Seventy two-hour glucose monitoring profiles in mild gestational diabetes mellitus: differences from healthy pregnancies and influence of diet counseling

Abstract

Objective: To study glucose profiles of gestational diabetes (GDM) patients with 72 h of continuous glucose monitoring (CGM) either before (GDM1) or after (GDM2) dietary counseling, comparing them with nondiabetic (NDM) controls. Design and methods: We performed CGM on 22 GDM patients; 11 before and 11 after dietary counseling and compared them to 11 healthy controls. Several physiological and clinical characteristics of the glucose profiles were compared across the groups, including comparisons for pooled 24-h measures and hourly median values, summary measures representing glucose exposure (area under the median curves) and variability (amplitude, standard deviation, interquartile range), and time points related to meals. Results: Most women (81.8%) in the GDM groups had fasting glucose <95 mg/dL, suggesting mild GDM. Variability, glucose levels 1 and 2 h after breakfast and dinner, peak values after dinner and glucose levels between breakfast and lunch, were all significantly higher in GDM1 than NDM (P < 0.05 for all comparisons). The GDM2 results were similar to NDM in all aforementioned comparisons (P > 0.05). Both GDM groups spent more time with glucose levels above 140 mg/dL when compared with the NDM group. No differences among the groups were found for: pooled measurements and hourly comparisons, exposure, nocturnal, fasting, between lunch and dinner and before meals, as well as after lunch (P > 0.05 for all). Conclusion: The main differences between the mild GDM1 group and healthy controls were related to glucose variability and excursions above 140 mg/dL, while glucose exposure was similar. Glucose levels after breakfast and dinner also discerned the GDM1 group. Dietary counseling was able to keep glucose levels to those of healthy patients.

Comparative analysis of 2‐week glycaemic profile of healthy versus mild gestational diabetic pregnant women using flash glucose monitoring system: an observational study

“…This was comparable to the figure of 81.4% with blood glucose values below 95 mg/dl among women with GDM reported by Carreiro et al 9 Postprandial blood glucose values and time to peak in our study were also comparable. This was comparable to the figure of 81.4% with blood glucose values below 95 mg/dl among women with GDM reported by Carreiro et al 9 Postprandial blood glucose values and time to peak in our study were also comparable.…”

“…All our women with GDM had fasting blood glucose levels far below 92 mg/dl as evidenced on the AGP recording. This was comparable to the figure of 81.4% with blood glucose values below 95 mg/dl among women with GDM reported by Carreiro et al 9 Postprandial blood glucose values and time to peak in our study were also comparable. 9 The present study shows significant differences in preprandial and postprandial blood glucose values between the three groups, with blood glucose values higher in GDM subjects at all points of time, compared with healthy pregnant subjects.…”

The Role of Dietary Carbohydrates in Gestational Diabetes

“…These data show that a diet high in complex CHO and reduced fat still achieved glycemia below current treatment targets and lower postprandial free fat acids. Subsequently, Carreiro et al, 2016 [95] used CGM to more accurately assess the impact of dietary recommendations on women suffering from gestational diabetes and they concluded that dietary counseling was able to keep glucose levels close to those of healthy patients. In a prospective observational study with GDM patients two methods to evaluate glucose readings, CGM and self-monitor blood sugar glucose (SMBG), during Ramadan fasting were compared [96].…”

Controversies and Advances in Gestational Diabetes—An Update in the Era of Continuous Glucose Monitoring

“…Studies with CGM have helped to unmask important features such as glucose exposure and variability, in addition to glucose peaks related to meals [ 30 , 31 , 32 ]. They have also been extremely useful in strengthening our understanding of normal pregnancy glucose profiles, as well as to disclose differences from diabetic pregnancies [ 33 ]. The relationship between CGM data and pregnancy outcomes needs further clarification, in order to better understand which glucose features really impact on outcomes.…”

“…This study suggests that targeting specific glucose time points may occasionally miss important glucose variations. It also suggests that, whenever glucose exposures are equal, variability and/or other factors other than glucose may be related to poor outcomes, such as fetal overgrowth [ 33 ].…”