Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study

Liang, Xiubo; Fu, Yuanqing; Lu, Sha; Shuai, Menglei; Miao, Zelei; Gou, Wanglong; Shen, Luqi; Liang, Yuhui; Xu, Fengzhe; Tian, Yunyi; Wang, Jiali; Zhang, Ke; Xiao, Congmei; Jiang, Zengliang; Shi, Mei-qi; Wu, Yingying; Wang, Xuhong; Hu, Wensheng; Zheng, Ju‐Sheng

doi:10.1016/j.lanwpc.2023.100823

Cited by 8 publications

(6 citation statements)

References 33 publications

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“…In a study of women with GDM, receiver operating characteristic (ROC) curves were analyzed to explore the optimal thresholds for TAR and mean glucose in predicting adverse pregnancy outcomes. 62 The optimal thresholds for TAR were 1.9% for LGA, 1.2% for NICU admission, and 2.5% for any adverse pregnancy outcome. The optimal thresholds for mean glucose were 81 mg/dL for LGA and 86 mg/dL for any adverse outcome, considerably lower than the mean glucose target suggested for T1D.…”

Section: Controversies In Establishing the Tir Target In Pregnancy: W...mentioning

confidence: 90%

“…61 A recent and much larger study of 1302 individuals with GDM who used CGM for 14 days at a mean of 26 weeks of gestation found that TAR, area under the curve (AUC), nighttime mean glucose, daytime mean glucose, and daily mean glucose were all associated with a composite adverse pregnancy outcome. 62 In addition, TIR, TAR, AUC, MAGE and nighttime, daytime, and daily mean glucose were 8,11 and in Table 2; however, there are currently no published trials in T2D alone. Efficacy studies addressing CGM use in T2D and GDM demand immediate attention, but such widespread implementation of CGM technology would also mandate the availability of more diabetes care and education specialists to assist patients and their providers.…”

Section: What Are the Challenges For Use Of The Agp In Pregnancy?mentioning

confidence: 99%

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Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence

Szmuilowicz,

Barbour,

Brown

et al. 2024

J Diabetes Sci Technol

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Ascertaining the utility of continuous glucose monitoring (CGM) in pregnancy complicated by diabetes is a rapidly evolving area, as the prevalence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM) escalates. The seminal randomized controlled trial (RCT) evaluating CGM use added to standard care in pregnancy in T1D demonstrated significant improvements in maternal glycemia and neonatal health outcomes. Current clinical guidance recommends targets for percentage time in range (TIR), time above range (TAR), and time below range (TBR) during pregnancy complicated by T1D that are widely used in clinical practice. However, the superiority of CGM over blood glucose monitoring (BGM) is still questioned in both T2D and GDM, and whether glucose targets should be different than in T1D is unknown. Questions requiring additional research include which CGM metrics are superior in predicting clinical outcomes, how should pregnancy-specific CGM targets be defined, whether CGM targets should differ according to gestational age, and if CGM metrics during pregnancy should be similar across all types of diabetes. Limiting the potential for CGM to improve pregnancy outcomes may be our inability to maintain TIR > 70% throughout gestation, a goal achieved in the minority of patients studied. Adverse pregnancy outcomes remain high in women with T1D and T2D in pregnancy despite CGM technology, and this review explores the potential reasons and questions yet to be investigated.

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Section: Controversies In Establishing the Tir Target In Pregnancy: W...mentioning

confidence: 90%

Section: What Are the Challenges For Use Of The Agp In Pregnancy?mentioning

confidence: 99%

Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence

Szmuilowicz,

Barbour,

Brown

et al. 2024

J Diabetes Sci Technol

View full text Add to dashboard Cite

show abstract

“…rtCGM use in all pregnant women with T2D or gestational diabetes mellitus is currently not recommended because of limited data in these cohorts. Glucose profiling with CGM data in gestational diabetes mellitus could potentially be utilized to predict adverse pregnancy outcomes 26 . Further studies to better understand CGM‐derived glycaemic changes throughout pregnancy is needed to inform future management, including the role of rtCGM, gestational diabetes and T2D in pregnancy 27 …”

Section: Real‐time Continuous Glucose Monitoring Technologymentioning

confidence: 99%

The role of real‐time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management

Reddy,

Oliver

2024

Diabetes Obesity Metabolism

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Diabetes is a complex metabolic condition that demands tailored, individualized approaches for effective management. Real‐time continuous glucose monitoring (rtCGM) systems have improved in terms of design, usability and accuracy over the years and play a pivotal role in the delivery of integrated personalized diabetes management (iPDM). iPDM is a comprehensive multidisciplinary approach that combines individualized care strategies utilizing technologies and interventions and encourages the active involvement of the person with diabetes in the care provided. The use of stand‐alone rtCGM and its integration with other diabetes technologies, such as hybrid automated insulin delivery, have enabled improved glycaemic and quality of life outcomes for people with diabetes. As the uptake of rtCGM and associated technologies is increasing and becoming the standard of care for people with diabetes, it is important that efforts are focused on associated goals such as reducing health inequalities in terms of access, aligning structured education with rtCGM usage, choosing the right technology based on needs and preferences, and minimizing burden while aiming for optimal glucose outcomes. Utilizing rtCGM in other settings than outpatients and in diabetes cohorts beyond type 1 and type 2 diabetes needs further exploration. This review aims to provide an overview of the role of rtCGM and how best to link rtCGM to iPDM, highlighting its role in enhancing personalized treatment strategies.

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“…Additional metrics included the glucose management indicator (GMI), mean glucose, and glycaemic variability. These metrics provide a comprehensive framework for assessing and managing glycaemic control in pregnancy[ 29 ].…”

Section: Clinical Targets For Cgm Monitoring Data In Pregnancymentioning

confidence: 99%

“…The duration of CGM wear in pregnant women with type 1 diabetes critically influences maternal and neonatal outcomes[ 29 ]. Consistent use of CGM in pregnancy leads to more effective glucose control, which is pivotal in reducing risks associated with T1DM.…”

Section: Correlation Of Each Parameter To Pregnancy and Neonatal Outc...mentioning

confidence: 99%

Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

Jeeyavudeen,

Crosby,

Pappachan

2024

World J Methodol

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Managing diabetes during pregnancy is challenging, given the significant risk it poses for both maternal and foetal health outcomes. While traditional methods involve capillary self-monitoring of blood glucose level monitoring and periodic HbA1c tests, the advent of continuous glucose monitoring (CGM) systems has revolutionized the approach. These devices offer a safe and reliable means of tracking glucose levels in real-time, benefiting both women with diabetes during pregnancy and the healthcare providers. Moreover, CGM systems have shown a low rate of side effects and high feasibility when used in pregnancies complicated by diabetes, especially when paired with continuous subcutaneous insulin infusion pump as hybrid closed loop device. Such a combined approach has been demonstrated to improve overall blood sugar control, lessen the occurrence of preeclampsia and neonatal hypoglycaemia, and minimize the duration of neonatal intensive care unit stays. This paper aims to offer a comprehensive evaluation of CGM metrics specifically tailored for pregnancies impacted by type 1 diabetes mellitus.

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Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study

Cited by 8 publications

References 33 publications

Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence

Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence

The role of real‐time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management

Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

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