VIDEO: CGM can provide range of benefits for pregnant women with diabetes
In this Healio Video Exclusive, Caroline T. Nguyen, MD, speaks with Sarit Polsky, MD, MPH, about the use of continuous glucose monitoring for pregnant women with gestational diabetes and type 1 diabetes.
CGM can provide a multitude of benefits for pregnant women with diabetes, according to Polsky, associate professor of medicine and pediatrics in the adult clinic of the Barbara Davis Center for Diabetes at University of Colorado Anschutz Medical Campus. Polsky said studies have found pregnant women with type 1 diabetes using CGM have higher maternal time in range and lower risk for neonatal adverse events than women performing self-monitoring blood glucose. Additionally, pregnant women with gestational diabetes may be able to advance insulin therapy with CGM, according to Polsky.
Polsky and Nguyen, who is assistant professor of clinical medicine, obstetrics and gynecology in the division of endocrinology, diabetes and metabolism at the University of Southern California (USC) Keck School of Medicine, course director for the USC Jorge H. Mestman Endocrine and Women’s Health Symposium and a Healio | Endocrine Today Editorial Board Member, also discuss some of the challenges with using CGM during pregnancy.
You can view the full video interview above or read the Q&A transcript below.
Editor’s note: This is a three-part Healio Video Exclusive series. Check out the other videos on menopausal HT and Graves' disease.
Video transcript
Nguyen: Can you briefly describe what CGMs are?
Polsky: A CGM is a small sensor that is inserted into the skin that measures the interstitial glucose value, typically every 5 minutes, and then transmits that glucose measurement to a receiver of some sort, which can be a phone and sometimes a smartwatch.
Nguyen: We’re starting to hear a lot more about them. They’re showing up everywhere. There’s now even some that are available over the counter, and so a lot of patients are asking about them. What are some of the potential benefits and positive impacts of CGM use in diabetes care and pregnancy?
Polsky: It’s a really great question. We have the most data about using CGM in type 1 diabetes pregnancies, and it’s actually been shown in a large randomized controlled trial that when you compare a group using self-monitoring blood glucose or finger-stick glucose measurements to a group using CGM, it increases the maternal time in range, which is 63 mg/dL to 140 mg/dL.
It also significantly reduces the risk for neonatal adverse events, including large for gestational age infants. It reduces the risk that the baby has severe neonatal hypoglycemia. It reduces the rate of a neonatal ICU admission that lasts more than 24 hours, and it reduces the infant length of stay in the hospital by 1 day. So there’s a lot of great benefits there.
For individuals who are pregnant who don’t have type 1 diabetes, there are some data showing that, for example for gestational diabetes, using CGM may advance therapy. If someone’s on medical nutrition therapy, with the use of the CGM, you see that you need to advance to something else like insulin. But we’re still uncovering what the potential benefits are for other groups of pregnant individuals.
Nguyen: I can imagine with any new technology and its introduction into care, are there any challenges in using CGM in pregnancy?
Polsky: Some of the challenges are similar, both in and outside of pregnancy. It is a wearable technology. There are people who develop an allergy to the adhesive that adheres the sensor to the skin so they can get irritation, hives or welts. Also, it’s very, very rare, but the sensor can actually break off in the skin and then you have to do a minor surgical procedure to extract that.
Some other challenges are there’s a slight lag time between the sensor glucose value and what the blood glucose is measuring. But all in all, it is well tolerated and there are many studies that have shown that individuals who are pregnant actually prefer CGM over self-monitoring blood glucose in many cases, so the benefits tend to outweigh the risks.
Nguyen: Just for the patients that I take care of, so many prefer the CGM because to check [glucose] four times a day is asking a lot of our patients. What kind of areas of research are active right now, in this space of CGM use in pregnancy?
Polsky: It’s a really exciting time to be in the area of diabetes technology, in general, but especially in pregnancy.
Two populations where we have relatively little data are type 2 diabetes in pregnancy and gestational diabetes. There are a number of studies that are ongoing to determine how efficacious it is, safe [and] cost-effective. Also, what is normal pregnancy glucose physiology compared to someone with gestational diabetes, and how early can we detect hyperglycemia in pregnancy, and if we start therapy early, is that beneficial for people? There are a number of studies in those areas.
Then in the area of type 1 diabetes, which I mentioned already had relatively more research, there’s still some unanswered questions there. Which CGM metrics might predict adverse pregnancy outcomes, which might be the most valuable to us, and which time point is necessary to actually see that the CGM metric is tied to an adverse pregnancy outcome? There are actually some studies looking into that as well.
For more information:
Sarit Polsky, MD, MPH, will speak more about the role of CGM during pregnancy at the USC Jorge H. Mestman Endocrine and Pregnancy Symposium taking place in person and virtually March 1. Register for the symposium at https://keckusc.cloud-cme.com/course/courseoverview?P=0&EID=8796.
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