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All pregnant women with type 1 diabetes should be offered continuous glucose monitoring

24-hour glucose monitoring during pregnancy improves outcomes for women with type 1 diabetes and their babies

Ingrid Torjesen

Friday, 15 September 2017

Monitoring blood sugar levels of women with type 1 diabetes continuously during pregnancy via an implanted device helps better manage the disease, and improves birth outcomes compared to traditional finger-prick tests, a study* published in The Lancet and presented at the European Association for the Study of Diabetes (EASD) conference has shown.

The researchers argue that, based on their findings, this type of monitoring should now be offered to all pregnant women with type 1 diabetes.

One in two newborns of women with type 1 diabetes may face complications as a result of being exposed to maternal high blood sugar levels. Complications can include congenital anomaly, premature birth, stillbirth, need for intensive care after birth, and being larger than average at birth for the baby, as well as higher rates of pre-eclampsia and caesarean section for the mother.

In the study, researchers trialled an implanted continuous glucose monitoring (CGM) device that gives 288 glucose recordings per day, allowing users to recognise and respond to changes in blood sugar levels as they occur. They compared this with traditional monitoring used 4-8 times a day, which involves pricking the finger and putting the blood onto a test-strip to measure blood sugar levels.

The study involved 214 pregnant women with type 1 diabetes aged 18-40 who managed their condition with daily insulin therapy (insulin pumps or multiple daily injections). Half were randomly allocated to use the CGM device, and half to use the traditional monitoring method. The device was worn for approximately 24 weeks (from 10-12 weeks gestation until the end of their pregnancy). The study took place in 31 hospitals in Canada, England, Scotland, Spain, Ireland, Italy and the USA.

On average, women used the continuous glucose monitoring device for 6.1 days per week, and 70% of them used it for more than 75% of the time.

The continuous glucose monitoring device helped reduce blood sugar levels by a small amount [0.2% (-0.34 to -0.03)]. Compared to traditional monitoring, women who used the device spent more time in the normal range for blood sugar levels (68% versus 61% – equivalent to 100 minutes more per day) and spent less time with high blood sugar levels (27% vs 32%– equivalent to 1 hour less per day). The number of severe hypoglycaemia episodes and the time spent hypoglycaemic was comparable in the two groups (18 vs 21 and 3% vs 4% respectively).

Importantly, birth outcomes improved for those using continuous glucose monitoring, reducing the number of babies being born larger than average (53% vs 69%), the number of babies admitted to intensive care for more than 24 hours (27% vs 43%), and the number of babies born with low blood sugar levels (15% vs 28%). On average, babies whose mothers had used the continuous glucose monitoring device also left hospital one day earlier than babies whose mothers used traditional monitoring (3.1 vs 4 days).

Dr Denice Feig, University of Toronto and Sinai Health System, Canada, said: “For a long time there has been limited progress in improving birth outcomes for women with type 1 diabetes, so we’re pleased that our study offers a new option to help pregnant women with diabetes and their children.”

She added: “Keeping blood sugar levels within the normal range during pregnancy for women with type 1 diabetes is crucial to reduce risks for the mother and child. However, with traditional monitoring, this can be difficult as sensitivity to insulin fluctuates throughout pregnancy, meaning that accurately adjusting insulin doses is complex. As a result of our findings, we believe that this type of monitoring should be offered to all pregnant women with type 1 diabetes.”

Professor Helen Murphy, from the University of East Anglia, UK, adds: “Although continuous monitoring is expensive, the extra costs are likely be offset by the shorter hospital stays for babies and the reduction in neonatal intensive care unit admissions. We only need to treat six pregnant women with continuous glucose monitoring to prevent one baby weighing more than average at birth and one neonatal intensive care unit admission.”

* Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. The Lancet, published: 15 September 2017. DOI: 10.1016/S0140-6736(17)32400-5

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