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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 2 Mean HbA1c levels every four weeks in women receiving standard antenatal care (n=33) or antenatal care plus continuous glucose monitoring (n=38). Vertical lines are standard deviation at each time point
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fig2: Fig 2 Mean HbA1c levels every four weeks in women receiving standard antenatal care (n=33) or antenatal care plus continuous glucose monitoring (n=38). Vertical lines are standard deviation at each time point

Mentions: Although the HbA1c level was consistently lower in the intervention arm no statistical difference was found in mean levels between the two groups at booking or throughout the first two trimesters (fig 2). Differences between the two arms began to emerge between 28 and 32 weeks’ gestation: mean HbA1c levels in the intervention arm were 6.1% (SD 0.6) compared with 6.4% (SD 0.8) in the control arm, with a trend towards but not reaching statistical significance (P=0.1). In later pregnancy, at 32-36 weeks’ gestation, a further reduction in HbA1c levels was seen in the intervention arm but no further reductions in the control arm—a difference in mean HbA1c levels of 0.6% between groups: 5.8% (SD 0.6) in intervention arm compared with 6.4% (SD 0.7) in control arm (P=0.007).


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 2 Mean HbA1c levels every four weeks in women receiving standard antenatal care (n=33) or antenatal care plus continuous glucose monitoring (n=38). Vertical lines are standard deviation at each time point
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Fig 2 Mean HbA1c levels every four weeks in women receiving standard antenatal care (n=33) or antenatal care plus continuous glucose monitoring (n=38). Vertical lines are standard deviation at each time point
Mentions: Although the HbA1c level was consistently lower in the intervention arm no statistical difference was found in mean levels between the two groups at booking or throughout the first two trimesters (fig 2). Differences between the two arms began to emerge between 28 and 32 weeks’ gestation: mean HbA1c levels in the intervention arm were 6.1% (SD 0.6) compared with 6.4% (SD 0.8) in the control arm, with a trend towards but not reaching statistical significance (P=0.1). In later pregnancy, at 32-36 weeks’ gestation, a further reduction in HbA1c levels was seen in the intervention arm but no further reductions in the control arm—a difference in mean HbA1c levels of 0.6% between groups: 5.8% (SD 0.6) in intervention arm compared with 6.4% (SD 0.7) in control arm (P=0.007).

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