Efficacy of flash glucose monitoring in pregnant women with poorly controlled pregestational diabetes (FlashMom): A randomized pilot study

Tumminia, Andrea; Milluzzo, Agostino; Festa, Camilla; Fresa, R.; Pintaudi, Basilio; Scavini, Marina; Vitacolonna, Ester; Napoli, Angela; Sciacca, Laura

doi:10.1016/j.numecd.2021.03.013

Cited by 13 publications

(4 citation statements)

References 38 publications

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“…There were no differences in perinatal outcomes. 16 In a retrospective cohort in 12 women with GDM and 53 with type 2 diabetes, Bitar et al found that higher TIR (>70%) was associated with increased adverse neonatal and maternal outcomes.…”

Section: Yamamoto Et Al Reported An Association Between Tir Tar Andmentioning

confidence: 99%

Continuous glucose monitoring metrics and pregnancy outcomes in insulin‐treated diabetes: A post‐hoc analysis of the GlucoMOMS trial

Rademaker,

van der Wel,

van Eekelen

et al. 2023

Diabetes Obesity Metabolism

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AimTo investigate the association between continuous glucose monitoring (CGM) metrics and perinatal outcomes in insulin‐treated diabetes mellitus in pregnancy.Materials and MethodsIn a post‐hoc analysis of the GlucoMOMS randomized controlled trial, we investigated the association between the metrics of an offline, intermittent CGM, glycated haemoglobin (HbA1c) and perinatal outcomes per trimester in different types of diabetes (type 1, 2 or insulin‐treated gestational diabetes mellitus [GDM]). Data were analysed using multivariable binary logistic regression. Outcomes of interest were neonatal hypoglycaemia, pre‐eclampsia, preterm birth, large for gestational age (LGA) and Neonatal Intensive Care Unit (NICU) admission. The glucose target range was defined as 3.5–7.8 mmol/L (63–140 mg/dL).ResultsOf the 147 participants (N = 50 type 1 diabetes, N = 94 type 2 diabetes/insulin‐treated GDM) randomized to the CGM group of the GlucoMOMS trial, 115 participants had CGM metrics available and were included in the current study. We found that, in pregnancies with type 1 diabetes, a higher second trimester mean glucose was associated with LGA (odds ratio 2.6 [95% confidence interval 1.1–6.2]). In type 2 and insulin‐treated gestational diabetes, an increased area under the curve above limit was associated with LGA (odds ratio 10.0 [95% confidence interval 1.4–72.8]). None of the CGM metrics were associated with neonatal hypoglycaemia, pre‐eclampsia, shoulder dystocia, preterm birth and NICU admission rates for pregnancies complicated by any type of diabetes.ConclusionIn this study, in type 2 diabetes or insulin‐treated GDM, the glucose increased area under the curve above limit was associated with increased LGA. In type 1 diabetes, the mean glucose was the major determinant of LGA. Our study found no evidence that other CGM metrics determined adverse pregnancy outcomes.

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Section: Yamamoto Et Al Reported An Association Between Tir Tar Andmentioning

confidence: 99%

Continuous glucose monitoring metrics and pregnancy outcomes in insulin‐treated diabetes: A post‐hoc analysis of the GlucoMOMS trial

Rademaker,

van der Wel,

van Eekelen

et al. 2023

Diabetes Obesity Metabolism

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“…isCGM also has a number of benefits over SMBG including less hypoglycaemia and greater TIR ( 69 , 70 ). Despite these advantages, discrepancies exist between isCGM and SMBG.…”

Section: Technologiesmentioning

confidence: 99%

“…In one study isCGM under-estimated glucose levels and potentially lead to differences in treatment decisions in up to 30% of instances ( 71 ). Finally improved fetal outcomes have not been demonstrated when compared to SMBG ( 69 ). In larger observational studies of over 300 women with type 1 diabetes, isCGM resulted in better glycaemic control in trimester 2 compared to conventional SMBG - however this translated to higher rates of neonatal hypoglycaemia and no improvement in rates of LGA or prematurity ( 72 ).…”

Section: Technologiesmentioning

confidence: 99%

Glycaemic control and novel technology management strategies in pregestational diabetes mellitus

2023

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IntroductionPregestational diabetes (PGDM) is an increasingly common and complex condition that infers risk to both mother and infant. To prevent serious morbidity, strict glycaemic control is essential. The aim of this review is to review the glucose sensing and insulin delivering technologies currently available for women with PGDM.MethodsWe reviewed online databases for articles relating to technology use in pregnancy using a combination of keywords and MeSH headings. Relevant articles are included below.ResultsA number of technological advancements have improved care and outcomes for women with PGDM. Real time continuous glucose monitoring (rtCGM) offers clear advantages in terms of infants size and neonatal intensive care unit admissions; and further benefits are seen when combined with continuous subcutaneous insulin delivery (insulin pump) and algorithms which continuously adjust insulin levels to glucose targets (hybrid closed loop). Other advancements including flash or intermittent scanning CGM (isCGM) and stand-alone insulin pumps do not confer as many advantages for women and their infants, however they are increasingly used outside of pregnancy and many women enter pregnancy already using these devices.DiscussionThis article offers a discussion of the most commonly used technologies in pregnancy and evaluates their current and future roles.

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“…La HbA1c si è ridotta significativamente nella stessa misura nei due gruppi durante la gravidanza, mentre il TBR e la variabilità glicemica sono risultate significativamente inferiori nel gruppo utilizzatore di is-CGM nel secondo trimestre rispetto al gruppo SMBG. Il tasso di eventi avversi perinatali non è stato differente nei due gruppi dello studio (34).…”

Section: Cgm In Gr Avidanz A: Evidenze Scientificheunclassified

Il monitoraggio in continuo della glicemia: stato dell’arte

Irace¹,

Molfetta²

2022

Il Diabete

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Continuous glucose monitoring (CGM) system is largely used in clinical practice in patients with type 1 diabetes and insulin-treated patients with type 2 diabetes. It is a needful tool for a more comprehensive assessment of glucose control. Patients can benefit from real-time information on current glucose, glucose trend, and hypo or hyperglycemia alarms. Healthcare can rapidly understand how much time patients spend in a good glucose range, hypoglycemia or hyperglycemia. Several clinical trials have demonstrated the benefits of CGM in reducing glycated hemoglobin, as well as the time spent in hypoglycemia, and increasing the time in range. CGM reduces the rate of severe acute complications and hospital admission improving the quality of life. Patients on insulin treatment and pregnant women are the perfect candidates for CGM. However, even patients on non-intensive insulin treatment or other therapies might benefit from CGM to gain and maintain reasonable glycemic control, and again improve the quality of life.

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Efficacy of flash glucose monitoring in pregnant women with poorly controlled pregestational diabetes (FlashMom): A randomized pilot study

Cited by 13 publications

References 38 publications

Continuous glucose monitoring metrics and pregnancy outcomes in insulin‐treated diabetes: A post‐hoc analysis of the GlucoMOMS trial

Continuous glucose monitoring metrics and pregnancy outcomes in insulin‐treated diabetes: A post‐hoc analysis of the GlucoMOMS trial

Glycaemic control and novel technology management strategies in pregestational diabetes mellitus

Il monitoraggio in continuo della glicemia: stato dell’arte

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