Gestational diabetes mellitus

Continuous glucose monitoring

Continuous glucose monitoring (CGM) has been used widely in glucose management in those with diabetes. The use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributable to reduced exposure to maternal hyperglycaemia. CONCEPTT, a multicentre international randomised controlled trial, concluded that CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy.[92]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. Lancet. 2017 Nov 25;390(10110):2347-59. https://www.doi.org/10.1016/S0140-6736(17)32400-5 http://www.ncbi.nlm.nih.gov/pubmed/28923465?tool=bestpractice.com The UK National Institute for Health and Care Excellence recommends offering CGM to all pregnant women with type 1 diabetes.[4]National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication]. https://www.nice.org.uk/guidance/ng3 The American Diabetes Association (ADA) recommends that CGM should be offered for diabetes management in adults with diabetes on basal insulin, who are capable of using the devices safely.[3]American Diabetes Association. Standards of care in diabetes - 2023. Diabetes Care. 2023 Jan;46(Suppl 1):S1-291. https://diabetesjournals.org/care/issue/46/Supplement_1 ​ The ADA also notes that when used in addition to pre- and post-prandial blood glucose monitoring, CGM can help to achieve HbA1C targets in diabetes and pregnancy.[3]American Diabetes Association. Standards of care in diabetes - 2023. Diabetes Care. 2023 Jan;46(Suppl 1):S1-291. https://diabetesjournals.org/care/issue/46/Supplement_1  Research among women with GDM found that mothers who went on to deliver large-for-gestational-age (LGA) infants had higher overnight glucose levels during pregnancy compared with mothers without LGA infants, suggesting that detecting and addressing nocturnal glucose control may help to reduce rates of LGA infants in women with GDM. However, the study was unable to conclude whether CGM used throughout pregnancy reduces the risk of delivering a LGA infant.[93]Law GR, Alnaji A, Alrefaii L, et al. Suboptimal nocturnal glucose control is associated with large for gestational age in treated gestational diabetes mellitus. Diabetes Care. 2019 May;42(5):810-5. https://www.doi.org/10.2337/dc18-2212 http://www.ncbi.nlm.nih.gov/pubmed/30765428?tool=bestpractice.com One systematic review found that evidence suggests CGM is superior to self-monitoring of blood glucose among women with GDM, in terms of detecting hypoglycemic and hyperglycemic episodes, which might result in an improvement of maternal and fetal outcomes.[94]Yu Q, Aris IM, Tan KH, et al. Application and utility of continuous glucose monitoring in pregnancy: a systematic review. Front Endocrinol (Lausanne). 2019;10:697. https://www.doi.org/10.3389/fendo.2019.00697 http://www.ncbi.nlm.nih.gov/pubmed/31681170?tool=bestpractice.com Larger sample sizes and complete pregnancy coverage is needed to determine the effectiveness of CGM in GDM.