University Hospitals Comprehensive Approach to Gestational Diabetes Care
July 04, 2022
Innovations in Obstetrics & Gynecology | Summer 2022
Each year, the multidisciplinary team at University Hospitals' program dedicated to diabetes in pregnancy manages approximately 600 patients, most of whom have gestational diabetes. “Aggressive treatment and tight control for gestational diabetes has been directly associated with improved perinatal outcomes,” says Christopher Nau, MD, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University Hospitals Cleveland Medical Center. Dr. Nau shares an inside look at how this innovative UH program connects with patients to address gestational diabetes with comprehensive, equitable care, an ongoing priority at University Hospitals, which serves a diverse patient population with varying needs and obstacles to accessing care. For example, patients who live in rural areas may struggle to find transportation to UH’s maternal and fetal medicine offices. Dr. Nau and his colleagues in the diabetes in pregnancy program take a proactive and flexible approach to addressing individual patients’ needs and says that glucose monitoring is the foundation of managing gestational diabetes.
“The most important thing for improving pregnancy-associated complications with diabetes is a very strict and tight glucose control,” says Dr. Nau.
Once patients have been screened and ultimately diagnosed with gestational diabetes, UH has a variety of ways they can enter care for glucose monitoring and gestational diabetes treatment. Dr. Nau says he and his colleagues can co-manage care for gestational diabetes patients with their main OB provider, or they can manage all prenatal care. Expectant mothers can attend in-person visits at the University Hospitals Rainbow Ahuja Center for Women & Children in Cleveland and meet with the team’s dietician and diabetes nurse educator on the same day. Patients can also access care through the program’s Gestational Diabetes Management Boot Camp, a weekly virtual offering that features education and nutrition counseling. Prior to the COVID-19 pandemic, classes were held in-person, but the transition to a virtual platform has improved patient access, says Dr. Nau.
Women can also meet with a nutritionist virtually or in-person for nutrition and dietary counseling through UH’s program, or schedule a consult at their local hospital. Access to virtual care, or care consolidated to a single location, can help patients who struggle with transportation or scheduling.
UH also integrates remote care into its diabetes in pregnancy program through remote glucose monitoring. Throughout the course of a pregnancy, it is the standard of care for the team to monitor glucose levels at least once a week.
And when it comes to treating gestational diabetes, insulin is the front-line therapy. But the UH program does not take a one-size-fits-all approach to building treatment plans. Dr. Nau also discusses with his patients oral medications, such as metformin, and while the long-term effects on those exposed to it in utero are not yet fully understand, in some cases oral medication may be a better option than insulin injections. For example, Dr. Nau has worked with patients who have severe needle phobias and those with a history of IV drug use who fear an injection could trigger relapse.
UH has had a robust gestational diabetes program for years and continues to provide top-notch care to the community.
“UH has a longstanding commitment to women's health and for diabetes in pregnancy,” says Dr. Nau. He sees the program’s strength not only in its physicians but in all of its team members, including the diabetes nurse education, nutritionist and advanced practice RN.
“A big reason I came to UH was because this program existed. And then, I saw the opportunities to expand and develop the program even further,” says Dr. Nau. Today, the program’s team is embracing a heightened focus on remote care and looking for more ways to connect patients with equitable diabetes care and education.
Dr. Nau hopes to explore ways in which the program can help women with gestational diabetes in their post-partum care. While gestational diabetes can resolve within hours of delivery, it does increase the overall lifetime risk of developing type 2 diabetes. Dr. Nau sees an “opportunity to intervene early, connect people with good follow-up care and make sure we're passing the baton with these patients to their primary care providers.”