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Continuous glucose monitoring results in lower HbA 1c in Malaysian women with insulin‐treated gestational diabetes: a randomized controlled trial
Author(s) -
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.
Publication year - 2018
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13649
Subject(s) - medicine , gestational diabetes , asymptomatic , gestation , insulin , diabetes mellitus , randomized controlled trial , pregnancy , gestational age , endocrinology , genetics , biology
Aims To determine if therapeutic, retrospective continuous glucose monitoring ( CGM ) improves HbA 1c with less hypoglycaemia in women with insulin‐treated gestational diabetes mellitus ( GDM ). Methods 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 1c 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. Results Baseline characteristics (age, pre‐pregnancy BMI , HbA 1c , total insulin dose) were similar between groups. There was a lower increase in HbA 1c from 28 to 37 weeks’ gestation in the CGM group [∆HbA 1c : CGM + 1 mmol/mol (0.09%), control + 3mmol/mol (0.30%); P = 0.024]. Mean HbA 1c remained unchanged throughout the trial in the CGM group, but increased significantly in controls as pregnancy advanced. Mean HbA 1c 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 1c ≤ 39 mmol/mol (≤ 5.8%) at 37 weeks compared with 68% of the control group ( P = 0.012). Neither group experienced severe hypoglycaemia. Conclusion CGM use may be beneficial in insulin‐treated GDM because it improves HbA 1c compared with usual antenatal care without increasing severe hypoglycaemia. (Clinical Trials Registry No.: NCT02204657).