The role of continuous glucose monitoring in clinical decision‐making in diabetes in pregnancy

Abstract

CGMS is a well-tolerated clinically useful tool in the management of gestational diabetes and pre-existing diabetes in pregnancy.

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

“…CGM can also be used as an adjunct to BGM to monitor nocturnal hypoglycemia and hyperglycemia, as well as the peak and duration of postprandial hyperglycemia. A 2007 clinical trial of CGM in pregnancy reported that the additional information provided by CGM altered clinical management decisions in 62% of cases (this trial did not evaluate patient outcomes) (121). Table A3 in Appendix A of this document summarizes pivotal trials of BGM and CGM in patients with pregnancy complicated by diabetes.…”

A randomised controlled trial to compare minimally invasive glucose monitoring devices with conventional monitoring in the management of insulin-treated diabetes mellitus (MITRE)

“…In the study by McLachlan and colleagues, 98 the majority of respondents reported that the CGMS was either 'very easy to use' or 'easy to use' (n = 44, 92%), the level of inconvenience was 'minimal' or 'minor' (n = 39, 81%), their understanding of how they could control blood glucose was either 'clearly better' or 'better' (n = 43, 90%) and they felt that the benefits of the CGMS outweighed the inconvenience (n = 37, 77%). In a study of 9 days of continuous CGMS 81 use in 22 patients, 9% reported sleep disturbances, 5% attention deficits, 18% discomfort related to the sensor, 27% discomfort related to the adhesive tape and 23% technical monitor-related problems.…”

“…A total of 21 studies 31,41,43,49,50,53,55,56,59,74,79,81,82,84,87,89,90,[95][96][97][98] report on some aspect of the user's perspective on the various continuous glucose monitoring devices. The majority of these studies limited their assessment of the user perspective to either anecdotal or subjective reports on the part of the investigator.…”

“…Seven studies 54,81,82,84,89,98,99 developed questionnaires specifically to assess various aspects of the user's perspective. It is assumed that the three studies 43,87,95 assessing the GlucoDay used the same patient-reported questionnaire to measure levels of pain and discomfort.…”

Objectives and methods of the ORCHESTRA FOUNDATION Registry study: a multicenter observational study of the use of insulin pump therapy in pregnant women with type 1 diabetes mellitus in Poland.

“…However, women with type 1 diabetes mellitus (T1DM) treated with multiple daily injections (MDI) throughout pregnancy experience prolonged daily exposure to higher than recommended glucose levels, resulting in a 3-5-fold greater incidence of complications than that observed in the general population [11]. Some studies have shown that improvements in HbA 1c levels achieved with MDI are associated with an increased risk of severe hypoglycemia, particularly nocturnal and undetected postprandial hyperglycemia [16][17][18]. Severe hypoglycemia affects 25-40% of pregnant women and is 3-5 times more common in early pregnancy than in the period before pregnancy [18,19].…”