Benefits of Real-Time Continuous Glucose Monitoring in Pregnancy
Published Online:2 Mar 2021
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Abstract
In recent years, continuous glucose monitoring (CGM) has become increasingly available with the introduction of devices that are specifically approved for use during pregnancy. Evidence in the form of randomized-controlled trials and cohort studies continues to build support for the use of CGM during pregnancy to improve measures of maternal glycemia as well as obstetric and neonatal outcomes. Based on data from the CGM in pregnant women with type 1 diabetes (CONCEPTT) trial alongside a Swedish cohort study of real-world outcomes of pregnant women with type 1 diabetes, the UK National Institute for Health and Clinical Excellence (NICE) guidelines now recommend that real-time CGM be offered to all pregnant women with type 1 diabetes. Based on these guidelines, all pregnant individuals in the United Kingdom with type 1 diabetes will receive government-funded real-time CGM for a 12-month duration. These guidelines are a game-changer and will continue to facilitate more widespread access to CGM use in the United Kingdom and beyond. This review describes the role of CGM in the management of diabetes in pregnancy, discusses contemporary maternal glucose levels and their relationship with outcomes in diabetes pregnancies, and examines the high-quality, randomized-controlled trial and the real-world clinical data evaluating the impact of CGM use.
From the article
Introduction
While continuous glucose monitoring (CGM) has been available for the past two decades, it is only in recent years that we have had access to devices that are specifically approved for use during pregnancy. Undoubtedly, the increasing availability, affordability, and usability of the FreeStyle Libre (also known as intermittent CGM or flash), which is CE marked for use in pregnancy, have transformed the clinical management of diabetes before and during pregnancy.1 The Dexcom G6 is a game changer in terms of real-time CGM with hypoglycemia alerts and alarms. It is accurate enough to replace self-monitoring of blood glucose (SMBG) for precise prandial insulin dosing in type 1 diabetes pregnancy and is also CE marked for use during pregnancies complicated by type 1 diabetes, type 2 diabetes, and gestational diabetes.2 The Dexcom G6 further benefits from its interoperability, meaning that it can be used either as a standalone real-time CGM system for those using insulin pumps or multiple daily injections or together with a subcutaneous insulin pump (currently a DANA pump in Europe or Tandem T-slim pump in North America) as part of an automated insulin delivery system. As evidence supporting the use of CGM in pregnancy continues to build, it is important to understand how CGM can be leveraged to improve pregnancy outcomes as well as to better characterize the relationship between maternal glycemia and diabetes-related complications in pregnancy.
The aim of this review is to describe contemporary maternal glucose levels and their relationship with obstetric and neonatal outcomes in diabetes pregnancies and to examine the high-quality, randomized-controlled trial and the real-world clinical data evaluating the impact of CGM use
Conclusions
CGM has transformed diabetes care in pregnancy with an increasing body of evidence demonstrating that CGM can improve maternal antenatal glucose levels and neonatal outcomes. Over time, CGM has become increasingly user-friendly and we now have glucose sensors that are approved for use during pregnancy. Online CGM platforms have given diabetes care providers access to CGM profiles in this increasing world of virtual care.
While the use of CGM has been shown to improve pregnancy outcomes in type 1 diabetes, more data are needed in pregnancies complicated by gestational and type 2 diabetes. It is also clear that diabetes technology, whether it is CGM, insulin pump therapy, or closed-loop systems, cannot overcome all of the physiological and pharmacological challenges of pregnancy.
Health care teams must continue to optimize the basics of diabetes treatment, including increasing access to contraception and prepregnancy care, timing and escalating prandial insulin dosing appropriate to advancing gestational age, and strategically utilizing dietary intake and daily exercise for optimal glycemia.
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https://www.liebertpub.com/doi/10.1089/dia.2020.0667
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