Glucose management indicator better for determining glycemic profile early in pregnancy
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Glucose management indicator, a metric used with continuous glucose monitors, may be a better indicator of glycemic control during the first trimester of pregnancy than HbA1c, according to study findings.
In data from 27 pregnant women with type 1 diabetes, glucose management indicator strongly correlated with time in range during all three trimesters, whereas HbA1c correlated with time in range during only the second and third trimesters.
“To our knowledge, this is the first study to evaluate correlations between glucose management indicator and HbA1c levels with continuous glucose monitoring-based time in range by trimester in pregnant women with type 1 diabetes,” Sarit Polsky, MD, MPH, associate professor at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, and colleagues wrote. “Our study found strong correlations between time in range and glucose management indicator and between HbA1c levels and glucose management indicator. These findings suggest that glucose management indicator may be used in pregnancies associated with diabetes.”
Researchers conducted a secondary analysis of data from a pilot study comparing glycemic control by pregnant women with type 1 diabetes using CGM alone, CGM with remote monitoring and not using CGM. Data on 27 women using CGM were obtained for the analysis (mean age, 27.9 years; 77% white women). Glucose management indicator was calculated using a regression formula. HbA1c was measured in every month of pregnancy, with the mean calculated for each trimester.
Higher time in range was significantly correlated with lower HbA1c during pregnancy, with each 10% increase in time in range associated with a 0.3% reduction in HbA1c. Stronger correlations between time in range and HbA1c were observed during the second and third trimesters (r = –0.8; P < .001) compared with the first trimester (r = –0.4; P = .02).
Time in range was strongly correlated with glucose management indicator during all three trimesters (r = –0.9; P < .001). There were strong relationships between glucose management indicator and HbA1c during the first trimester (r = 0.6; P = .02) and second and third trimesters (r = 0.8; P < .001).
“Time in range and glucose management indicator reflected better glycemic control than HbA1c levels during the first trimester, which may be due to various reasons,” the researchers wrote “The change in glucose is generally rapid during the first trimester due to intensive insulin treatment, physiological changes such as alteration in red blood cell turnover, and iron deficiency or supplements may play a role in dissociations between time in range and HbA1c levels.”
The researchers said with glucose management indicator now included in CGM downloads, providers may be able to translate mean glucose to glucose management indictor and use it as an estimated HbA1c.
“Future studies with complete data in organogenesis and larger sample sizes are needed to fully determine the applicability of glucose management indicator and time in range clinically and as possible predictors of adverse gestational health outcomes,” the researchers wrote.
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