Oral Concurrent 5 – Diabetes and Nutrition

Abstract

Objective: To prospectively assess the validity, safety, feasibility, and clinical impact of a novel risk stratification tool to identify individuals with gestational diabetes mellitus (GDM) at low risk of lifestyle modification (LM) failure who can be managed in a less resource-intensive pathway. Study Design: Parallel-group proof-of-concept RCT at St. Michael’s Hospital (Aug 2022–Jul 2024). Of 582 screened, 211 were eligible; 150 participants with singleton GDM pregnancies controlled on LM were randomized to routine care (RC) or modified care (MC) using a validated risk tool (75/group). In MC, low-risk individuals were discharged to routine obstetric care with blinded remote glucose monitoring, while high-risk individuals remained in the Diabetes in Pregnancy clinic. ∙ Primary outcome: model performance (sensitivity, specificity, PPV, NPV). ∙ Exploratory outcomes: glycemic control, maternal/neonatal outcomes, patient satisfaction, and resource utilization. Results: In the intervention arm, 18 (24%) were classified as low-risk and 57 as high-risk. All low-risk participants maintained glycemic control on LM (NPV 100%), with specificity 30.2% and AUC 0.732 (95% CI 0.649–0.814). Patient satisfaction was high (mean 3.86/5; no group differences). There was a trend toward lower cesarean rates (6.7% vs 35.8%, p = 0.051) and shorter hospital stays (2.8 ± 0