Continuous glucose monitoring results in lower HbA 1c in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial

• Published in: Diabetic medicine Vol. 35; no. 8; pp. 1118 - 1129
• Main Authors: Paramasivam, S S, Chinna, K, Singh, A K K, Ratnasingam, J, Ibrahim, L, Lim, L L, Tan, A T B, Chan, S P, Tan, P C, Omar, S Z, Bilous, R W, Vethakkan, S R
• Format: Journal Article
• Language: English
• Published: England 01.08.2018
• Subjects: Adult; Blood Glucose - analysis; Blood Glucose - drug effects; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - instrumentation; Blood Glucose Self-Monitoring - methods; Diabetes, Gestational - blood; Diabetes, Gestational - drug therapy; Female; Glycated Hemoglobin A - analysis; Glycated Hemoglobin A - drug effects; Glycated Hemoglobin A - metabolism; Humans; Insulin - therapeutic use; Malaysia; Pregnancy; Prenatal Care - methods; Standard of Care; Malaysia
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13649

To determine if therapeutic, retrospective continuous glucose monitoring (CGM) improves HbA with less hypoglycaemia in women with insulin-treated gestational diabetes mellitus (GDM). This prospective, randomized controlled, open-label trial evaluated 50 women with insulin-treated GDM randomized to either retrospective CGM (6-day sensor) at 28, 32 and 36 weeks' gestation (Group 1, CGM, n = 25) or usual antenatal care without CGM (Group 2, control, n = 25). All women performed seven-point capillary blood glucose (CBG) profiles at least 3 days per week and recorded hypoglycaemic events (symptomatic and asymptomatic CBG < 3.5 mmol/l; non-fasting < 4.0 mmol/l). HbA was measured at 28, 33 and 37 weeks. In Group 1, both CGM and CBG data were used to manage diabetes, whereas mothers in Group 2 were managed based on CBG data alone. Baseline characteristics (age, pre-pregnancy BMI, HbA , total insulin dose) were similar between groups. There was a lower increase in HbA from 28 to 37 weeks' gestation in the CGM group [∆HbA : CGM + 1 mmol/mol (0.09%), control + 3mmol/mol (0.30%); P = 0.024]. Mean HbA remained unchanged throughout the trial in the CGM group, but increased significantly in controls as pregnancy advanced. Mean HbA in the CGM group was lower at 37 weeks compared with controls [33 ± 4 mmol/mol (5.2 ± 0.4%) vs. 38 ± 7 mmol/mol (5.6 ± 0.6%), P < 0.006]. Some 92% of the CGM group achieved an HbA ≤ 39 mmol/mol (≤ 5.8%) at 37 weeks compared with 68% of the control group (P = 0.012). Neither group experienced severe hypoglycaemia. CGM use may be beneficial in insulin-treated GDM because it improves HbA compared with usual antenatal care without increasing severe hypoglycaemia. (Clinical Trials Registry No.: NCT02204657).