient location. Instead of arranging for childcare or time off from work to attend an office visit, telehealth offers the patient a convenient and effective mode of care.

5. Telehealth

Physical examination is an obvious component of prenatal care, but some services, like diabetes education, are perfect for telehealth. In patients with GDM, telehealth interventions may be more successful in lowering the rate of c-section and decreasing the two-hour postprandial glucose level of GDM patients than standard therapy.⁶

Telehealth may be an adjunct to care that improves outcomes after delivery as well. The postpartum period is often a time when patients are lost to follow-up. A recent study found that there are ways to enhance engagement with postpartum care in pregnancies complicated by GDM (and preeclampsia).⁷

While telehealth is often underutilized, there’s increasing insurance coverage to expand care. Likewise, the integration of other related technology into routine prenatal care is becoming more accessible. 

6. Apps and Other Digital Interventions

Most of your pregnant patients have grown up in the digital age and are extremely comfortable with technology. In fact, paper logs are likely more difficult to manage than an interactive app for those with GDM. 

Smartphones can be useful tools that may improve diabetes self-care behaviors. Interventions that combined motivational interviewing with a smartphone application to promote physical activity levels in women with GDM were widely accepted and participants were highly engaged.⁸ 

Additionally, digital interventions are often most acceptable when they are relevant to the target audience, are user-friendly, and consider personalization preferences.⁹ Apps can be used anywhere, so they are convenient and can complement in-person obstetrics visits and diabetes education.

7. Comprehensive Diabetes Education

There’s a lot involved in GDM education—pathophysiology, diet, exercise, medications, stress management, sleep, etc. You’ve probably recognized you can’t thoroughly address all of these things. There’s nothing wrong with outsourcing to create a robust patient experience and improve maternal and infant outcomes. 

Diabetes care and education specialists are trained to assess education needs and guide patients through self-care practices. And that’s exactly what your patients need. Women with GDM want timely and comprehensive education around gestational diabetes that is personalized and tailored for them.¹⁰ 

Other factors that have been shown to improve care include increasing support for women and having active engagement of their family members.

8. Social Support

In order to have buy-in from your patients, they have to feel supported—not only in your office but in their own environments as well. Social support from family, friends, and peer groups is key for participation in gestational diabetes care behaviors and long-term success.¹¹

Involving your patient’s partner or primary support person may motivate your patient to make necessary lifestyle changes. A study surveying pregnant participants found that women thought partner involvement would improve their success with healthy eating and physical activity, as well as enhancing bonding between them.¹²

Key Takeaways

Gestational diabetes is a condition that is primarily self-managed. To improve outcomes, blood glucose levels need to be kept within the target range. The majority of the work is the responsibility of the patient, but as the medical expert, you can empower them to make behavior changes by:

• Showing empathy
• Sharing decision making
• Building trust
• Providing convenient options
• Incorporating technology
• Ensuring patient receives comprehensive diabetes education
• Involving social support system

Already feeling stretched to the limit? LilyLink can help! Our platform is convenient for both patients and providers. The app automates postprandial glucose readings and streamlines glucose data for easy analysis. Our certified diabetes care and education specialists also offer virtual education created specifically for diabetes in pregnancy. Schedule a demo today.

Frequently Asked Questions

1. What action best promotes patient engagement?

Actively listening to your patient is the essential and most common action involved in each strategy for improving patient care. Effectively communicating with your patients will establish trust and build rapport.

2. Why is patient engagement important?

The bulk of diabetes care happens outside of the office. Your patient needs to be able to confidently take action to manage their blood glucose levels.

3. What are the benefits of patient engagement?

Actively engaging your patients in their care may improve health behaviors and overall outcomes.¹³

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References:

1. Schöps AM, Skinner TC, Fosgerau CF. Tele-health coaches' responses to clients' emotional cues and concerns and engagement with the Bump to Baby and Me Intervention. Patient Educ Couns. 2024;127:108370. doi:10.1016/j.pec.2024.108370
2. Montori VM, Ruissen MM, Hargraves IG, Brito JP, Kunneman M. Shared decision-making as a method of care. BMJ Evid Based Med. 2023;28(4):213-217. doi:10.1136/bmjebm-2022-112068
3. McGovern L, O'Toole L, Houshialsadat Z, O'Reilly SL. Women's perspectives on mHealth behavior change interventions for the management of overweight, obesity, or gestational diabetes: A qualitative meta-synthesis. Obes Rev. 2024;25(8):e13761. doi:10.1111/obr.13761
4. Lamontagne F. Establishing trust through clear communication and shared decision-making. CMAJ. 2023;195(49):E1725-E1726. Published 2023 Dec 17. doi:10.1503/cmaj.231583
5. Safiee L, Rough DJ, Whitford H. Barriers to and Facilitators of Using eHealth to Support Gestational Diabetes Mellitus Self-management: Systematic Literature Review of Perceptions of Health Care Professionals and Women With Gestational Diabetes Mellitus. J Med Internet Res. 2022;24(10):e39689. Published 2022 Oct 27. doi:10.2196/39689
6. El Seifi OS, Younis FE, Ibrahim Y, et al. Telemedicine and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis. Cureus. 2024;16(10):e71907. Published 2024 Oct 20. doi:10.7759/cureus.71907
7. Whyler NCA, Krishnaswamy S, Price S, Giles ML. Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review. Arch Gynecol Obstet. 2024;310(1):69-82. doi:10.1007/s00404-024-07562-7
8. Smith R, Gould R, Kenworthy Y, et al. A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes. BMC Pregnancy Childbirth. 2024;24(1):360. Published 2024 May 14. doi:10.1186/s12884-024-06508-w
9. Karim JL, Wan R, Tabet RS, Chiu DS, Talhouk A. Person-Generated Health Data in Women's Health: Scoping Review. J Med Internet Res. 2024;26:e53327. Published 2024 May 16. doi:10.2196/53327
10. Feng YJ, Deng Z, Sivak A, Yeung RO, Nagpal T. Women's perspectives to improve prenatal care for gestational diabetes: A systematic review and meta-aggregation of qualitative studies. Acta Obstet Gynecol Scand. Published online December 10, 2024. doi:10.1111/aogs.14973
11. Guo S, Liu D, Bi X, et al. Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model. Midwifery. 2024;138:104141. doi:10.1016/j.midw.2024.104141
12. Rhodes A, Smith AD, Llewellyn CH, Croker H. Investigating partner involvement in pregnancy and identifying barriers and facilitators to participating as a couple in a digital healthy eating and physical activity intervention. BMC Pregnancy Childbirth. 2021;21(1):450. Published 2021 Jun 28. doi:10.1186/s12884-021-03917-z
13. Marzban S, Najafi M, Agolli A, Ashrafi E. Impact of Patient Engagement on Healthcare Quality: A Scoping Review. J Patient Exp. 2022;9:23743735221125439. Published 2022 Sep 16. doi:10.1177/23743735221125439

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