Continuous glucose monitoring system profile of women diagnosed as gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups criteria and labeled as normoglycemic by alternate criteria in early pregnancy

Abstract

Aims/Introduction: We aimed to evaluate and compare continuous glucose monitoring system (CGMS)-based glycemic parameters in women in early pregnancy (<20 weeks of gestation) who were classified as: (i) gestational diabetes mellitus (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), but normoglycemia by alternate (UK National Institute for Health and Care Excellence, Canadian Diabetes Association and Diabetes in Pregnancy Study group of India) criteria; and (ii) normoglycemia by both (IADPSG and alternate) criteria. Material and Methods: In this cross-sectional study, eligible women underwent standard 75-g oral glucose tolerance test, followed by the placement of a CGMS. Glycemia-related parameters were calculated using the standard approach for CGMS data in pregnancy. Results: We enrolled 96 women at 14.0 -3.2 weeks of gestation. Of the women diagnosed as GDM by IADPSG criteria, 34.2%, 26.3% and 44.7% were classified as normoglycemic by UK National Institute for Health and Care Excellence, Canadian Diabetes Association and Diabetes in Pregnancy Study group of India criteria, respectively. Mean 1-h postprandial glucose and time above range were significantly higher in women who were GDM by IADPSG, but normoglycemia by Canadian Diabetes Association criteria, compared with women with normoglycemia using both criteria. Similarly, mean 1-h postprandial glucose, 2-h postprandial glucose, peak postprandial glucose, 1-h postprandial glucose excursion and time above range were significantly higher in women who were not identified as GDM by the UK National Institute for Health and Care Excellence criteria. Finally, women missed by the Diabetes in Pregnancy Study group of India criteria had significantly higher mean 1-h postprandial glucose, 2-h postprandial glucose, peak postprandial glucose, postprandial glucose excursion, 24-h glucose and time above range parameters.

Glucose levels measured with continuous glucose monitoring in uncomplicated pregnancies

“…There is no standard CGM-based glucose range for normoglycemic pregnancies; recommendations for glucose levels using CGM are mainly based on studies of participants with type 1 diabetes 11. In one study of 58 normoglycemic participants between gestational age 8 and 20 weeks, CGM data for up to 72 hours showed a per cent time 63–140 mg/dL (3.5–7.8 mmol/L) of 98.2% 12. Another study used a matched control group based on age, parity and BMI (no GDM), and found a per cent time 63–140 mg/dL (3.5–7.8 mmol/L) of 96.1%, 95.9% and 93.5% in trimesters one, two and three, respectively, among those without GDM 9.…”

“… 11 In one study of 58 normoglycemic participants between gestational age 8 and 20 weeks, CGM data for up to 72 hours showed a per cent time 63–140 mg/dL (3.5–7.8 mmol/L) of 98.2%. 12 Another study used a matched control group based on age, parity and BMI (no GDM), and found a per cent time 63–140 mg/dL (3.5–7.8 mmol/L) of 96.1%, 95.9% and 93.5% in trimesters one, two and three, respectively, among those without GDM. 9 The CGM-based glucose ranges observed in this study may be representative of glucose levels in all trimesters of uncomplicated pregnancies.…”

Continuous Glucose Monitoring System Profile of Women with Gestational Diabetes Mellitus Missed Using Isolated Fasting Plasma Glucose-Based Strategies Alternative to WHO 2013 Criteria: A Cross-Sectional Study

“…With this background, this study aims to evaluate whether the continous glucose monitoring system (CGMS) profile of women with isolated mild FPG elevation (5.1-5.5 mmol/L or 92-99 mg/dL), isolated post-load plasma glucose elevation [1 h C 10.0 mmol/L (180 mg/dL) or 2 h C 8.5 mmol/L (153 mg/dL)], or both are different from those with normoglycemia defined using WHO criteria. We have used a CGMS-derived dataset from our previous studies to answer these objectives [10,11]. Briefly, in these studies, we reported: (a) differences in CGMS profile between women with normoglycemia and early GDM per IAPDSG/WHO 2013 criteria [10], and (b) differences in CGMS profile between women with normoglycema and early GDM by IADPSG/WHO 2013 criteria but normoglycemia defined by alternative criteria [NICE, Canadian Diabetes Association (CDA) and Diabetes in Pregnancy Study Group of India (DIPSI)] [11].…”

“…We have used a CGMS-derived dataset from our previous studies to answer these objectives [10,11]. Briefly, in these studies, we reported: (a) differences in CGMS profile between women with normoglycemia and early GDM per IAPDSG/WHO 2013 criteria [10], and (b) differences in CGMS profile between women with normoglycema and early GDM by IADPSG/WHO 2013 criteria but normoglycemia defined by alternative criteria [NICE, Canadian Diabetes Association (CDA) and Diabetes in Pregnancy Study Group of India (DIPSI)] [11]. The data emerging from the current study would help to delineate the significance of a milder degree of FPG elevation in early pregnancy and of post-load plasma glucose values derived from a 75 g OGTT as well as the appropriateness of using higher isolated FPG thresholds (5.6-6.9 mmol/L or 100-125 mg/dL) for the diagnosis of GDM in early pregnancy.…”