Clinical Summary for Obstetrical Diabetes Management

How the Program Works | Facts You Need to Know | Diabetes Outcomes

How the Program Works

Diabetes during pregnancy poses serious health threats to the unborn child, which can result in irreversible and costly health consequences for infants. Poorly managed diabetes can lead to birth defects, brain damage and respiratory or heart problems.

Matria's Obstetrical Diabetes Management Program offers three service levels:

Gestational Diabetes 21-Day Program

• One in-home visit
• Assessment
• Education
• Counseling about diabetes in pregnancy, glucose monitoring, meal planning and exercise
• Education session with registered dietician (RD) and certified diabetes educator (CDE) to assess dietary needs
• Blood glucose testing and reporting to RN and CDE
• Intensive management to achieve glycemic control
• Blood glucose testing every six weeks
• Dietary analysis/ongoing counseling
• All supplies delivered to the home
• 24-hour RN, CDE and RD availability
• Outcome reports
• Online, real-time patient reports through www.matria.com

Daily Insulin Injection 28-Day Program

• Two in-home visits
• Insulin administration via injection
• Additional home training
• Insulin
• Syringes and associated supplies
• Support for insulin adjustments as clinically required
• Multiple daily assessment of glycemic control

Continuous Subcutaneous Insulin Infusion 42-Day Program

• Four in-home visits
• Additional home training on insulin pump therapy and pump operation
• All supplies:
• Pump
• Insulin
• Infusion/site care supplies
• Multiple daily RN and CDE assessments
• Patient compliance
• Glycemic control
• Support in managing insulin dose changes and carbohydrate-to-insulin ratio

Facts You Need to Know

Hospitalization for neonatal intensive care units (NICUs) average $2,000 a day. Costs for premature infants with health problems from diabetes can soar as high as $1 million depending on the severity of their problems.

Case management of gestational diabetes produces significant cost savings by helping to reduce the need for neonatal admissions or at least reduce the length of time an infant must stay in the NICU. In one landmark study comparing two groups of women with gestational diabetes, one group received intensive diabetes management services while the control group was treated with conventional diabetes management.

In the control group, 25 percent of neonates were admitted to the NICU for an average length of stay of 4.4 days. In the group receiving intensive diabetes management services, only 6.3 percent of neonates needed to be admitted to the NICU, and the average length of stay was 2.8 days.

Costs for the conventional management group of 1,316 cases reached nearly $2.8 million while the intensified management group of 1,145 cases cost $440,000.

Diabetes Outcomes

In an internal study of 2,000 patients conducted from 2000 to 2004, Matria produced the followed results for insulin-dependant and non-insulin requiring patients:

Gestational diabetes (non-insulin):

• Admitted only 9.4 percent of newborns to the neonatal intensive care unit born to women with gestational diabetes, a significant drop from a benchmark study [1] in which 25 percent of neonates born to women receiving conventional treatment were admitted

• In less than one week, the number of patients complying with blood-glucose testing increased from 8.5 percent to 87 percent

Pregestational diabetes (insulin dependant):

• 33.6 percent reduction in out-of-target blood glucose levels
• 100 percent improvement in compliance with blood glucose testing
• 51 percent reduction in the number of Type 2 diabetes patients with A1C greater than 6 percent

[1] Langer O, Rodriguez DA, et al, Intensified versus conventional management of gestational diabetes, American Journal of Obstetrical Gynecology, 1994; 170(4): 1036-47.