Abstract
Objective: To describe glucose metrics in a high-risk population of women with type 2 diabetes (T2DM) in pregnancy and to explore the associations with neonatal outcomes.
Research Design and Methods: Prospective observational study of 57 women. Continuous glucose monitoring (CGM) trajectories were determined from metrics collected in early and late gestation using the first and last two (mean 16 and 35) weeks of Freestyle Libre data. Logistic regression was used to examine associations of CGM metrics with neonatal hypoglycemia (glucose <2.6 mmol/L requiring intravenous dextrose) and large for gestational age (LGA) (>90th percentile for gestational age and sex). Pregnancy-specific target glucose range was 3.5–7.8 mmol/L (63–140 mg/dL).
Results: Forty-one women used CGM for 15 weeks (mean age 33 years, 73% Aboriginal or Torres Strait Islander, 32% living remotely). There was limited change in average metrics from early to late pregnancy. For the subgroup with sensor use >50% (n = 29), mean time in range (TIR) increased by 9%, time above range reduced by 12%, average glucose reduced by 1 mmol/L, and time below range increased by 3%. Neonatal hypoglycemia was associated with most CGM metrics, HbA1c and CGM targets, particularly those from late pregnancy. LGA was associated with hyperglycemic metrics from early pregnancy. Each 1% increase TIR was associated with a 4%–5% reduction in risk of neonatal complications.
Conclusion: In this high-risk group of women with T2DM, CGM metrics only improved during pregnancy in those with greater sensor use and were associated with LGA in early pregnancy and neonatal hypoglycemia throughout. Culturally appropriate health care strategies are critical for successful use of CGM technology.
| Original language | English |
|---|---|
| Pages (from-to) | 836-844 |
| Number of pages | 9 |
| Journal | Diabetes Technology and Therapeutics |
| Volume | 25 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Dec 2023 |
Bibliographical note
Funding Information:The continuous glucose monitors and research nurse time were supported by a Queensland Health (state government) New Technology Funding and Evaluation Program. L.M.-B. was supported by a National Health and Medical Research Council (NHMRC) investigator grant no. 1194698. A.M. was supported by an NHMRC postgraduate scholarship no. 1168623. The Far North Queensland (FNQ) Diabetes in Pregnancy Clinical Register was supported by an NHMRC Global Alliance for Chronic Diseases grant no. 1092968. The funders had no role in the study design, data collection and analysis, and in the decision to publish or preparation of the article. The study was also supported by Wuchopperen Health Service, Apunipima Cape York Health Council, Gurriny Yealamucka, and the Torres and Cape Hospital and Health Service.
Publisher Copyright:
© Anna McLean, et al., 2023.
