Gestational Diabetes Mellitus Clinical Trial
Official title:
The Impact of Activity Promoting Video Games on Glycemic Control in Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) affects up to 3-5% of all pregnancies. When diagnosed with GDM, women undergo nutritional counseling, blood sugars monitoring and are encouraged to exercise regularly. Women who do not meet therapeutic targets may need to add insulin injections. Activity promoting video games are an attractive possibility for improvement of exercise compliance. The objective of this study is to determine whether providing women recently diagnosed with GDM with a Nintendo Wii™ activity promoting gaming platform will increase activity levels, improve glycemic control of sugar levels and decrease the need for supplementary insulin treatment.
As part of the standard of care, all pregnant women are screened with a 50 gram glucose
challenge test between 24-28 weeks gestation. Women are diagnosed with GDM when they have two
abnormal values on the 75 gram oral glucose tolerance test. Once a diagnosis of GDM has been
made women are referred to the diabetes in pregnancy clinic within 1-2 weeks. All women
initially undergo a group session with a clinical nutritionist and a registered nurse
specializing in diabetic care. During this session women receive basic information regarding
gestational diabetes, instruction regarding dietary management of GDM and standard
recommendations regarding physical activity. Women also routinely receive a glucometer for
self monitoring of glucose levels and are instructed regarding its use. One week after this
group session an intake session with an endocrinologist and Maternal-Fetal Medicine
specialist occurs and glycemic control is reviewed. Follow up visits are scheduled every 1-4
weeks depending on adequacy of glycemic control. Decisions regarding adequacy of dietary
management and need for insulin therapy are made by the endocrinologist at each subsequent
visit.
For the purpose of our study, patients will be approached after this group teaching session.
Eligible patients who have consented to participate in the study will undergo randomization
into two groups:
1. Control - routine GDM care as mentioned above.
2. Intervention - This group will undergo all aspects of routine GDM care but will also
receive a Nintendo Wii gaming console + Wii Fit activity platform. The games provided
include "Wii sport" and Wii Fit Plus". Each participant will receive a 30-60 minute
guided information session to ensure that she is able to install the console at home and
to set up her personal login information. At this session an overview of the available
Wii activities will be presented. Each participant will receive a telephone number to
call in case technical difficulties are encountered at home. At 36 weeks of gestation,
the Wii hardware and programs will be returned to the investigators. Participants will
be instructed to note the following warning signs for termination of the exercise
session; vaginal bleeding, dyspnea before exertion, dizziness, headache, chest pain,
muscle weakness, calf pain or swelling, preterm labor, decreased fetal movement, and
amniotic fluid leakage.
As mentioned, all participants in the study will be encouraged to be physically active. In
order to independently calculate and compare the overall level of physical activity in both
groups all participating women will receive a pedometer (StepsCount Digi-Walker SW700) and
will be instructed to wear it daily during waking hours.
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