Managing Gestational Diabetes Through Better Care Plan Adherence
Why it’s difficult, and what to do about it
November 11, 2020

Gestational diabetes costs the U.S. $636 million a year—or $596 million in costs for the mothers and $40 million in infant care.


Better care plan adherence at the onset of gestational diabetes—and remaining consistently adherent through postpartum—reduces the cost of care of these members and improves the health of these mothers and their babies. But achieving adherence starts with understanding the condition itself, the challenges in managing it, and how members can overcome those challenges.

What is the impact of gestational diabetes? 

Gestational diabetes occurs during pregnancy when the mother experiences insulin resistance—or the inability to access needed insulin due to the growing baby—and impacts roughly 10% of pregnant women. 


Unmanaged, gestational diabetes can lead to hypoglycemia or preeclampsia for the mother—causing further complications like an early or difficult delivery. In addition, unmanaged gestational diabetes in the mother can directly impact the baby beyond delivery through low blood sugar, macrosomia, or development of Type 2 diabetes later in life. 


Managing gestational diabetes from the onset is the key to a healthy pregnancy and better member outcomes for both mother and baby. 

Why is managing gestational diabetes so difficult?

We take for granted the lengths many parents are willing to go to give their babies the best start possible. But even with the best intentions, we all sometimes fall short. 


In the case of gestational diabetes, successfully managing the condition can be incredibly difficult—requiring collaboration between multiple care teams including an obstetrician, an endocrinologist, a certified diabetes nurse and nutritionist, case managers, and others. For the mother, this often means a multi-faceted care plan often involving a strict diet, careful glucose monitoring before and after meals, regular insulin injections, and/or oral medications and treatments. 


The result? 


Less than 7% of mothers diagnosed with gestational diabetes achieve even 73% care plan adherence. 


When care plans require multiple complex tasks each day to reach full adherence, it can be difficult for even the most motivated members to stay consistent. 


Imagine your daily routine: getting up to exercise, eating right, working, socializing, completing needed chores, and taking time to unwind. 


If you could fit all of that into each day, imagine convincing yourself to also fit in time for finger-prick glucose tests before and after each meal (in other words… no drive-through coffee breakfast allowed). Then, add time to log all your meals for your nutritionist—all while dealing with the regular side-effects of pregnancy. 


Understanding why members need motivation—not just a care plan—to be healthy is the first step in improving outcomes.

 

How can we better manage gestational diabetes in our members? 

The importance of motivation is not unique to members with gestational diabetes. In fact, nationwide studies show that roughly 50% of individuals do not take medications as prescribed by physicians.


Leveraging principles of behavioral economics can help motivate members to make healthy choices through incentives that encourage individuals to overcome barriers to adherence and develop lasting healthy habits. 


Wellth uses financial incentives to help build healthy habits in members—utilizing proven behavioral economics concepts like loss aversion—to ensure lasting change. 


For more information on behavioral economics, check out our ebook on behavioral economics! 


In addition to financial incentives, Wellth provides a member support team to help encourage adherence through regular enrollment outreach and follow-up. This combination of financial and social support has proven effective in increasing adherence—even for complex conditions. As a 2017 study published in the Journal of Diabetes Research reiterates: 


Barriers [to adherence] include poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. Possible solutions [include] fostering social support, financial support, and improvement of [healthcare] services.


Plans can support their mothers with gestational diabetes in adhering to care plans—no matter how complicated—through financially incentivizing tasks like healthy eating, glucometer checks, medication adherence, and insulin with programs like Wellth. And when these incentives are combined with a dedicated social support system, outcomes improve for both mothers and the babies they carry.


For more information about this or other diabetes programs offered through Wellth, contact us.