CGM best at assessing Night time hyperglycemia in Gestational Diabetes: Study
According to recent research published in the Journal of Diabetes Technology & Therapeutics, researchers have found that CGM provides a more comprehensive assessment of nocturnal hyperglycemia than SMBG and could improve targeting of interventions in GDM.
Gestational diabetes mellitus (GDM) management using self-monitoring blood glucose (SMBG) does not normalize pregnancy outcomes. Worldwide, one in 10 pregnancies is associated with diabetes, 90% of which is Gestational diabetes mellitus. Undiagnosed or inadequately treated Gestational diabetes mellitus can lead to significant maternal & fetal complications. Moreover, women with Gestational diabetes mellitus and their off-springs are at increased risk of developing type 2 diabetes later in life.
Hence, Dessi P. Zaharieva and associates from the Chronic Disease Unit, School of Kinesiology & Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity, York University, Toronto, Ontario, Canada aimed to conduct an observational study to explore if continuous glucose monitoring (CGM) could identify elevated glucose levels not apparent in women with GDM managed using SMBG.
The study included ninety women of mean gestational age weeks 27. A 7-day masked-CGM was performed within 2 weeks of GDM diagnosis, immediately post-GDM education, but before insulin commencement as determined by SMBG. CGM data regarding hyperglycemia, time with health care professionals, treatment, and pregnancy outcome were collected. Comparisons were performed between subjects subsequently commenced on insulin versus those continued with diet and lifestyle measures alone.
The following results were observed-
a. Those prescribed insulin (n = 34) compared with those managed with diet and lifestyle alone (n = 56) had a greater time in hyperglycemia.
b. Of those not prescribed insulin, 61% breached Gestational diabetes mellitus cutoffs between 00:00 and 06:00 h; 20% breached 6.00–00.00 h CGM cutoffs for >10% of the time; and 47% with optimal CGM glucose levels during the daytime spent >10% time in hyperglycemia between 00.00 and 06:00 h.
c. In contrast, SMBG measurements exceeded the clinical targets of <120 mg/dL post dinner in 5.4% and <100 mg/dL fasting in 0% of the subjects.
Hence, the authors concluded that "although CGM provides a more comprehensive assessment of nocturnal hyperglycemia than SMBG and could improve targeting of interventions in GDM, larger studies are needed to define CGM targets better, which once established will inform studies aimed at targeting nocturnal glucose levels."
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