Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

Kristensen, Karl; Ögge, Linda Englund; Sengpiel, Verena; Kjölhede, Karin; Dotevall, Annika; Elfvin, Anders; Knop, Filip K.; Wiberg, Nana; Katsarou, Anastasia; Shaat, Nael; Kristensen, Lars Erik; Berntorp, Kerstin

doi:10.1007/s00125-019-4850-0

Cited by 146 publications

(192 citation statements)

References 45 publications

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“…The standard CGM metrics readily showed significant differences when it came to LGA, with a higher mean glucose at 24 and 34 weeks gestation; significantly lower time spent in pregnancy target range in each trimester, significantly higher time spent above the pregnancy target range of 3.5-7.8 mmol/l (63-140mg/dL) throughout pregnancy; and greater glucose variability in the first and second trimesters in those women who went on to have an LGA infant. This is consistent with the recent findings of an observational study of 186 pregnant women with type 1 diabetes using CGM in Sweden which showed that higher mean CGM glucose levels in the second and third trimester were significantly associated with LGA, as well as less time spent in pregnancy target range, and greater SD in second trimester (19).…”

Section: Discussionsupporting

confidence: 92%

Continuous Glucose Monitoring in Pregnancy: Importance of Analyzing Temporal Profiles to Understand Clinical Outcomes

Law

Murphy

Grisoni³

et al. 2020

Diabetes Care

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Objective: To determine if temporal glucose profiles differed between: 1) women who were randomized to continuous glucose monitoring (RT-CGM) or self-monitored blood glucose (SMBG); 2) women who used insulin pumps or multiple daily injections (MDI); 3) women whose infants were born large for gestational age (LGA) or not, by assessing CGM data obtained from the CONCEPTT trial. Research Design and Methods: Standard summary metrics and functional data analysis (FDA) were applied to CGM data from the CONCEPTT trial (n=100 CGM; n=100 SMBG) taken at baseline, 24 and 34 weeks gestation. Multivariable regression analysis determined if temporal differences in 24 hour 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 (7-14mg/dL)] for 7 hrs/day (08.00-12.00 and 16.00-19.00) compared to SMBG. Women using pumps had significantly higher glucose [0.4-0.9 mmol/l (7-16mg/dL)] for 12

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Section: Discussionsupporting

confidence: 92%

Continuous Glucose Monitoring in Pregnancy: Importance of Analyzing Temporal Profiles to Understand Clinical Outcomes

Law

Murphy

Grisoni³

et al. 2020

Diabetes Care

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“…In a commentary of this study, Helen Murphy suggests that for optimal obstetric and neonatal outcomes, women should aim to reach a TIR > 70% and a time above range < 25%, as early as possible during pregnancy. Those who can't achieve this target should be encouraged that any 5% increase in TIR is associated with clinically relevant improvements in neonatal health [25]. "…”

Section: Main Textmentioning

confidence: 99%

Time in range: a new parameter to evaluate blood glucose control in patients with diabetes

Gabbay

Rodacki

Calliari

et al. 2020

Diabetol Metab Syndr

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The International Consensus in Time in Range (TIR) was recently released and defined the concept of the time spent in the target range between 70 and 180 mg/dL while reducing time in hypoglycemia, for patients using Continuous Glucose Monitoring (CGM). TIR was validated as an outcome measures for clinical Trials complementing other components of glycemic control like Blood glucose and HbA1c. The challenge is to implement this practice more widely in countries with a limited health public and private budget as it occurs in Brazil. Could CGM be used intermittently? Could self-monitoring blood glucose obtained at different times of the day, with the amount of data high enough be used? More studies should be done, especially cost-effective studies to help understand the possibility of having sensors and include TIR evaluation in clinical practice nationwide.

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“…In the recent, “Recommendations from the International Consensus on Time in Range (TIR),” the lower glucose target threshold suggested during pregnancy is 3.5 mmol/L (63 mg/dL) 91 . Based on data from Sweden and the Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT), the TBR <3.5 mmol/L (<63 mg/dL) recommended is <4% of readings 127, 128 . However, the evidence on CGM metrics and targets, including TBR, for women with T2DM and gestational diabetes mellitus, is lacking.…”

Section: Hypoglycaemia During Pregnancymentioning

confidence: 99%

Hypoglycaemia and its management in primary care setting

Ibrahim¹,

Baker

Cahn³

et al. 2020

Diabetes Metabolism Res

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Hypoglycaemia is common in patients with type 1 diabetes and type 2 diabetes and constitutes a major limiting factor in achieving glycaemic control among people with diabetes. While hypoglycaemia is defined as a blood glucose level under 70 mg/dL (3.9 mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycaemic control. Severe hypoglycaemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery. Hypoglycaemia is the most important safety outcome in clinical studies of glucose lowering agents. The American Diabetes Association Standards of Medical Care recommends that a management protocol for hypoglycaemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan. A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients. Data from recent large clinical trials reported low risk of hypoglycaemic events with the use of newer anti‐diabetic drugs. Increased hypoglycaemia risk is observed with the use of insulin and/or sulphonylureas. Vulnerable patients with T2D at dual risk of severe hypoglycaemia and cardiovascular outcomes show features of “frailty.” Many of such patients may be better treated by the use of GLP‐1 receptor agonists or SGLT2 inhibitors rather than insulin. Continuous glucose monitoring (CGM) should be considered for all individuals with increased risk for hypoglycaemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia and with history of severe hypoglycaemia. Patients with impaired awareness of hypoglycaemia benefit from real‐time CGM. The diabetes educator is an invaluable resource and can devote the time needed to thoroughly educate the individual to reduce the risk of hypoglycaemia and integrate the information within the entire construct of diabetes self‐management. Conversations about hypoglycaemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycaemia among patients with diabetes and their family members. Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycaemia. Several therapeutic considerations are important to reduce hypoglycaemia risk during pregnancy including administration of rapid‐acting insulin analogues rather than human insulin, pre‐conception initiation of insulin analogues, and immediate postpartum insulin dose reduction.

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Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

Cited by 146 publications

References 45 publications

Continuous Glucose Monitoring in Pregnancy: Importance of Analyzing Temporal Profiles to Understand Clinical Outcomes

Continuous Glucose Monitoring in Pregnancy: Importance of Analyzing Temporal Profiles to Understand Clinical Outcomes

Time in range: a new parameter to evaluate blood glucose control in patients with diabetes

Hypoglycaemia and its management in primary care setting

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