Measuring glycated haemoglobin in women with gestational diabetes mellitus: How useful is it?

Wong, Vincent W.; Chong, Shanley; Mediratta, Sahil; Jalaludin, Bin

doi:10.1111/ajo.12511

Cited by 12 publications

(21 citation statements)

References 20 publications

(29 reference statements)

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“…Determining the adequacy of blood glucose control during pregnancy is challenging. Although we report no difference in HbA 1c , it is a poor measure of glucose control in the context of rapid changes in glycemia over a short period of time [ 23 ]. Likewise, we did not have access to continuous glucose monitoring, thus the overall linear rate of change of blood glucose we present was reliant on the woman’s capillary testing and may have missed differences in fetal glucose exposure during the trial.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial

Mackillop¹,

Hirst²,

Bartlett³

et al. 2018

JMIR Mhealth Uhealth

146

289

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BackgroundTreatment of hyperglycemia in women with gestational diabetes mellitus (GDM) is associated with improved maternal and neonatal outcomes and requires intensive clinical input. This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits.ObjectiveWe conducted a randomized controlled trial to determine whether the use of a mobile phone-based real-time blood glucose management system to manage women with GDM remotely was as effective in controlling blood glucose as standard care through clinic attendance.MethodsWomen with an abnormal oral glucose tolerance test before 34 completed weeks of gestation were individually randomized to a mobile phone-based blood glucose management solution (GDm-health, the intervention) or routine clinic care. The primary outcome was change in mean blood glucose in each group from recruitment to delivery, calculated with adjustments made for number of blood glucose measurements, proportion of preprandial and postprandial readings, baseline characteristics, and length of time in the study.ResultsA total of 203 women were randomized. Blood glucose data were available for 98 intervention and 85 control women. There was no significant difference in rate of change of blood glucose (–0.16 mmol/L in the intervention and –0.14 mmol/L in the control group per 28 days, P=.78). Women using the intervention had higher satisfaction with care (P=.049). Preterm birth was less common in the intervention group (5/101, 5.0% vs 13/102, 12.7%; OR 0.36, 95% CI 0.12-1.01). There were fewer cesarean deliveries compared with vaginal deliveries in the intervention group (27/101, 26.7% vs 47/102, 46.1%, P=.005). Other glycemic, maternal, and neonatal outcomes were similar in both groups. The median time from recruitment to delivery was similar (intervention: 54 days; control: 49 days; P=.23). However, there were significantly more blood glucose readings in the intervention group (mean 3.80 [SD 1.80] and mean 2.63 [SD 1.71] readings per day in the intervention and control groups, respectively; P<.001). There was no significant difference in direct health care costs between the two groups, with a mean cost difference of the intervention group compared to control of –£1044 (95% CI –£2186 to £99). There were no unexpected adverse outcomes.ConclusionsRemote blood glucocse monitoring in women with GDM is safe. We demonstrated superior data capture using GDm-health. Although glycemic control and maternal and neonatal outcomes were similar, women preferred this model of care. Further studies are required to explore whether digital health solutions can promote desired self-management lifestyle behaviors and dietetic adherence, and influence maternal and neonatal outcomes. Digital blood glucose monitoring may provide a scalable, practical method to address the growing burden of GDM around the world.Trial RegistrationClinicalTrials.gov NCT01916694; https://clinicaltrials.gov/ct2/show/NCT01916694 (Archived by WebCite at http://www.webcitat...

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Section: Discussionmentioning

confidence: 99%

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial

Mackillop¹,

Hirst²,

Bartlett³

et al. 2018

JMIR Mhealth Uhealth

146

289

View full text Add to dashboard Cite

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“…Gestational weight gain and average third trimester HbA1c level (>5%) were found as risk factors for neonatal complications in mothers with GDM [64]. Likewise, measurement of HbA1c, at the end of pregnancy was associated with adverse pregnancy outcomes [65]. Piuri et al also observed a positive correlation between methylglyoxal (MGO) levels, the major precursor in the formation of AGEs, and HbA1c both at diagnosis and after 12 weeks of gestation.…”

Section: Plos Onementioning

confidence: 98%

The relationship between advanced glycation end products and gestational diabetes: A systematic review and meta-analysis

et al. 2020

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Introduction Gestational Diabetes Mellitus (GDM) is a condition in which women without history of diabetes experience hyperglycemia during pregnancy, especially at the second and third trimesters. In women who have had GDM, an elevated body mass index (BMI) may have a substantial impact for persistent hyperglycemia in their lives after gestation. Beyond hyperglycemia, increased local oxidative stress directly promotes the formation of Advanced Glycation End-products (AGEs). Hence, this systematic review and meta-analysis was aimed to determine the relationship between the level of AGEs and/or related metabolic biomarkers with GDM. Methods Literature search was carried out through visiting electronic databases, indexing services, and directories including PubMed/MEDLINE (Ovid ®), EMBASE (Ovid ®), google scholar and WorldCat to retrieve studies without time limit. Following screening and eligibility evaluation, relevant data were extracted from included studies and analyzed using Rev-Man 5.3 and STATA 15.0. Inverse variance method with random effects pooling model was used for the analysis of outcome measures at 95% confidence interval. Hedge's adjusted g statistics was applied to calculate the standardized mean difference (SMD) to consider the small sample bias. Besides, meta-regression, meta-influence, and publication bias analyses were conducted. The protocol has been registered on PROSPERO with ID: CRD42020173867. Results A total of 16 original studies were included for the systematic review and meta-analysis.

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“…Whilst we report no difference in HbA1c, it is a poor measure of glucose control in the context of rapid changes in glycaemia over a short period of time [23]. Likewise, we did not have access to continuous glucose monitoring thus the overall linear rate of change of BG we present was reliant on the woman's capillary testing and may have missed differences in fetal glucose exposure during the trial.…”

Section: Discussionmentioning

confidence: 75%

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial (Preprint)

Mackillop¹,

Hirst²,

Bartlett³

et al. 2017

Preprint

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Measuring glycated haemoglobin in women with gestational diabetes mellitus: How useful is it?

Cited by 12 publications

References 20 publications

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial

The relationship between advanced glycation end products and gestational diabetes: A systematic review and meta-analysis

Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial (Preprint)

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