Researchers: Enav Yefet¹, Yuri Perlitz¹

Background: Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and requires close monitoring to prevent adverse maternal and neonatal outcomes. At Tzafon medical center, a hybrid care model combining in-person visits with telemedicine has been implemented; however, adherence to follow-up remains suboptimal.

Objectives: To characterize barriers to adherence in a hybrid GDM clinic in a peripheral region and to identify predictors of adherence.

Method: A retrospective cohort study combined with questionnaire-based assessment was conducted among women treated between 2019 and 2022. Demographic and clinical data were collected, and a structured telephone questionnaire was administered to evaluate barriers. Women with good adherence (≥2 monthly interactions with the clinic via e-mail) were compared to those with poor adherence.

Findings: Among 187 respondents, 49% demonstrated good adherence. No significant association was found between demographic characteristics and adherence. In contrast, poor adherence was associated with inadequate understanding of the follow-up process, perception of excessive glucose monitoring requirements, low awareness of the importance of follow-up, and perceived insufficient clinical support. Geographic distance, daily workload, and technological factors were not significant barriers. Most participants expressed satisfaction with the hybrid model and interest in improved technological solutions, such as a dedicated monitoring application.

Conclusions: Patients’ understanding of the follow-up process and expectations is a key determinant of adherence. Perceptual barriers appear to be more influential than demographic or technological factors.

Recommendations: Telemedicine services are well accepted among women with GDM. Development of a dedicated digital application for monitoring is recommended, and inclusion of continuous glucose monitoring sensors in the national health basket should be considered to address the burden of frequent capillary glucose testing.

Research end date: 04/2026