Search

The article focuses on the transformative impact of continuous glucose monitoring (CGM) on managing diabetes during pregnancy, emphasizing the association between various CGM metrics and maternal and neonatal outcomes. It discusses research findings that suggest specific CGM targets for women with type 1 diabetes in pregnancy, underscoring the importance of achieving optimal time in range and minimizing time above and below certain glucose levels for improved perinatal outcomes.

Objective: To determine if temporal glucose profiles differed between 1) women who were randomized to real-time continuous glucose monitoring (RT-CGM) or self-monitored blood glucose (SMBG), 2) women who used insulin pumps or multiple daily insulin injections (MDIs), and 3) women whose infants were born large for gestational age (LGA) or not, by assessing CGM data obtained from the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT).Research Design and Methods: Standard summary metrics and functional data analysis (FDA) were applied to CGM data from the CONCEPTT trial (RT-CGM, n = 100; SMBG, n = 100) taken at baseline and at 24- and 34-weeks' gestation. Multivariable regression analysis determined if temporal differences in 24-h glucose profiles occurred between comparators in each of the three groups.Results: FDA revealed that women using RT-CGM had significantly lower glucose (0.4-0.8 mmol/L [7-14 mg/dL]) for 7 h/day (0800 h to 1200 h and 1600 h to 1900 h) compared with those with SMBG. Women using pumps had significantly higher glucose (0.4-0.9 mmol/L [7-16 mg/dL]) for 12 h/day (0300 h to 0600 h, 1300 h to 1800 h, and 2030 h to 0030 h) at 24 weeks with no difference at 34 weeks compared with MDI. Women who had an LGA infant ran a significantly higher glucose by 0.4-0.7 mmol/L (7-13 mg/dL) for 4.5 h/day at baseline, by 0.4-0.9 mmol/L (7-16 mg/dL) for 16 h/day at 24 weeks, and by 0.4-0.7 mmol/L (7-13 mg/dL) for 14 h/day at 34 weeks.Conclusions: FDA of temporal glucose profiles gives important information about differences in glucose control and its timing, which are undetectable by standard summary metrics. Women using RT-CGM were able to achieve better daytime glucose control, reducing fetal exposure to maternal glucose. [ABSTRACT FROM AUTHOR]

Background: Continuous glucose monitoring (CGM) provides far greater detail about fetal exposure to maternal glucose across the 24 hour day, but recommended summary statistics give no dynamic information about the glucose profile across 24 hours. Aim: To examine whether differences in temporal glucose control occur in women with type 1 diabetes who develop large for gestational age infants (LGA). Research Design and Methods: CGM data was available from 200 pregnant women (100 CGM intervention; 100 controls) in the CONCEPTT study, at baseline, 24 and 34 weeks gestation. All women were being treated to tight glycemic targets (mean HbA1c 6.4% at 34 weeks gestation). Functional data analysis (FDA) was applied to determine differences in temporal glucose profiles. LGA was defined as birth weight ≥90th percentile adjusted for infant sex, gestational age, maternal BMI, ethnicity and parity. Results: 122/200 women had a LGA infant (61%). FDA revealed that those women who gave birth to a LGA infant ran a significantly higher glucose (by 9-14mg/dL; 0.5-0.8 mmol/l) for 16.5 hours of the day compared to those women who did not have a LGA infant (see fig). Conclusion: Women who go on to have LGA infants have significantly higher fetal exposure to glucose across the 24 hour day, despite being treated to tight glucose targets. Disclosure: E.M. Scott: Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott, Eli Lilly and Company. H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc. D. Feig: Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. G. Law: None. Funding: JDRF; Canadian Clinical Trials Network; National Institute for Health Research [ABSTRACT FROM AUTHOR]

Background: The CONCEPTT randomized trial of CGM in pregnant women with type 1 diabetes showed significant improvement in pregnancy outcomes, but no difference in mean CGM glucose between those allocated to CGM vs. capillary glucose monitoring. Whilst summary statistics are recommended for the reporting of CGM data, they do not give dynamic information about the glucose profile across 24 hours. Aim: To determine, using novel functional data analysis (FDA), if differences in the temporal glucose profile occurred in women randomized to CGM. Methods: CGM data was available from 200 pregnant women (100 CGM intervention; 100 control) in the CONCEPTT study, at baseline, 24 and 34 weeks gestation. FDA was applied to the glucose data to generate functional glucose curves and multivariable statistical analysis applied. Results: Despite having the same mean CGM glucose as those on capillary glucose monitoring alone 121 vs. 126 mg/dL; 6.7 vs. 7.0 mmol/l p=0.14, FDA revealed that pregnant CGM users were in fact running a significantly lower glucose (by 9-14mg/dL; 0.5-0.8 mmol/l) for a total of 8 hours a day (08.30-12.30 and 15.00-19.00). Conclusion: Analysis of temporal glucose profiles gives key information about glucose control, missed by commonly reported CGM metrics. The women allocated to CGM ran a significantly lower glucose for 33% of the day. Disclosure: E.M. Scott: Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott, Eli Lilly and Company. H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc. D. Feig: Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. G. Law: None. Funding: JDRF; Canadian Clinical Trials Network; National Institute for Health Research [ABSTRACT FROM AUTHOR]