Virtual vs. In-Person Care in Gestational Diabetes Management: A Retrospective Cohort Analysis.

Abstract

Objectives: The rising prevalence of gestational diabetes (GDM) presents a challenge to healthcare systems. Virtual care has emerged as a potential solution to alleviate this burden, but limited data exist on its effectiveness. This study evaluated maternal and neonatal outcomes in individuals with GDM managed with virtual care versus in-person care.

Methods: A retrospective cohort study was conducted among individuals with GDM attending interdisciplinary diabetes in pregnancy clinics in Calgary, Alberta between 2017-2022. The primary exposure was modality of the initial visit (virtual or in-person) with a diabetes educator. Logistic regression models were used to analyze the relationship between visit modality and outcomes, adjusting for multiples, socioeconomic status, maternal age, infant sex, parity, and before vs during the SARS-CoV-2 coronavirus (COVID-19) pandemic.

Results: Of the 9,511 individuals included, 4,236 had an initial virtual visit. Those in the virtual care group had lower odds of delivering large-for-gestational-age infants (aOR 0.79, 95% CI 0.65-0.97) and undergoing caesarean section (aOR 0.88, 95% CI 0.79-0.99). They also had lower odds of missing at least one appointment (aOR 0.89, 95% CI 0.77-0.99) and greater odds of being prescribed both insulin and metformin (aOR 1.30, 95% CI 1.16-1.46). No significant differences were found in rates of operative vaginal birth, induction of labour, small for gestational age infants, 5-minute Apgar score <7, or neonatal intensive care unit admission.

Conclusion: This study highlights the potential of virtual care to enhance GDM management. Further research is needed to assess its broader impact and optimize implementation strategies for diverse populations.