Redesigning patient care with gestational diabetes apps

• Redesigning care pathways, rather than simply adding technology, can simultaneously improve safety, patient experience, and operational efficiency

• A structured co-creation phase with clinicians and patients is critical to building scalable, real-world solutions for digital diabetes management

• A “home-first” model using a gestational diabetes app can reduce burden and medicalization while maintaining clinical outcomes, offering a viable blueprint for broader chronic disease management

For years, the standard of care for Gestational Diabetes Mellitus (GDM) has been a demanding regimen of frequent, in-person clinical visits. This commitment, while necessary, has placed a profound logistical and emotional burden on expectant mothers. In the Italian province of Ferrara, however, a team at the Ferrara Local Health Authority looked beyond the traditional clinic walls. They didn't just want to manage a disease; they wanted to re-imagine the patient experience entirely.

Over a 14-month period, this innovative tele-monitoring initiative integrated applications for digital diabetes management, shifting GDM care from a time-consuming process to a remotely observed, patient-centric journey. Healthcare Transformers spoke with Dr. Marcello Monesi, Director of the Territorial Diabetology Complex Operative Unit at Azienda Unità Sanitaria Locale, to talk about the results of the pilot and the potential of gestational diabetes apps to improve the quality of care for mothers with GDM. 

HT:  Can you describe the clinical and logistical barriers—such as difficulties with insulin adjustments or travel burdens—that made the previous standard of care unsustainable for patients at AUSL?

Dr. Monesi: Absolutely. The traditional model relied on frequent in-person visits, sometimes every two or three weeks. For our patients, who are pregnant and often still working or caring for other children, this meant significant travel, waiting time, and time off work.

Many of our patients live about 30 kilometers from the clinic. Even a short appointment could take half a day. Clinically, gestational diabetes requires rapid insulin adjustments and close glucose monitoring. But if you only see the patient every two or three weeks, you are always reacting late. It was stressful for patients and inefficient for us. We realized the system was not sustainable, either from a human perspective or from an organizational one.

HT: Your initiative describes a paradigm shift toward “home as the first place of care.” How did this project blend traditional care models with telemedicine, and in what ways did it enhance patient experience and the quality of care?

Dr. Monesi: This was not about replacing traditional care. It was about redesigning it.

We maintained the first visit in person, as required by regulatory limits in Italy, and because education and engagement are essential at the beginning. After that, most follow-ups moved to remote monitoring. Patients used a gestational diabetes app to upload glucose data daily. We reviewed everything through a clinical platform that was simple and intuitive for both patients and clinicians.

This allowed us to intervene quickly when needed, without asking women to physically come to the clinic. Care remained continuous and personalized, but much more convenient.

Interestingly, patients felt even more closely followed than before. Because we were reviewing their data daily, they perceived a stronger presence of the care team. It became an organizational and co-creation approach, rather than simply a technological one. 

HT:  You described the project as including a distinct design and co-creation phase. How did you gather input from patients and stakeholders to refine the care model before the full introduction of the app for digital diabetes management?

Dr. Monesi: Before launching the project, we organized workshops with the entire multidisciplinary team, including diabetologists, nurses, dieticians, and administrative staff. Together, we mapped the full patient journey, from diagnosis to delivery, and identified inefficiencies.

We then redesigned the pathway collaboratively. We also collected patient feedback early on. We asked them about their digital habits, their expectations, and whether they were comfortable using smartphones and apps. We found that almost all of them were already confident with digital tools.

Throughout the pilot, we continued asking patients whether they liked the app, whether anything could be simplified, and how we could reduce their burden. We also engaged with patient associations to gather broader feedback on how to manage the entire clinical path more effectively.

This collaborative phase helped us build a model that was practical, not theoretical.

HT:  Given the risks associated with GDM, such as preeclampsia and neonatal hypoglycemia, how did the telemedicine model ensure safety? 

Dr. Monesi: Safety was and always is our top priority.

In fact, telemedicine improved safety because we had real-time or near-real-time glucose data instead of isolated snapshots during clinic visits. Patients performed capillary glucose measurements four times a day at the beginning, fasting and one hour after each meal, and uploaded the results through the app.

We monitored fasting and post-meal targets daily and could adjust therapy immediately if needed. If something appeared concerning, we scheduled an in-person visit right away.

At the end of the evaluation period, glycemic control and pregnancy outcomes were comparable to traditional care. So we maintained safety while reducing burden.

HT: The data you’ve reported indicates significant reductions in patient burden, including 438 avoided visits and an average of 8.5 hours saved per patient. Beyond the metrics, how did these savings in time and travel distance (30 km on average) translate into improved satisfaction rates for expectant mothers balancing daily responsibilities?

Dr. Monesi: The numbers are impressive, but what really matters is what they mean in daily life.

These women are pregnant, often working, and sometimes caring for other children. Saving hours of travel and waiting time dramatically reduces stress. Patients told us they felt more supported and less overwhelmed.

Satisfaction rates were around 90 percent. It was not just about convenience. It was about improving quality of life and reducing fear. When you have to come to the hospital every two or three weeks, you feel like a sick person. If you can stay at home and still be safely monitored, pregnancy becomes less medicalized. That was one of our goals.

HT: Can you elaborate on how this model fared in terms of economic resources and its impact on the workload of the Diabetology Unit?

Dr. Monesi: From an organizational perspective, it was very efficient.

We reduced unnecessary in-person visits and optimized staff time. On average, nurses and physicians spent about two hours per week monitoring patients through the platform, even while following more than 70 women.

We improved access and quality without increasing workload. In a public health system that is often overwhelmed, this kind of efficiency is essential for long-term sustainability.

HT: Based on the 14-month success of this initiative, do you see this model as a scalable solution in different contexts or for managing other chronic conditions beyond gestational diabetes?

Dr. Monesi: Definitely.

Gestational diabetes was a good starting point because it requires intensive but time-limited follow-up. However, the same principles, remote data sharing, proactive monitoring, and fewer unnecessary visits, apply to many chronic conditions.

We plan to extend this model to type 1 diabetes with pumps, type 2 diabetes, and potentially beyond diabetes where frequent monitoring is needed.

For us, this was not just a pilot. It was a new way of thinking about how to organize our work.

For more on the pilot to improve patient care for women with gestational diabetes, read the journal article in Diabetic Medicine.