Diurnal glycemic profile in obese and normal weight nondiabetic pregnant women

Continuous Glucose Monitoring

“…This technology has similarly been used in hyperglycemia in type 1 diabetic subjects using insulin pump therapy (65,66), type 1 diabetic subjects using insulin injections (67), pregnant women with (55)(56)(57)(58)(59)68) and without (68,69) diabetes, gastroparesis patients (70), and cystic fibrosis patients (71). Continuous glucose monitoring has also been used as a therapeutic tool to decrease the incidence and magnitude of hypoglycemia in three studies (46,72,73).…”

Goals of Metabolic Management of Gestational Diabetes

“…Controversy further exists with regard to the appropriate threshold (Ͻ140 mg/dl in 1-h and Ͻ120 mg/dl 2-h postprandial) to define normality (8,9,16,17). We demonstrated (14) in nondiabetic gravid subjects that peak glucose value is achieved at ϳ70 Ϯ 13 min postprandial at a mean glucose level of 110 Ϯ 16 mg/dl. Therefore, whether the postprandial threshold should be modified in GDM patients or the targeted postprandial values in the pregnant diabetic woman should remain higher than the postprandial values found in nondiabetic women requires further study.…”

“…This idea is supported by the finding in our study that, in patients with wellcontrolled diabetes, the peak glucose value was 103 Ϯ 26 mg/dl, and in patients whose diabetes was poorly controlled, the peak value was 164 Ϯ 53 mg/dl. Thus, it would be logical to combine both studies (14,24) and to suggest that blood glucose determinations should be taken at 90 min postmeal, with a desired glucose value of ϳ110 mg/dl. Nevertheless, we recognize that future studies qualified by the frequency and timing of testing are needed for evaluating the association between pregnancy outcome and these glycemic goals before advocating using these criteria for routine management guidelines.…”

“…In a recent study (14), we used continuous glucose monitoring (MiniMed, Sylmar, CA) in nondiabetic obese and nonobese gravid patients. A total of 57 gravid women with singleton pregnancies were studied, after completion of 20 weeks of pregnancy, with normal glucose challenge tests (Ͻ130 mg/dl) or normal oral glucose tolerance tests.…”

Point: Oral Hypoglycemic Agents Should Not Be Used to Treat Diabetic Pregnant Women

“…In addition, Frazier (5) reported that the peak glucose concentration is 1 h after eating (e.g., lunch at 12:00 P.M. and peak response at 1:00 P.M.). Recently, Yogev et al (6) evaluated the ambulatory daily glycemic profile in the second half of pregnancy in normal healthy women for 72 consecutive hours per patient with continuous glucose monitoring by measurement of interstitial glucose levels in subcutaneous tissue every 5 min. They reported that the mean Ϯ SD fasting blood glucose level was 75 Ϯ 12 mg/dl, the blood glucose level 83.7 Ϯ 18 mg/dl, and the postprandial peak glucose value level 110 Ϯ 16 mg/dl; the time interval needed to reach peak postprandial glucose level was 70 Ϯ 13 min.…”