Frequent Monitoring of A1C During Pregnancy as a Treatment Tool to Guide Therapy

Abstract

OBJECTIVENo guidelines for A1C measurement exist for women with gestational diabetes mellitus (GDM). The aim of this study was to document the rate of A1C decline in women with GDM.RESEARCH DESIGN AND METHODSWomen with GDM in the Santa Barbara County Endocrine Clinic are managed with a carbohydrate-restricted diet and self-monitored blood glucose before and 1-h postprandial. Insulin is started if the preprandial glucose concentration is ≥90 mg/dl and/or a 1-h postprandial glucose concentration is ≥120 mg/dl. Capillary A1C was tested weekly using the DCA2000+ analyzer.RESULTSTwenty-four women with GDM (aged 29.0 ± 7.3 years) with initial A1C ≥7.0% were recruited. Baseline A1C was 8.8 ± 1.8%. Mean A1C decline was 0.47% per week (range 0.10–1.15%); the maximum was 4.3% in 4 weeks.CONCLUSIONSThis study documents rapid decline in A1C during pregnancy and the utility of weekly A1C to guide therapy.

5. Glycemic Targets

“…As people with type 1 or type 2 diabetes are living longer healthier lives, individuals who have been successfully using CGM should have continued access after they turn 65 years of age. (27).…”

Gestational diabetes mellitus

“…Životni vek eritrocita tokom trudnoće je skraćen na oko 90 dana, tako da nivo HbA1c u trudnoći odražava glikemijsku kontrolu tokom nekoliko prethodnih nedelja. Češće merenje HbA1c tokom trudnoće može se koristiti kao vodič za terapijsku odluku u trudnoći praćenoj dijabetesom (16,39).…”

Pregnancy and Diabetes Management: Advances and Controversies

“…In pregnancy, during which there is increased turnover of red blood cells, Hb A 1c reflects the mean blood glucose in the prior 4 -6 weeks (8 ). Pregnant women show a decrease in Hb A 1c after 1 week of physician intervention, and with continued therapy Hb A 1c can decrease at a rate of 0.5% per week (9 ). Point-of-care Hb A 1c determination is an integral tool in assessing a woman's glycemic control before and during pregnancy, especially during the critical period of fetal organogenesis (10 ).…”

“…The use of weekly Hb A 1c measurement in conjunction with frequent SMBG is a powerful tool to safely and aggressively adjust insulin concentrations and prevent hypoglycemia (9 ).…”