Greater use of CGM linked to glycemic benefits for pregnant women with type 2 diabetes
Click Here to Manage Email Alerts
Key takeaways:
- Pregnant women with type 2 diabetes did not improve CGM metrics from early pregnancy to late pregnancy.
- An increase in time in range was observed for women who used CGM at least 50% of the time.
Pregnant women with type 2 diabetes who used continuous glucose monitoring only had improvements in CGM metrics if they used the device more than 50% of the time, according to data published in Diabetes Technology & Therapeutics.
“In this study involving high-risk women from regional and remote Australia, a key finding was the limited change in glucose metrics from early to late pregnancy,” Anna McLean, MBBS, FRACP, a research assistant in the Menzies School of Health Research at Charles Darwin University in Australia, and colleagues wrote. “However, significant improvement in glucose trajectories was observed in the subgroup that had greater sensor activity time.”
Researchers conducted a prospective observational study of 41 women aged 18 years and older who were pregnant and had preexisting type 2 diabetes before 30 weeks of gestation (mean age, 33 years; median first trimester HbA1c, 7.8%). Enrollment occurred from August 2019 to March 2021. The FreeStyle Libre 1 (Abbott) flash glucose monitor was given to all participants in conjunction with usual care. CGM metrics were analyzed in early pregnancy during the first 2 weeks when sensors were used and late pregnancy during the last 2 weeks when sensors were used before delivery. Time in range with a glucose level of 63 mg/dL to 140 mg/dL, time above range with glucose greater than 140 mg/dL and time below range with glucose of less than 63 mg/dL were collected. Mean glucose, glucose standard deviation, interquartile range and glucose management indicator were analyzed. Maternal characteristics and pregnancy outcomes were collected from a clinical register. Neonatal hypoglycemia was defined as offspring with a blood glucose of less than 2.6 mmol/L requiring IV dextrose. Large for gestational age included offspring in the greater than 90th percentile for gestational age at birth and sex.
Of the participants, 51% had offspring with neonatal hypoglycemia and 56% met the criteria for large for gestational age. No changes in any CGM metrics were observed from early pregnancy to late pregnancy. Among 29 women who used CGM more than 50% of the time, there was a 9 percentage point increase in time in range, a 12 percentage point reduction in time above range, a 1 mmol/L drop in average glucose and a 3 percentage point increase in time below range and coefficient of variation from early pregnancy to late pregnancy.
Each 1% increase in time in range in early pregnancy reduced the odds for large for gestational age (OR = 0.96; 95% CI, 0.92-0.99) and each 1% increase in time in range in late pregnancy lowered the likelihood for neonatal hypoglycemia (OR = 0.94; 95% CI, 0.9-0.99). Each 1 mmol/L increase in mean glucose during early pregnancy increased the likelihood for neonatal hypoglycemia (OR = 1.67; 95% CI, 1.01-2.78) and large for gestational age (OR = 1.84; 95% CI, 1.04-3.28). Each 1 mmol/L increase in glucose during late pregnancy increased the odds for neonatal hypoglycemia (OR = 1.97; 95% CI, 1.08-3.61).
“Future studies are required to assess whether CGM technology interventions starting in early pregnancy can reduce the risk of large for gestational age and other neonatal complications,” the researchers wrote. “It is imperative that new approaches to diabetes management for women with type 2 diabetes, particularly those from culturally and linguistically diverse backgrounds, are established in partnership with women and their communities to improve outcomes for women and their offspring.”
Collapse
Read more about
Click Here to Manage Email Alerts