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Campos Lopes S, Brito AI, Barbosa M, Matos AC, Lopes Pereira M, Monteiro AM, Fernandes V. Flash glucose monitoring system in gestational diabetes: a study of accuracy and usability. Hormones (Athens) 2023; 22:703-713. [PMID: 37740861 DOI: 10.1007/s42000-023-00485-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Studies of flash glucose monitoring systems (FGMSs) in pregnancy are insufficient, especially in gestational diabetes (GD). Our aim was to evaluate Freestyle Libre's usability and accuracy (compared to self-monitoring of blood glucose [SMBG]) for GD patients in real-life conditions. METHODS This is a prospective study with pregnant women diagnosed with GD (n = 24 for the usability analysis; n = 19 for the accuracy analysis). The study duration was up to 28 days (lifetime of two sensors). Participants executed a minimum of four daily FGMS readings obtained immediately after capillary SMBG. Analytical accuracy was assessed with mean absolute relative difference (MARD) and mean absolute difference (MAD); clinical accuracy was assessed with Surveillance Error Grid (SEG). Usability was evaluated with a user acceptability questionnaire. RESULTS The mean pregestational BMI was 25.21 ± 5.15 kg/m2 (mean ± SD), the mean gestational age was 30.31 ± 2.02 weeks, and the mean glucose values were 76.63 ± 7.49 mg/dL. A total of 1339 SMBG-FGMS pairs of values were obtained. Analytical accuracy was good with an overall MARD of 14.07% and an in-target MARD of 13.79%. The number of SMBG-FMGS pairs for above-target values was low (122 of 1339) with an associated MARD of 17.95%. Clinical accuracy of the FGMS was demonstrated, with 94.4% of values in the no-risk or slight, lower risk zones of the SEG. FGMS accuracy was unaffected by pregestational BMI or gestational age. The user acceptability questionnaire showed high levels of satisfaction, with 95.8-100% preferring FGMS to SMBG. No unexpected or severe adverse effects occurred. CONCLUSION FGMS showed good performance in GD regarding accuracy and usability. Larger studies are needed to corroborate our results, verify the analytical accuracy of above-target values as this glucose range might lead to initiation or adjustment of pharmacological therapy, and ultimately establish definitive recommendations regarding prescription of FGMS for GD patients.
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Affiliation(s)
| | | | - Mariana Barbosa
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
| | | | | | | | - Vera Fernandes
- Department of Endocrinology, Hospital de Braga, Braga, Portugal
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Efficacy of Continuous Glucose Monitoring on Glycaemic Control in Pregnant Women with Gestational Diabetes Mellitus-A Systematic Review. J Clin Med 2022; 11:jcm11102932. [PMID: 35629058 PMCID: PMC9145267 DOI: 10.3390/jcm11102932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 12/25/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, affecting up to 14% of pregnant women. The population of patients with risk factors of GDM is increasing; thus, it is essential to improve management of this condition. One of the key factors affecting perinatal outcomes in GDM is glycaemic control. Until recently, glucose monitoring was only available with self-monitoring of blood glucose (SMBG). However, nowadays, there is a new method, continuous glucose monitoring (CGM), which has been shown to be safe in pregnancy. Since proper glycaemia assessment has been shown to affect perinatal outcomes, we decided to perform a systematic review to analyse the role of CGM in glycaemic control in GDM. We conducted a web search of the MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science databases according to the PRISMA guidelines. The web search was performed by two independent researchers and resulted in 14 articles included in the systematic review. The study protocol was registered in the PROSPERO database with registration number CRD42021289883. The main outcome of the systematic review was determining that, when compared, CGM played an important role in better glycaemic control than SMBG. Furthermore, glycaemic control with CGM improved qualification for insulin therapy. However, most of the articles did not reveal CGM’s role in improving neonatal outcomes. Therefore, more studies are needed to analyse the role of CGM in affecting perinatal outcomes in GDM.
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Valero P, Salas R, Pardo F, Cornejo M, Fuentes G, Vega S, Grismaldo A, Hillebrands JL, van der Beek EM, van Goor H, Sobrevia L. Glycaemia dynamics in gestational diabetes mellitus. Biochim Biophys Acta Gen Subj 2022; 1866:130134. [PMID: 35354078 DOI: 10.1016/j.bbagen.2022.130134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 12/19/2022]
Abstract
Pregnant women may develop gestational diabetes mellitus (GDM), a disease of pregnancy characterised by maternal and fetal hyperglycaemia with hazardous consequences to the mother, the fetus, and the newborn. Maternal hyperglycaemia in GDM results in fetoplacental endothelial dysfunction. GDM-harmful effects result from chronic and short periods of hyperglycaemia. Thus, it is determinant to keep glycaemia within physiological ranges avoiding short but repetitive periods of hyper or hypoglycaemia. The variation of glycaemia over time is defined as 'glycaemia dynamics'. The latter concept regards with a variety of mechanisms and environmental conditions leading to blood glucose handling. In this review we summarized the different metrics for glycaemia dynamics derived from quantitative, plane distribution, amplitude, score values, variability estimation, and time series analysis. The potential application of the derived metrics from self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) in the potential alterations of pregnancy outcome in GDM are discussed.
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Affiliation(s)
- Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile.
| | - Rodrigo Salas
- Biomedical Engineering School, Engineering Faculty, Universidad de Valparaíso, Valparaíso 2362905, Chile; Instituto Milenio Intelligent Healthcare Engineering, Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Metabolic Diseases Research Laboratory, Interdisciplinary Centre of Territorial Health Research (CIISTe), Biomedical Research Center (CIB), San Felipe Campus, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, San Felipe 2172972, Chile
| | - Marcelo Cornejo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta 02800, Chile; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Gonzalo Fuentes
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Sofía Vega
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil
| | - Adriana Grismaldo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Nutrition and Biochemistry, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - Jan-Luuk Hillebrands
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Eline M van der Beek
- Department of Pediatrics, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands; Nestlé Institute for Health Sciences, Nestlé Research, Societé des Produits de Nestlé, 1000 Lausanne 26, Switzerland
| | - Harry van Goor
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Queensland, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico.
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Quah PL, Tan LK, Lek N, Thain S, Tan KH. Glycemic Variability in Early Pregnancy May Predict a Subsequent Diagnosis of Gestational Diabetes. Diabetes Metab Syndr Obes 2022; 15:4065-4074. [PMID: 36597491 PMCID: PMC9805730 DOI: 10.2147/dmso.s379616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/30/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study examined the prospective association between CGM-derived glycemic variability (GV) and glycemic control (GC) parameters in the first and second trimester, with subsequent diagnosis of GDM in the early third trimester. METHODS In a longitudinal observational study, 60 study participants in the first trimester (9-13 weeks' gestation), and 53 participants (18-23 weeks' gestation) in the second trimester of pregnancy had CGM data extracted after a minimum of 8 days' wear time (up to 14 days). At 24-31 weeks' gestation, participants underwent a 75 g, 2-hour oral glucose-tolerance test as per IADPSG criteria to diagnose GDM. GV parameters examined in both first and second trimesters were mean amplitude of glycemic excursion (MAGE), standard deviation (SD), mean glucose, and coefficient of variation (CV). GC parameters measured were J-Index and percentage of time spent in glucose target ranges. RESULTS The first trimester SD and MAGE were significantly higher in participants subsequently diagnosed with GDM (SD adjusted median 1.31 [interquartile range 1.2-1.3] mmol/L; MAGE 3.26 [3.2-3.3] mmol/L) than those who were not (SD 1.01 [0.9-1.0] mmol/L, MAGE 2.59 [2.4-2.6] mmol/L; p<0.05). Similarly, second trimester SD and MAGE were also significantly higher in participants subsequently diagnosed with GDM (SD 1.35 [1.3-1.4] mmol/L; MAGE 3.32 (3.31-3.41) mmol/L) than those who were not (SD 0.99 [0.98-1.01] mmol/L, MAGE 2.42 [2.42-2.55] mmol/L; p<0.05). Associations between SD and MAGE with GDM outcomes were adjusted for prepregnancy BMI and ethnicity. There were nonsignificant trends of higher J-Index scores in the first and second trimester, higher CV in the first trimester only, and higher mean in the second trimester only in participants diagnosed with GDM. Other study parameters measured were not significantly different between groups (p>0.003). CONCLUSION Our study suggests the potential value of CGM-derived SD and MAGE in early pregnancy as potential predictors of subsequent GDM diagnosis.
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Affiliation(s)
- Phaik Ling Quah
- Deparment of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
- Correspondence: Phaik Ling Quah, Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital (KKH), 100 Bukit Timah Road, 229899, Singapore, Tel +65 9773-2543, Email
| | - Lay Kok Tan
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Ngee Lek
- Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore
- OBGYN ACP, Duke-NUS Medical School, Singapore
| | - Serene Thain
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Kok Hian Tan
- Deparment of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
- OBGYN ACP, Duke-NUS Medical School, Singapore
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Ziegler R, Heinemann L, Freckmann G, Schnell O, Hinzmann R, Kulzer B. Intermittent Use of Continuous Glucose Monitoring: Expanding the Clinical Value of CGM. J Diabetes Sci Technol 2021; 15:684-694. [PMID: 32064909 PMCID: PMC8120049 DOI: 10.1177/1932296820905577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In addition to the continuous use, the intermittent use of continuous glucose monitoring (CGM) is an application of CGM, expanding the typical medical use cases. There are a variety of reasons and occasions that speak in favor of using CGM only for a limited time. To date, these circumstances have not been sufficiently discussed. In this article, we define discontinuous or intermittent CGM use, provide reasons for using it, and expand on the benefits and possibilities of using CGM on a temporary basis. We aim to draw attention to this important topic in the discussion of CGM use and give examples for a different method of CGM use. As well, we would like to foster the allocation of CGM to the right patient groups and indications, especially in cases of limited resources. From a global point of view, intermittent CGM use is more likely to occur than continuous use, primarily for economic reasons.
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Affiliation(s)
- Ralph Ziegler
- Diabetes Clinic for Children and
Adolescents, Muenster, Germany
- Ralph Ziegler, MD, Diabetes Clinic
for Children and Adolescents Mondstr. 148, Muenster 48155, Germany.
| | | | - Guido Freckmann
- Institut für Diabetes-Technologie,
Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm,
Germany
| | - Oliver Schnell
- Forschergruppe Diabetes e.V.,
Helmholtz Zentrum, Munich, Germany
| | | | - Bernd Kulzer
- Diabetes Center Bad Mergentheim,
Research Institute of the Diabetes Academy, Bad Mergentheim, University
Bamberg, Germany
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Márquez-Pardo R, Torres-Barea I, Córdoba-Doña JA, Cruzado-Begines C, García-García-Doncel L, Aguilar-Diosdado M, Baena-Nieto MG. Continuous Glucose Monitoring and Glycemic Patterns in Pregnant Women with Gestational Diabetes Mellitus. Diabetes Technol Ther 2020; 22:271-277. [PMID: 31638416 DOI: 10.1089/dia.2019.0319] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Continuous glucose monitoring (CGM) could detect certain patterns of hyperglycemia at different times of the day that may help predict the development of maternal-fetal complications and the probability of needing pharmacological treatment. Methods: This study prospectively examined 77 women with gestational diabetes mellitus (GDM) who were placed on a CGM system for 6 days after diagnosis between 26 and 32 weeks of gestation. Patterns of hyperglycemia before meals (period of time of an hour just before meal) (>95 mg/dL), after meals (time interval of 2 h and half just after meal) (>140 mg/dL), and overnight (0-7 am) (>120 mg/dL) and their association with maternal-fetal complications and pharmacological treatment were analyzed. Receiver operating characteristic curves were developed to estimate the validity of the various patterns in detecting the need for pharmacological treatment. Results: A statistically significant relationship was observed between time in hyperglycemia after lunch and macrosomia (P = 0.035) and large for gestational age infants (P = 0.010). Pharmacological treatment was required for patients with time above range (TAR; P = 0.006) and those with hyperglycemia patterns before breakfast (P < 0.001), after breakfast (P = 0.006), before dinner (P = 0.012), and overnight (P = 0.001). Every additional percentage point of TAR was associated with a 24% increase in the probability of pharmacological treatment. Conclusions: The use of CGM for the diagnosis of GDM allows the identification of those patients who would benefit from closer monitoring during pregnancy, including self-monitoring of both pre- and postprandial blood glucose levels, facilitating the initiation of early pharmacological treatment.
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Affiliation(s)
- Rosa Márquez-Pardo
- Department of Endocrinology and Nutrition and Jerez Hospital, Jerez de la Frontera, Spain
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
| | - Isabel Torres-Barea
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, Cádiz, Spain
| | - Juan-Antonio Córdoba-Doña
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
- Department of Preventive Medicine and Public Health, Jerez Hospital, Jerez de la Frontera, Spain
| | | | - Lourdes García-García-Doncel
- Department of Endocrinology and Nutrition and Jerez Hospital, Jerez de la Frontera, Spain
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
| | - Manuel Aguilar-Diosdado
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
- Department of Endocrinology and Nutrition, Puerta del Mar Hospital, Cádiz, Spain
| | - María-Gloria Baena-Nieto
- Department of Endocrinology and Nutrition and Jerez Hospital, Jerez de la Frontera, Spain
- Biomedical Research and Innovation Institute of Cádiz (INIBiCA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
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Yu W, Wu N, Li L, OuYang H, Qian M, Shen H. A Review of Research Progress on Glycemic Variability and Gestational Diabetes. Diabetes Metab Syndr Obes 2020; 13:2729-2741. [PMID: 32801819 PMCID: PMC7414929 DOI: 10.2147/dmso.s261486] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/11/2020] [Indexed: 01/27/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is associated with many adverse obstetric outcomes and neonatal outcomes, including preeclampsia, Cesarean section, and macrosomia. Active screening and early diabetes control can reduce the occurrence of adverse outcomes. Glycosylated hemoglobin (HbA1c) only reflects average blood glucose levels, but not glycemic variability (GV). Studies have shown that GV can cause a series of adverse reactions, and good control of GV can reduce the incidence of adverse pregnancy outcomes in patients with GDM. In order to provide clinicians with a better basis for diagnosis and treatment, this study reviewed the measurement, evaluation, and control of GV, the importance of GV for patients with GDM, and correlations between GV and maternal and neonatal outcomes.
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Affiliation(s)
- Wenshu Yu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
- Correspondence: Na Wu Department of Endocrinology, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang, Liaoning Province110004, People’ s Republic of ChinaTel +86 18940258445 Email
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Hong OuYang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Meichen Qian
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Haitao Shen
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
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Farabi SS, Hernandez TL. Low-Carbohydrate Diets for Gestational Diabetes. Nutrients 2019; 11:E1737. [PMID: 31357598 PMCID: PMC6723585 DOI: 10.3390/nu11081737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes.
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Affiliation(s)
- Sarah S Farabi
- Goldfarb School of Nursing, Office of Nursing Research, Barnes-Jewish College, St. Louis, MO 63110, USA
- Department of Medicine, Division of Nutritional Science, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
- Department of Research, Innovation, and Professional Practice, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA.
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Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract 2018; 145:39-50. [PMID: 29679625 PMCID: PMC6195478 DOI: 10.1016/j.diabres.2018.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/03/2018] [Indexed: 02/08/2023]
Abstract
With the global rising prevalence of gestational diabetes (GDM), an adaptable, economical approach to nutrition therapy that effectively controls maternal glycemia while promoting normal fetal growth will have far-reaching implications. The conventional focus has been to rigidly limit all types of carbohydrate. While controlling glucose, this approach fosters maternal anxiety and is a primary barrier to adherence. Many mothers substitute fat for carbohydrate, which may unintentionally enhance lipolysis, promote elevated free fatty acids (FFA), and worsen maternal insulin resistance (IR). Nutrition that worsens IR may facilitate nutrient shunting across the placenta, promoting excess fetal fat accretion. Evidence suggests that liberalizing higher quality, nutrient-dense carbohydrates results in controlled fasting/postprandial glucose, lower FFA, improved insulin action, vascular benefits, and may reduce excess infant adiposity. Thus, a less carbohydrate-restricted approach may improve maternal adherence when combined with higher quality carbohydrates, lower fat, appropriate caloric intake, and ethnically acceptable foods. Such a diet can be culturally sensitive, socioeconomically attentive, minimize further weight gain in GDM, with potential relevance for pregnancies complicated by overweight/obesity. Future research is needed to better understand the effect of macronutrient composition on the placenta and gut microbiome, the benefits/risks of nonnutritive sweeteners, and whether precision-nutrition is beneficial in pregnancy.
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Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
| | - Archana Mande
- Colorado Clinical and Translational Science Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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11
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Naik D, Hesarghatta Shyamasunder A, Doddabelavangala Mruthyunjaya M, Gupta Patil R, Paul TV, Christina F, Inbakumari M, Jose R, Lionel J, Regi A, Jeyaseelan PV, Thomas N. Masked hypoglycemia in pregnancy. J Diabetes 2017; 9:778-786. [PMID: 27625296 DOI: 10.1111/1753-0407.12485] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/10/2016] [Accepted: 09/08/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Hypoglycemia is a major hindrance for optimal glycemic control in women with gestational diabetes mellitus (GDM) on insulin. In the present study, masked hypoglycemia (glucose <2.77mmol/L for ≥30 min) was estimated in pregnant women using a continuous glucose monitoring (CGM) system. METHODS Twenty pregnant women with GDM on insulin (cases) and 10 age-matched euglycemic pregnant women (controls) between 24 and 36 weeks gestation were recruited. Both groups performed self-monitoring of blood glucose (SMBG) and underwent CGM for 72 h to assess masked hypoglycemia. Masked hypoglycemic episodes were further stratified into two groups based on interstitial glucose (2.28-2.77 and ≤2.22 mmol/L). RESULTS Masked hypoglycemia was recorded in 35% (7/20) of cases and 40% (4/10) of controls using CGM, with an average of 1.28 and 1.25 episodes per subject, respectively. Time spent at glucose levels between 2.28 and 2.77 mmol/L did not differ between the two groups (mean 114 vs 90 min; P = 0.617), but cases spent a longer time with glucose ≤2.2 mmol/L. Babies born to women with GDM were significantly lighter than those born to controls (2860 vs 3290 g; P = 0.012). There was no significant difference in birth weight within the groups among babies born to women with or without hypoglycemia. CONCLUSION Euglycemic pregnant women and those with GDM on insulin had masked hypoglycemia. Masked hypoglycemia was not associated with adverse maternal or fetal outcomes. Therefore, low glucose levels in the hypoglycemic range may represent a physiologic adaptation in pregnancy. This response is exaggerated in women with GDM on insulin.
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Affiliation(s)
- Dukhabandhu Naik
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | | | | | - Rita Gupta Patil
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Flory Christina
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Mercy Inbakumari
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Ruby Jose
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Annie Regi
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | | | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
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12
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Abstract
The definition of optimal glycemic control in pregnancies affected by diabetes remains enigmatic. Diabetes phenotypes are heterogeneous. Moreover, fetal macrosomia insidiously occurs even with excellent glycemic control. Current blood glucose (BG) targets (FBG ≤95, 1-h post-prandial <140, 2 h <120 mg/dL) have improved perinatal outcomes, but arguably they have not normalized. The conventional management approach has been to replicate a pattern of glycemia in normal pregnancy. Although these patterns are lower than previously appreciated, a randomized controlled trial (RCT) has never compared current vs. lower glucose targets powered on maternal/fetal outcomes. This paper provides historical context to the current targets by reviewing evidence supporting their evolution. Using lower targets (FBG <90, 1 h <122, 2 h <110, mean BG ≤95 mg/dL) may help normalize outcomes, but phenotypic differences (type 1 vs. type 2 vs. gestational diabetes) might require different glycemic goals. There remains a critical need for well-designed RCTs to confirm optimal glycemic control that minimizes both small for and large for gestational age across pregnancies affected by diabetes.
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MESH Headings
- Adult
- Birth Weight
- Body Mass Index
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/history
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/history
- Diabetes, Gestational/blood
- Diabetes, Gestational/history
- Female
- Fetal Macrosomia/history
- Fetal Macrosomia/prevention & control
- Glycated Hemoglobin/metabolism
- Glycemic Index
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Humans
- Infant, Newborn
- Meta-Analysis as Topic
- Postprandial Period
- Pregnancy
- Pregnancy in Diabetics/blood
- Pregnancy in Diabetics/history
- Randomized Controlled Trials as Topic
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Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, 12801 E. 17th Avenue, MS8106, Aurora, CO, 80045, USA,
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Yu F, Lv L, Liang Z, Wang Y, Wen J, Lin X, Zhou Y, Mai C, Niu J. Continuous glucose monitoring effects on maternal glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus: a prospective cohort study. J Clin Endocrinol Metab 2014; 99:4674-82. [PMID: 25057872 DOI: 10.1210/jc.2013-4332] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Clinical evidence on the consequential effects of continuous glucose monitoring (CGM) on pregnancy outcomes in women with gestational diabetes mellitus (GDM) is scarcely available. OBJECTIVE Our objective was to evaluate the effectiveness of CGM on maternal glycemic control and pregnancy outcomes in patients with GDM . PATIENTS In total, 340 Chinese pregnant women with GDM were allocated to either the routine care group (n = 190) or the CGM group (n =150). DESIGN AND SETTING This was a prospective cohort study in the Department of Obstetrics of GuangDong Women and Children Hospital in China. Recruitment started in April 2011 and stopped in August 2012. INTERVENTIONS A 72-hour CGM system was used as a supplementary tool for glucose monitoring in the CGM group. PRIMARY OUTCOME MEASUREMENTS: The parameters of glycemic variability included mean blood glucose, the SD of blood glucose, mean amplitude of glycemic excursions (MAGEs), and the mean of daily differences. The maternal outcomes (preeclampsia and cesarean delivery) and composite neonatal outcomes were analyzed. RESULTS The SD of blood glucose, MAGEs, and mean of daily differences values were significantly lower in the CGM group compared with those of the routine care group (P < .001). Subjects in the CGM group were at lower risk of preeclampsia and primary cesarean delivery compared with the routine care group (P < .05). The mean infant birth weight of women in the CGM group was lower than infants of women in the routine care group (P < .001). The MAGE was associated with birth weight (β = 0.196, P < .001), and it was an independent factor for preeclampsia (odds ratio, 3.66; 95% confidence interval 2.16-6.20) and composite neonatal outcome (odds ratio, 1.34; 95% confidence interval 1.01-1.77). CONCLUSIONS The use of supplementary CGM combined with routine antenatal care can improve the glycemic control and pregnancy outcomes of patients with GDM.
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Affiliation(s)
- Fan Yu
- Department of Obstetrics and Gynecology (F.Y., L.L., Y.W., J.Wen, X.L., Y.Z., C.M., J.N.) and Healthcare Department (Z.L.), GuangDong Women and Children Hospital, Guangzhou, China 510010
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14
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The efficacy and effectiveness of continuous glucose monitoring during pregnancy: a systematic review. Obstet Gynecol Surv 2014; 68:811-24. [PMID: 24193194 DOI: 10.1097/ogx.0000000000000002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Diabetic pregnancies carry a high risk for both mother and child, especially when glycemic control is poor. A novel technique that aims to improve glycemic control is the continuous glucose monitor (CGM). This tool is already in use to improve pregnancy outcome. This review presents the available evidence on the efficacy of CGM use in pregnancy and the effectiveness on pregnancy outcome. METHODS A systematic search was conducted using PubMed, EMBASE, and the Cochrane Libraries for articles on CGM in pregnancy. We evaluated the selected articles with particular attention for clinical and cost-effectiveness of CGM to improve pregnancy outcome. RESULTS We retrieved 5032 articles, 11 of which remained as relevant after selection according to predefined criteria. Most studies were limited to the evaluation of the role of CGM on clinical decision making. Only 2 studies were randomized controlled trials (RCTs) evaluating the effect on pregnancy outcome. One small RCT on retrospective CGM showed a significant reduction in third-trimester HbA1c and a significant reduction in neonatal macrosomia. A second RCT on real-time CGM did not show any effect on either glycemic control or on pregnancy outcome. CONCLUSIONS Current evidence on the efficacy of CGM on improving glycemic control during pregnancy as well as on the effectiveness on pregnancy outcome is limited to 2 RCTs with contradicting results. Evidence on the cost-effectiveness is lacking. Further proper RCTs on the effectiveness and cost-effectiveness of CGM in pregnancy are required before wide implementation in practice.
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15
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16
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Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, Kozak S, Ryan E, Sermer M, Vinokuroff C. Diabetes and pregnancy. Can J Diabetes 2013; 37 Suppl 1:S168-83. [PMID: 24070943 DOI: 10.1016/j.jcjd.2013.01.044] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Hernandez TL, Barbour LA. A standard approach to continuous glucose monitor data in pregnancy for the study of fetal growth and infant outcomes. Diabetes Technol Ther 2013; 15:172-9. [PMID: 23268584 PMCID: PMC3558676 DOI: 10.1089/dia.2012.0223] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The power of continuous glucose monitoring system (CGMS) technology to profile glycemic patterns throughout a 24-h period has benefited the care of individuals with diabetes mellitus for over 10 years. Recently, this technology has been utilized to better understand glucose patterns in pregnancy, especially as they relate to abnormal fetal growth given that adiposity at birth is associated with increased risks for childhood obesity and metabolic syndrome. However, the lack of a standardized approach to defining glucose measures associated with maternal outcomes and fetal growth has greatly limited comparison and pooling of CGMS data among pregnancy trials, hindering our ability to take advantage of the enormous amount of data available to explore these relationships. The purpose of this article is to offer a methodical approach to the identification and extraction of CGMS-derived glucose variables for the characterization of glycemic profiles in pregnant women, particularly focusing on women with gestational diabetes or obesity who are at risk for abnormal fetal growth. A review of the properties of CGMS data and examples of how CGMS data in pregnancy have been reported to date are included. We further define several pregnancy-relevant, CGMS-derived glucose variables and directly apply them to unpublished data to illustrate how these measures might be utilized. This approach offers one possible standardized method to define and analyze these time-sensitive glucose measures to facilitate comparisons among studies and to increase our understanding of how glycemic profiles contribute to excess infant adiposity in pregnant women with and without diabetes.
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Affiliation(s)
- Teri L Hernandez
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado 80045, USA.
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18
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Hewapathirana NM, O'Sullivan E, Murphy HR. Role of continuous glucose monitoring in the management of diabetic pregnancy. Curr Diab Rep 2013; 13:34-42. [PMID: 23081851 DOI: 10.1007/s11892-012-0337-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-monitoring of blood glucose (SMBG) with intermittent capillary glucose fingerstick tests is currently the universally accepted method of glucose monitoring in pregnancy. During pregnancy SMBG tests are recommended before and after meals and before bed (typically 7 values/d). Continuous glucose monitoring systems consist of a disposable subcutaneous glucose-sensing device, electrochemically measuring glucose levels in subcutaneous tissues every 10 seconds, providing an average interstitial glucose value every 5 minutes (typically 288 values/d). From a research perspective this provides unprecedented insights into the pathophysiology of glucose metabolism, while from a clinical perspective it can facilitate enhanced patient-professional decision making, patient motivation, and improved glycaemic control. CGM has thus been described as a "roadmap for effective self-management" and as a "stepping stone in the journey towards a cure." This review will consider the lessons learned and evidence supporting current and potential future use of CGM in the management of diabetes in pregnancy.
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Affiliation(s)
- Niranjala M Hewapathirana
- MRCP, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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19
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Sung JF, Taslimi MM, Faig JC. Continuous glucose monitoring in pregnancy: new frontiers in clinical applications and research. J Diabetes Sci Technol 2012; 6:1478-85. [PMID: 23294795 PMCID: PMC3570890 DOI: 10.1177/193229681200600629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current treatment of diabetes in pregnancy relies on intermittent self-monitoring of blood glucoses using finger sticks to monitor capillary blood glucoses. Continuous glucose monitoring (CGM) systems are an emerging technology that allow frequent glucose measurements (every 5 min) and the ability to monitor glucose trends in real time. Although these devices are currently expensive and mildly invasive to use, there is huge potential for their use in both the research and clinical realms. From a research perspective, there is the potential to better understand glucose metabolism in pregnancy, both in patients with and without diabetes. For the treating clinician, CGM has the potential to improve detection of hyperglycemic excursions as well as asymptomatic hypoglycemia and the data to improve management of glucose levels in diabetes patients. In this article, we review current literature examining use of CGM in both research and clinical applications.
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Affiliation(s)
- Joyce F Sung
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA 80045, USA.
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20
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Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care 2011; 34:1660-8. [PMID: 21709299 PMCID: PMC3120213 DOI: 10.2337/dc11-0241] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.
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Seshiah V, Chandrasekar A, Balaji V, Balaji MS, Srinivasan A, Suganthi S, Thiyagarajah A. Glycemic excursions in Indian pregnant women monitored by continuous glucose monitoring system—A pilot study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2008. [DOI: 10.1016/j.dsx.2008.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Taslimi MM, Navabi K, Acosta R, Helmer A, El-Sayed YY. Concealed maternal blood glucose excursions correlate with birth weight centile. J Diabetes Sci Technol 2008; 2:456-60. [PMID: 19885210 PMCID: PMC2769734 DOI: 10.1177/193229680800200315] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of this study was to test the hypothesis that maternal blood glucose excursions correlate with deviation from optimized birth weight. METHODS Patients were recruited for 3-day continuous glucose monitoring (CGM) plus self-blood glucose monitoring followed by routine diabetes screening at 26-28 weeks gestation. Patients and caregivers were blinded to CGM results. The magnitude and duration of blood glucose (BG) excursions were measured as a "glycemia index." A customized birth weight centile was calculated. RESULTS Twenty-three patients consented, 21 completed the study: 5 diabetic and 16 nondiabetic individuals. The duration of CGM was 72 (+/-7.2) hours, and each patient performed self-BG monitoring >/=3 times per day. All diabetic and 10 nondiabetic patients had several measured BG excursions above 130 mg/dl. A positive correlation was observed between birth weight centile and glycemia index above 130 (p < 0.03); the trend persisted for nondiabetic patients alone (p < 0.05). No significant correlation was noted between birth weight centile and average 3-day CGM values, 3-day fasting BG, average 3-day self-BG monitoring values, or diabetes screening BG value. CONCLUSIONS The glycemia index has a better correlation with birth weight centile than BG measured by conventional methods in a mixed diabetic and nondiabetic population. Fetal exposure to maternal blood glucose excursions correlates positively with fetal growth, even in nondiabetic patients with apparently normal glucose tolerance.
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Affiliation(s)
- Masoud Mark Taslimi
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California 94305-5317, USA.
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23
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Siegmund T, Rad NT, Ritterath C, Siebert G, Henrich W, Buhling KJ. Longitudinal changes in the continuous glucose profile measured by the CGMS in healthy pregnant women and determination of cut-off values. Eur J Obstet Gynecol Reprod Biol 2008; 139:46-52. [PMID: 18262325 DOI: 10.1016/j.ejogrb.2007.12.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 11/12/2007] [Accepted: 12/17/2007] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This longitudinal study performed continuous evaluation of daily blood glucose level profiles in healthy normal-weight pregnant patients during various gestational age and determined normal levels. STUDY DESIGN Thirty-two healthy normal-weight pregnant women received a continuous glucose monitoring system (CGMS) device for periods of 72h in the 16th, 22nd, 30th and 36th weeks of gestational age and at 6 weeks after delivery. All observations took place in the outpatient clinic of the Charité hospital. The daily blood glucose level profiles obtained with the CGMS provided pre- and postprandial blood glucose levels and a mean glucose value for a 24-h period. Caloric intake was determined using detailed food logs. Additionally, a fetal biometry and an measurement of maternal weight were performed at each visit. The correlation was tested using Spearman's test. RESULTS The average age of the study subjects was 29.6+/-4.5. Average pre-pregnancy BMI was 22.4+/-2.5kg/m(2). The births occurred on average in the 40th week of pregnancy. Average caloric intake was 2223+/-356kcal. No significant changes in caloric intake were observed during the course of the study. The blood glucose levels showed a significant rise throughout the course of the pregnancy, going from 4.84+/-0.4mmol/l (87.2+/-7.2mg/dl) during the 30th week of pregnancy to 5.22+/-0.5mmol/l (94.0+/-9.0mg/dl) during the 36th week (p=0.002). Postpartum levels were 5.20+/-0.5mmol/l (93.7+/-9.0mg/dl) (p=0.51). Fasting blood glucose levels did not change during the course of the pregnancy. A noticeable aspect were the significantly increased fasting postpartum levels with 5.02+/-0.6mmol/l (90.4+/-10.8mg/dl) (p=0.00). Analysis of the postprandial glucose levels confirmed a rise from 5.30+/-0.6mmol/l (95.5+/-10.8mg/dl) in the 16th week to 6.14+/-0.7mmol/l (110.6+/-12.6mg/dl) in the fourth study phase (36th week), and a decrease after the birth to 5.59+/-0.6mmol/l (100.7+/-10.8mg/dl). These measurements were adapted to the gestational age. CONCLUSION Continuous measured glucose levels rose during the pregnancy in healthy pregnant women in spite of normal pre-pregnancy metabolism and unchanged carbohydrate intake during gestation. These results suggest the necessity of gestational-age-dependent cut-off values.
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Affiliation(s)
- Tina Siegmund
- Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
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Bagosi Z, Oroszlán T, Bujtor Z, Gasztonyi B. The role of the continuous glucose monitoring system in control of the therapy of diabetes. Orv Hetil 2007; 148:1923-8. [DOI: 10.1556/oh.2007.28061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A diabetes mellitus kezelésének ellenőrzésében napjainkban egyre elterjedtebben használt módszer a folyamatos cukormérő rendszer, mely a hagyományos mérések között rejtve maradó vércukor-ingadozásokat rögzíti.
Betegek és módszer:
A szerzők 53 betegen végzett 79 mérés eredményeit elemzik. A betegek közül 48/53 fő (90,5%) (30 nő, 18 férfi, átlagéletkor 26,3 ± 16,8 év) 1-es típusú, 5/53 fő (9,5%) (4 nő, 1 férfi, átlagéletkor 58,4 ± 6,2 év) 2-es típusú diabetes mellitusban szenvedett. A módszer technikai ismertetését követően a szerzők saját betegeken végzett mérések eredményeit, illetve más vizsgálók tapasztalatait is felhasználva bemutatják a rendszer előnyeit és hátrányait. A szerzők az átlagosan 3–4 napos mérésekhez a MiniMed cég által kifejlesztett eszközt, illetve szenzort használták.
Eredmények:
Az elvégzett vizsgálatok alapján a módszert elsősorban a hajnali jelenség, valamint az észrevétlen hypoglykaemiák kimutatásában találták leginkább használhatónak, de számos esetben láttak tartós hyperglykaemiás időtartamokat is. A módszer az esetek 64,5%-ában jelentett segítséget a terápiás döntésekben, beszámolnak azonban szenzorhibából adódó sikertelen mérésekről, illetve olyan esetekről, amikor a vizsgálat elvégzése után sem tudtak érdemi terápiás változtatást javasolni.
Megbeszélés:
A szerzők – a saját eredmények, valamint más vizsgálók tapasztalatai alapján – széles körű indikációs listát vázolnak fel, bemutatva a módszer alkalmazhatóságának területeit, valamint korlátait. Kiemelik, hogy 2-es típusú diabéteszes betegek esetében nem nyújt érdemi segítséget. Az eredmények bemutatásával fontosnak tartották hangsúlyozni, hogy a módszerrel a hagyományos mérésekhez képest olyan többletinformációkhoz lehet jutni 1-es típusú diabéteszes betegek esetén, melyek segítségével e betegek glykaemiás kontrollja, ezáltal életkilátása javítható.
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Affiliation(s)
- Zoltán Bagosi
- 1 Zala Megyei Kórház Belgyógyászati Osztály Zalaegerszeg Zrínyi u. 1. 8900
| | - Tamás Oroszlán
- 1 Zala Megyei Kórház Belgyógyászati Osztály Zalaegerszeg Zrínyi u. 1. 8900
| | - Zoltán Bujtor
- 1 Zala Megyei Kórház Belgyógyászati Osztály Zalaegerszeg Zrínyi u. 1. 8900
| | - Beáta Gasztonyi
- 1 Zala Megyei Kórház Belgyógyászati Osztály Zalaegerszeg Zrínyi u. 1. 8900
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Kondepati VR, Heise HM. Recent progress in analytical instrumentation for glycemic control in diabetic and critically ill patients. Anal Bioanal Chem 2007; 388:545-63. [PMID: 17431594 DOI: 10.1007/s00216-007-1229-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 02/16/2007] [Accepted: 02/22/2007] [Indexed: 01/08/2023]
Abstract
Implementing strict glycemic control can reduce the risk of serious complications in both diabetic and critically ill patients. For this reason, many different analytical, mainly electrochemical and optical sensor approaches for glucose measurements have been developed. Self-monitoring of blood glucose (SMBG) has been recognised as being an indispensable tool for intensive diabetes therapy. Recent progress in analytical instrumentation, allowing submicroliter samples of blood, alternative site testing, reduced test time, autocalibration, and improved precision, is comprehensively described in this review. Continuous blood glucose monitoring techniques and insulin infusion strategies, developmental steps towards the realization of the dream of an artificial pancreas under closed loop control, are presented. Progress in glucose sensing and glycemic control for both patient groups is discussed by assessing recent published literature (up to 2006). The state-of-the-art and trends in analytical techniques (either episodic, intermittent or continuous, minimal-invasive, or noninvasive) detailed in this review will provide researchers, health professionals and the diabetic community with a comprehensive overview of the potential of next-generation instrumentation suited to either short- and long-term implantation or ex vivo measurement in combination with appropriate body interfaces such as microdialysis catheters.
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Affiliation(s)
- Venkata Radhakrishna Kondepati
- ISAS--Institute for Analytical Sciences at the University of Dortmund, Bunsen-Kirchhoff-Strasse 11, 44139, Dortmund, Germany
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