Disagreement between capillary blood glucose and flash glucose monitoring sensor can lead to inadequate treatment adjustments during pregnancy

Sola-Gazagnes, A.; Faucher, Pauline; Jacqueminet, S.; Ciangura, C.; Dubois-Laforgue, D.; Mosnier-Pudar, H.; Roussel, Ronan; Larger, Étienne

doi:10.1016/j.diabet.2019.08.001

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…Of the 12 studies included, 10 were performed in adults and two in children and adolescents with type 1 diabetes 8,9,16‐24 (Supplementary Appendix S1). In one adult study, isCGM accuracy was assessed in pregnant women with type 1 diabetes.…”

Section: Resultsmentioning

confidence: 99%

Performance of intermittently scanned continuous glucose monitoring systems in people with type 1 diabetes: A pooled analysis

Moser

Sternad

Eckstein

et al. 2021

Diabetes Obesity Metabolism

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Aims: To conduct a pooled analysis to assess the performance of intermittently scanned continuous glucose monitoring (isCGM) in association with the rate of change in sensor glucose in a cohort of children, adolescents, and adults with type 1 diabetes. Material and Methods:In this pooled analysis, isCGM system accuracy was assessed depending on the rate of change in sensor glucose. Clinical studies that have been investigating isCGM accuracy against blood glucose, accompanied with collection time points were included in this analysis. isCGM performance was assessed by means of median absolute relative difference (MedARD), Parkes error grid (PEG) and Bland-Altman plot analyses.Results: Twelve studies comprising 311 participants were included, with a total of 15 837 paired measurements. The overall MedARD (interquartile range) was 12.7% (5.9-23.5) and MedARD differed significantly based on the rate of change in glucose (P < 0.001). An absolute difference of À22 mg/dL (À1.2 mmol/L) (95% limits of agreement [LoA] 60 mg/dL (3.3 mmol/L), À103 mg/dL (À5.7 mmol/L)) was found when glucose was rapidly increasing (isCGM glucose minus reference blood glucose), while a À32 mg/dL (1.8 mmol/L) (95% LoA 116 mg/dL (6.4 mmol/L), À51 mg/dL (À2.8 mmol/ L)) absolute difference was observed in periods of rapidly decreasing glucose. Conclusions:The performance of isCGM was good when compared to reference blood glucose measurements. The rate of change in glucose for both increasing and Othmar Moser and Christoph Sternad share the first authorship.

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Section: Resultsmentioning

confidence: 99%

Performance of intermittently scanned continuous glucose monitoring systems in people with type 1 diabetes: A pooled analysis

Moser

Sternad

Eckstein

et al. 2021

Diabetes Obesity Metabolism

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“…evaluated a discrepancy between isCGM/FGM results and SMBG based on the outcome of the study of 33 pregnant women. Although close, the results of the sensor underestimated those of the SMBG, in which 25% to 35% of management choices would have diverged if based on isCGM/FGM than SMBG ( 39 ).…”

Section: Pregnancymentioning

confidence: 91%

Flash glucose monitoring system in special situations

Rigon¹,

Ronsoni²,

Vianna³

et al. 2022

Archives of Endocrinology and Metabolism

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The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.

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“…This was thought to affect the treatment of hypoglycaemia and adjustment of insulin regimens. Other maternal and neonatal outcomes were not assessed [89]. In this cohort of 33 participants, only 4 had T2DM and only 4 had GDM, limiting the findings for these groups of women.…”

Section: Gestational Diabetesmentioning

confidence: 91%

Glucose Treatment Targets in Pregnancy - A Review of Evidence and Guidelines

Byford

Forbes

Scott

2023

CDR

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Background: Maternal diabetes mellitus during pregnancy is associated with an increased risk of pregnancy complications for both the mother and the fetus. One of the most prevalent complications is pathological fetal growth, and particularly infants are born large for gestational age (LGA), which leads to problematic deliveries, including the need for caesarean section, instrumental delivery and further perinatal complications. Glucose monitoring during pregnancy is essential for ensuring appropriate glycaemic control and to reduce these associated risks. The current methods of glucose monitoring include measuring glycosylated haemoglobin (HbA1c), self-monitoring of capillary blood glucose (SMBG), and more recently, continuous glucose monitoring (CGM). Observational studies and randomised controlled trials (RCTs) have assessed the appropriate glycaemic targets for HbA1c, SMBG, and CGM in relation to pregnancy outcomes. Objective: In this review we identify current international guidelines on glycaemic targets and review the supporting evidence. Method: We performed an extensive literature search on glycaemic targets in pregnancies affected by diabetes and we researched international guidelines from recognised societies. Results and Conclusion: The majority of studies used to define the glucose targets associated with the best pregnancy outcomes, across all modalities, were in women with type 1 diabetes. There were limited studies in women with type 2 diabetes and gestational diabetes. We therefore suggest that further research needs to be conducted on glucose targets and clinical outcomes specifically in these populations where CGM technology offers the greatest potential for monitoring glucose and improving pregnancy outcomes.

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Disagreement between capillary blood glucose and flash glucose monitoring sensor can lead to inadequate treatment adjustments during pregnancy

Cited by 14 publications

References 16 publications

Performance of intermittently scanned continuous glucose monitoring systems in people with type 1 diabetes: A pooled analysis

Performance of intermittently scanned continuous glucose monitoring systems in people with type 1 diabetes: A pooled analysis

Flash glucose monitoring system in special situations

Glucose Treatment Targets in Pregnancy - A Review of Evidence and Guidelines

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