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Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial.

Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, Fowler D, Campbell PJ, Temple RC - BMJ (2008)

Bottom Line: Women randomised to continuous glucose monitoring had lower mean HbA(1c) levels from 32 to 36 weeks' gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7).Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98).Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes and Endocrinology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD. Helen.Murphy@ipswichhospital.nhs.uk

ABSTRACT

Objective: To evaluate the effectiveness of continuous glucose monitoring during pregnancy on maternal glycaemic control, infant birth weight, and risk of macrosomia in women with type 1 and type 2 diabetes.

Design: Prospective, open label randomised controlled trial.

Setting: Two secondary care multidisciplinary obstetric clinics for diabetes in the United Kingdom.

Participants: 71 women with type 1 diabetes (n=46) or type 2 diabetes (n=25) allocated to antenatal care plus continuous glucose monitoring (n=38) or to standard antenatal care (n=33).

Intervention: Continuous glucose monitoring was used as an educational tool to inform shared decision making and future therapeutic changes at intervals of 4-6 weeks during pregnancy. All other aspects of antenatal care were equal between the groups.

Main outcome measures: The primary outcome was maternal glycaemic control during the second and third trimesters from measurements of HbA(1c) levels every four weeks. Secondary outcomes were birth weight and risk of macrosomia using birthweight standard deviation scores and customised birthweight centiles. Statistical analyses were done on an intention to treat basis.

Results: Women randomised to continuous glucose monitoring had lower mean HbA(1c) levels from 32 to 36 weeks' gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7). Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98).

Conclusion: Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia.

Trial registration: Current Controlled Trials ISRCTN84461581.

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Related in: MedlinePlus

Fig 1 Progression of women through trial
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fig1: Fig 1 Progression of women through trial

Mentions: We enrolled pregnant women aged 16-45 with type 1 and type 2 diabetes if they provided written informed consent and were willing to wear a continuous glucose monitor. Exclusion criteria were limited to severe medical or psychological comorbidity, and no women were excluded. Overall, 71 of 93 (76%) women who were consecutively approached agreed to participate, of whom 46 (65%) had type 1 diabetes and 25 (35%) had type 2 diabetes. No significant differences were found between the women who participated or declined in age, ethnicity, type or duration of diabetes, HbA1c level or gestational age at booking, attendance for prepregnancy care, and folic acid supplementation. The participants were therefore representative of women attending our diabetes antenatal clinics. Figure 1 shows the reasons for declining participation.


Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial.

Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, Fowler D, Campbell PJ, Temple RC - BMJ (2008)

Fig 1 Progression of women through trial
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2563261&req=5

fig1: Fig 1 Progression of women through trial
Mentions: We enrolled pregnant women aged 16-45 with type 1 and type 2 diabetes if they provided written informed consent and were willing to wear a continuous glucose monitor. Exclusion criteria were limited to severe medical or psychological comorbidity, and no women were excluded. Overall, 71 of 93 (76%) women who were consecutively approached agreed to participate, of whom 46 (65%) had type 1 diabetes and 25 (35%) had type 2 diabetes. No significant differences were found between the women who participated or declined in age, ethnicity, type or duration of diabetes, HbA1c level or gestational age at booking, attendance for prepregnancy care, and folic acid supplementation. The participants were therefore representative of women attending our diabetes antenatal clinics. Figure 1 shows the reasons for declining participation.

Bottom Line: Women randomised to continuous glucose monitoring had lower mean HbA(1c) levels from 32 to 36 weeks' gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7).Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98).Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes and Endocrinology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD. Helen.Murphy@ipswichhospital.nhs.uk

ABSTRACT

Objective: To evaluate the effectiveness of continuous glucose monitoring during pregnancy on maternal glycaemic control, infant birth weight, and risk of macrosomia in women with type 1 and type 2 diabetes.

Design: Prospective, open label randomised controlled trial.

Setting: Two secondary care multidisciplinary obstetric clinics for diabetes in the United Kingdom.

Participants: 71 women with type 1 diabetes (n=46) or type 2 diabetes (n=25) allocated to antenatal care plus continuous glucose monitoring (n=38) or to standard antenatal care (n=33).

Intervention: Continuous glucose monitoring was used as an educational tool to inform shared decision making and future therapeutic changes at intervals of 4-6 weeks during pregnancy. All other aspects of antenatal care were equal between the groups.

Main outcome measures: The primary outcome was maternal glycaemic control during the second and third trimesters from measurements of HbA(1c) levels every four weeks. Secondary outcomes were birth weight and risk of macrosomia using birthweight standard deviation scores and customised birthweight centiles. Statistical analyses were done on an intention to treat basis.

Results: Women randomised to continuous glucose monitoring had lower mean HbA(1c) levels from 32 to 36 weeks' gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7). Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98).

Conclusion: Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia.

Trial registration: Current Controlled Trials ISRCTN84461581.

Show MeSH
Related in: MedlinePlus