Project Summary
Type 2 diabetes (T2D) in pregnancy increases the risk of adverse outcomes for both the mother and infant. Over
1 in 3 infants born to individuals with T2D will experience an adverse outcome, including large for gestational
age at birth, preterm birth, birth trauma, neonatal hypoglycemia, and stillbirth. Strict maternal glycemic control
throughout pregnancy is key to optimizing perinatal outcomes. This is possible with insulin pharmacotherapy,
vigilant glucose monitoring, lifestyle modifications including diet and exercise, and team-based prenatal care.
Medicaid-enrolled pregnant individuals with T2D experience non-medical social needs that limit their ability to
achieve glycemic control, including lack of reliable transportation to attend prenatal visits, access to resources
to engage in diet and exercise changes, and convenient methods to log self-monitored glucose values and adjust
insulin dosing. A multi-faceted provider-patient based approach is needed with proven strategies to
improve glycemic control. We propose “ACHIEVE: Successfully achieving and maintaining euglycemia
during pregnancy for type 2 diabetes through technology and coaching.” Our intervention is multi-
component, including a mobile health (mHealth) application (app), provider dashboard, DEXCOM continuous
glucose monitoring (CGM), and care team coaching for medical and social needs. This intervention empowers
Medicaid-enrolled pregnant individuals with T2D and their healthcare providers to achieve and maintain glycemic
control, improve access to care, and provide patient education and support. Each sub-component of the
proposed intervention is grounded in Social Cognitive Theory (SCT), and emphasizes on individuals’ skills,
knowledge and beliefs, and self-efficacy to achieve glycemic control. We propose three aims: AIM 1: Develop
the tailored ACHIEVE mHealth app and provider dashboard for Medicaid-enrolled pregnant individuals with T2D
and their healthcare team through active stakeholder engagement; AIM 2: Conduct an RCT and measure the
effect of the intervention (mHealth app with CGM, provider dashboard, and care team coaching) compared to
current standard care (prenatal visits, self-monitored blood glucose, and certified diabetes care and education
specialist) on achieving glycemic control (hemoglobin A1c <6.5% in the third trimester). We hypothesize a 25%
absolute increase in the proportion of participants in the intervention group who will meet the target hemoglobin
A1c <6.5% in the third trimester compared to the standard care group; and AIM 3: Identify multi-level patient and
provider barriers and facilitators to satisfaction, engagement, and use of the intervention and its subcomponents.
