Educational TOolS for Pregnant Women With Diabetes Mellitus (ETOS-DM)

A Randomized Controlled Trial Evaluating the Effect of Virtual Patient-centered Education on Infant Birthweight in Women With Diabetes Mellitus

A randomized controlled trial evaluating whether a patient-centered virtual educational tool based on small videos focusing on optimization of mental health, diet, physical activity, self-adjustment of insulin dose and use of diabetes technology in addition to usual individual face-to-face education, will improve glycemic control and pregnancy outcome in women with pre-existing diabetes mellitus compared to women receiving usual individual face-to-face education alone.

Study Overview

• Status: Completed
• Conditions: Diabetes Mellitus; Pregnancy Complications
• Intervention / Treatment: Other: Video-based education

Detailed Description

ETOS-DM is a national RCT evaluating the effect of combined virtual patient-centered education based on a tool of small videos accessible via smartphones in addition to usual individual face-to-face education during pregnancy or to routine individual face-to-face education only.

The small educational videos covering topics as food choices, physical activity, self-adjustment of insulin dose insulin pump settings during pregnancy, use of CGM during pregnancy, mental health among others,each of 1-4 minutes duration, will be developed in collaboration with user representatives (women with pre-existing diabetes who are or have recently been pregnant) and relevant health care professionals.

The inclusion period of the ETOS-DM study starts on September 1st 2023 and ends on August 31st 2025.

Pregnant women with pre-existing diabetes will be randomized before 14 gestational weeks. The women in the intervention group will have free, unlimited access to approximately 10 educational videos. The use of these virtual educational videos will be monitored and the women's own experience with the videos will be explored. The women will be followed during pregnancy, delivery until one month after delivery. Both groups of women follow usual local care and local face-to-face education which is allowed to change during the study period.

Stratification will be performed for diabetes center, for diabetes type and, in women with type 1 diabetes, use of MDI or insulin pump.

• Study Type: Interventional
• Enrollment (Actual): 621
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Copenhagen, Denmark
    • Center for Pregnant Women with Diabetes

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Women, age ≥ 18 years
• Type 1 diabetes, type 2 diabetes or other types of pre-existing diabetes (e.g., maturity onset diabetes of the young (MODY))
• Pregnant with one or more intrauterine living foetus(es) (5 to 13 completed gestational weeks) at inclusion confirmed by an ultrasound scan)

Exclusion Criteria:

• A diagnosis with severe mental or psychiatric barriers or a concurrent disease based on the decision of the investigator
• No proficiency in Danish to understand oral and written information

To secure independent observations, women can be randomized in the ETOS-DM study only once.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Randomized to usual care without acces to video-based education
Experimental: Intervention; Randomization to video-based education in addition to ussual care	Other: Video-based education; Randomization to video-based education delivered via a smartphone app in addition to usual care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Birthweight standard deviation score	Offspring birth weight adjusted for gestational age and gender (standard deviation (SD) score)	At delivery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
HbA1c during pregnancy	HbA1c levels during pregnancy at inclusion, 21, 33 and 35 weeks	At inclusion, at 21 weeks, at 33 weeks and at 35 weeks
Continuous glucose monitoring data	The average glucose level and percentage of time spent in the continuous glucose monitoring (CGM) target range 3.5-7.8 mmol/L, below target range (glucose <3.5 mmol/L) or above target range (glucose >7.8 mmol/L). The levels will be evaluated at night-time (24 pm to 6 am) and over 24 h, respectively, in pregnancy, during delivery and in the first one-month period after delivery. • The incidence of severe hypoglycemia in the year preceding pregnancy, during pregnancy and in the first one-month period after delivery	Throughout pregnancy and 1 month post delivery
Severe hypoglycemia	The incidence of severe hypoglycemia in the year preceding pregnancy, during pregnancy and in the first one-month period after delivery	2 years
Maternal weight gain	Maternal gestational weight gain and weight retention one month after delivery	At inclusion, at 21 weeks, at 33 weeks, 35 weeks and one month after delivery
Fetal overgrowth	The prevalence of fetal overgrowth, defined as the offspring birth weight SD score >90th percentile	At birth
Individuel insulin pump settings in women using insulin pump	In women using insulin pump the following will be collected: insulin pump settings at study visits, at delivery andthe first month after delivery during lactation	At inclusion, at 21 weeks, at 33 weeks, 35 weeks, at delivery and one month after delivery
Pregnancy complications	The prevalence of induced abortion (including indication for abortion), miscarriage, gestational hypertension, preeclampsia, need for maternal corticosteroid treatment for fetal lung maturation, diabetic ketoacidosis, urinary tract infection, early preterm delivery (before 34 completed weeks), preterm delivery (before 37 completed weeks), preterm prelabour rupture of the membranes	9 months
Prevalence of birth complications	The prevalence of shoulder dystocia, birth canal trauma, mode of delivery (vaginal, cesarean section, instrumental delivery), postpartum hemorrhage, maternal death, antihypertensive treatment given one month after delivery	At birth and one month post delivery
Prevalence of neonatal morbidity	Neonatal morbidity (neonatal hypoglycemia, jaundice, respiratory distress, transient tachypnoea, duration of stay in neonatal intensive care unit, total number of admission days), cord blood pH, stillbirths, infant death within one month	1 month
Major congenital malformations	Number of major congenital malformations (ICD10 Q00-Q99 or requiring medical or surgical treatment)	9 months
Infant growth at one month of age	Infant growth and health at one month of age	1 month
Maternal reported outcomes during pregnancy and one month postpartum	Maternal reported outcomes, including measures assessing health status (SF-12), depression (EPDS), well-being (WHO-5), pregnancy-specific worries (CWS), perceived stress (PSS), loneliness (T-ILS), diabetes related distress (PAID), fear of hypoglycaemia (HFS-II worry scale), satisfaction with care (PACIC), psychopathology developing during pregnancy and pre-natal attachment (MAAS).	In early pregnancy, in late pregnancy and one month post-partum.
Partner reported outcomes during pregnancy and one month postpartum	Partner reported outcomes, including measures assessing health status (SF-12), depression (EPDS), well-being (WHO-5), pregnancy-specific worries (CWS), perceived stress (PSS), loneliness (T-ILS), diabetes related distress (PAID), fear of hypoglycaemia (HFS-II worry scale), satisfaction with care (PACIC), psychopathology developing during pregnancy and pre-natal attachment (MAAS).	In early pregnancy, in late pregnancy and one month post-partum.
Continuous glucose monitoring metrics 1 months post delivery	Average glucose level and the percentage of time in the first one-month period after delivery spent in the CGM target range 3.9-10.0 mmol/L, below target range (glucose <3.5 mmol/L) or above target range (glucose >7.8 mmol/L) at night-time (24 pm to 6 am) and over 24 h, respectively.	1 months

Collaborators and Investigators

• Sponsor: Odense University Hospital
• Investigators: Principal Investigator: Elisabeth Mathiesen, Rigshospitalet, Denmark

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2023
• Primary Completion (Actual): June 1, 2026
• Study Completion (Actual): June 1, 2026

Study Registration Dates

• First Submitted: February 1, 2024
• First Submitted That Met QC Criteria: February 1, 2024
• First Posted (Actual): February 8, 2024

Study Record Updates

• Last Update Posted (Actual): June 16, 2026
• Last Update Submitted That Met QC Criteria: June 12, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Endocrine System Diseases; Female Urogenital Diseases and Pregnancy Complications; Metabolic Diseases; Glucose Metabolism Disorders; Nutritional and Metabolic Diseases; Diabetes Mellitus; Pregnancy Complications
• Other Study ID Numbers: 12345 (Danish Center for Healthcare Improvements)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No