Objective To evaluate the effectiveness of continuous glucose monitoring during pregnancy on maternal glycaemic control, infant birth weight, and risk of macrosomia in women with type 1 and type 2 diabetes.Design Prospective, open label randomised controlled trial.Setting Two secondary care multidisciplinary obstetric clinics for diabetes in the United Kingdom.Participants 71 women with type 1 diabetes (n=46) or type 2 diabetes (n=25) allocated to antenatal care plus continuous glucose monitoring (n=38) or to standard antenatal care (n=33).Intervention Continuous glucose monitoring was used as an educational tool to inform shared decision making and future therapeutic changes at intervals of 4-6 weeks during pregnancy. All other aspects of antenatal care were equal between the groups.Main outcome measures The primary outcome was maternal glycaemic control during the second and third trimesters from measurements of HbA1c levels every four weeks. Secondary outcomes were birth weight and risk of macrosomia using birthweight standard deviation scores and customised birthweight centiles. Statistical analyses were done on an intention to treat basis.Results Women randomised to continuous glucose monitoring had lower mean HbA1c levels from 32 to 36 weeks’ gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7). Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98).Conclusion Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia.Trial registration Current Controlled Trials ISRCTN84461581.

OBJECTIVE -To examine the changes in glycemic excursions that occur during pregnancy using continuous glucose monitoring and to compare patterns of glycemia in pregnant women with type 1 and type 2 diabetes.RESEARCH DESIGN AND METHODS -An observational data analysis was performed from a prospective randomized study of continuous glucose monitoring in 57 women with pregestational type 1 (n ϭ 40) or type 2 (n ϭ 17) diabetes with 7-day continuous glucose monitoring system profiles during each trimester. Serial glucose measurements were divided into periods of euglycemia (70 -140 mg/dl), hyperglycemia (Ͼ140 mg/dl), and hypoglycemia (Ͻ70 mg/dl). Generalized linear mixed effects models were fitted to the repeated measures data to determine how these glycemic characteristics varied during gestation and by diabetes type.RESULTS -A total of 180 continuous glucose profiles were examined (140 type 1 diabetes, 40 type 2 diabetes), providing 20,433 h of data for analysis (16,117 h type 1 diabetes, 4,316 type 2 diabetes). Women with type 2 diabetes spend ϳ33% less time hyperglycemic throughout pregnancy than women with type 1 diabetes (P ϭ 0.005), with a significantly more rapid reduction in time spent hyperglycemic in early pregnancy (P ϭ 0.02). Although women with type 2 diabetes spend less overall time hypoglycemic (P ϭ 0.04), their risk of nocturnal hypoglycemia is equivalent to that of women with type 1 diabetes (blood glucose level Ͻ70 mg/dl, P ϭ 0.9; blood glucose level Ͻ50 mg/dl, P ϭ 0.2).CONCLUSIONS -Continuous glucose monitoring reveals clear differences in the level of glycemic control that exist in women with type 1 and type 2 diabetes. These data will guide therapeutic interventions aimed at optimizing glycemic control and improving the pregnancy outcomes of both type 1 and type 2 diabetes.

Despite the scarcity of studies, work-related musculoskeletal disorders are common amongst ENT surgeons in the UK. Such disparity highlights the need for more research and appropriate ergonomic intervention within the specialty.

Neck and shoulder disorders are a considerable health problem amongst frequent microscope users. We aimed to investigate the neck and shoulder discomfort experienced during prolonged microscopic activity and to assess the benefits of minibreaks. A prospective crossover study was performed on 17 healthy volunteers sitting still while looking down a bench with and without the Ipswich Microbreak Technique (IMT). We used a subjective measure of time to fatigue and pain in the neck and shoulder regions as well as objective readings from a surface electromyogram (sEMG). The IMT delayed the sensation of pain in the neck and shoulder region while reducing the overall sEMG muscle activation. In conclusion, IMT is a useful strategy in reducing and delaying the pain in neck and shoulder from prolonged working under the microscope. This technique can be incorporated in other activities that involve a sustained stationary position.

Musculoskeletal pain is a common occupational hazard experienced by surgeons. Ear, nose and throat (ENT) surgeons are predisposed to neck and back pain due to regular prolonged microscopic work. We conducted a prospective pilot study to investigate the effects of sustained microscopic work on the neck and back, its correlation to surgical experience and to assess the benefits of a prototype postural support chair (PSC) amongst 10 male, ENT clinicians. We used a subjective measure of time to fatigue and pain for the neck and back as well as objective readings from a surface electromyogram (sEMG). We found that an increase in surgical experience correlated with the time taken to experience fatigue and pain in the neck and back. This was corroborated by our sEMG findings. The PSC significantly delayed the sensations in the neck and also eliminated the difference seen amongst the varying seniority of clinicians.