Flash glucose monitoring system significantly improves glycemic control in women with gestational diabetes

The researchers reported that FGM application significantly improved glycemic control in the 3rd and 4th weeks of the study. FGM led to higher EAT (Eating Assessment Test) scores, indicating better diet modifications following GDM diagnosis; however, it did not impact lifestyle interventions, including qualification for insulin therapy, gestational weight gain, or insulin dosage. FGM significantly decreased the incidence of fetal macrosomia but had no significant impact on neonatal hypoglycaemia incidence or birthweight percentile.

In pregnant women, gestational diabetes mellitus is the most common type of hyperglycaemia. GDM is a risk factor for poor perinatal outcomes, including neonatal hypoglycaemia, fetal macrosomia, and shoulder dystocia, and its incidence rate increases proportionally to the level of maternal dysglycaemia. Therefore, glycemic control has a vital role to play in GDM management.

There are several options for glycemic control, with SMBG (self-monitoring of blood glucose) being the most common and standard for pregnant women. However, in recent years new methods have been introduced, namely CGM (continuous glucose monitoring systems), which include flash glucose monitoring and real-time continuous glucose monitoring. There is no clarity on whether these systems impact perinatal outcomes, such as the incidence of neonatal hypoglycaemia or fetal macrosomia in this population.

Agata Majewska, Medical University of Warsaw, Warsaw, Poland, and colleagues aimed to evaluate the efficacy of flash glucose monitoring in gestational diabetes.

The study recruited 100 pregnant women diagnosed with GDM between 24 and 28 gestation weeks at the Medical University of Warsaw. Patients who met the inclusion criteria were randomly assigned to the study group (FGM, n = 50) or control group (SMBG, n = 50). Laboratory and clinical results were assessed at four follow-up visits.

The study's primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes.

The study led to the following findings:

• Between the groups, there was no significant difference in mean glycaemia.
• Compared to the control group, the study group remarkably reduced their fasting and postprandial glycaemia during the first four weeks after GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09).
• The incidence of fetal macrosomia was significantly higher in SMBG than in the FGM group (OR 5.63).

"The results indicate that flash glucose monitoring impacts dietary habits, glycaemic control, and incidence of fetal macrosomia in patients with gestational diabetes," the researchers concluded.

Reference:

Majewska, A., Stanirowski, P.J., Tatur, J. et al. Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomized controlled trial. Acta Diabetol (2023). https://doi.org/10.1007/s00592-023-02091-2