Time in Range and Pregnancy Outcomes in People with Diabetes Using Continuous Glucose Monitoring

Abstract

Objective The international consensus on continuous glucose monitoring (CGM) recommends time in range (TIR) target of >70% for pregnant people. Our aim was to compare outcomes between pregnant people with TIR ≤ versus >70%.

Study Design This study was a retrospective study of all people using CGM during pregnancy from January 2017 to May 2021 at a tertiary care center. All people with pregestational diabetes who used CGM and delivered at our center were included in the analysis. Primary neonatal outcome included any of the following: large for gestational age, neonatal intensive care unit (NICU) admission, need for intravenous (IV) glucose, or respiratory distress syndrome (RDS). Maternal outcomes included hypertensive disorders of pregnancy and delivery outcomes. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results Of 78 people managed with CGM, 65 (80%) met inclusion criteria. While 33 people (50.1%) had TIR ≤70%, 32 (49.2%) had TIR >70%. People with TIR ≤70% were more likely to be younger, have a lower body mass index, and have type 1 diabetes than those with TIR >70%. After multivariable regression, there was no difference in the composite neonatal outcome between the groups (aOR: 0.56, 95% CI: 0.16–1.92). However, neonates of people with TIR ≤70% were more likely to be admitted to the NICU (p = 0.035), to receive IV glucose (p = 0.005), to have RDS (p = 0.012), and had a longer hospital stay (p = 0.012) compared with people with TIR >70%. Furthermore, people with TIR ≤70% were more likely to develop hypertensive disorders (p = 0.04) than those with TIR >70%.

Conclusion In this cohort, the target of TIR >70% was reached in about one out of two people with diabetes using CGM, which correlated with a reduction in neonatal and maternal complications.

Key Points

• Among people with diabetes, 50% reached the recommended time in range using CGM.

• Time in range >70% was associated with reducing the rate of some neonatal complications.

• Time in range ≤70% was associated with increased risk for adverse maternal outcomes.

Keywords

neonatal morbidity - hypertensive disorder of pregnancy - continuous glucose monitoring - time in range

Note

This study was conducted at the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.

Publikationsverlauf

Eingereicht: 19. April 2022

Angenommen: 08. Juli 2022

Accepted Manuscript online:
20. Juli 2022

Artikel online veröffentlicht:
30. Dezember 2022

• References

• 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep 2021; 70 (02) 1-51
• 2 Metcalfe A, Sabr Y, Hutcheon JA. et al. Trends in obstetric intervention and pregnancy outcomes of Canadian women with diabetes in pregnancy From 2004 to 2015. J Endocr Soc 2017; 1 (12) 1540-1549
• 3 Murphy HR, Bell R, Cartwright C. et al. Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study. Diabetologia 2017; 60 (09) 1668-1677
• 4 Tinker SC, Gilboa SM, Moore CA. et al; National Birth Defects Prevention Study. Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997-2011. Am J Obstet Gynecol 2020; 222 (02) 176.e1-176.e11
• 5 Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013; 159 (02) 123-129
• 6 Tennant PW, Glinianaia SV, Bilous RW, Rankin J, Bell R. Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study. Diabetologia 2014; 57 (02) 285-294
• 7 Sweeting AN, Ross GP, Hyett J. et al. Gestational diabetes mellitus in early pregnancy: evidence for poor pregnancy outcomes despite treatment. Diabetes Care 2016; 39 (01) 75-81
• 8 Foster NC, Beck RW, Miller KM. et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther 2019; 21 (02) 66-72
• 9 Feig DS, Donovan LE, Corcoy R. et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 2017; 390 (10110): 2347-2359
• 10 García-Moreno RM, Benítez-Valderrama P, Barquiel B. et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med 2022; 39 (01) e14703
• 11 Murphy HR, Rayman G, Lewis K. et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ 2008; 337: a1680
• 12 Kestilä KK, Ekblad UU, Rönnemaa T. Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus. Diabetes Res Clin Pract 2007; 77 (02) 174-179
• 13 Paramasivam SS, Chinna K, Singh AKK. et al. Continuous glucose monitoring results in lower HbA_1c in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial. Diabet Med 2018; 35 (08) 1118-1129
• 14 Jones LV, Ray A, Moy FM, Buckley BS. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes. Cochrane Database Syst Rev 2019; 5: CD009613
• 15 Shen SY, Žurauskienė J, Wei DM. et al. Identification of maternal continuous glucose monitoring metrics related to newborn birth weight in pregnant women with gestational diabetes. Endocrine 2021; 74 (02) 290-299
• 16 Advani A. Positioning time in range in diabetes management. Diabetologia 2020; 63 (02) 242-252
• 17 Vigersky RA, McMahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther 2019; 21 (02) 81-85
• 18 Battelino T, Danne T, Bergenstal RM. et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care 2019; 42 (08) 1593-1603
• 19 Kristensen K, Ögge LE, Sengpiel V. et al. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia 2019; 62 (07) 1143-1153
• 20 Murphy HR. Continuous glucose monitoring targets in type 1 diabetes pregnancy: every 5% time in range matters. Diabetologia 2019; 62 (07) 1123-1128
• 21 Alexander GR, Kogan MD, Himes JH. 1994-1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Matern Child Health J 1999; 3 (04) 225-231
• 22 Bernard GR, Artigas A, Brigham KL. et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149 (3 Pt 1): 818-824
• 23 Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol 2020; 135 (01) e18-e35
• 24 Thornton PS, Stanley CA, De Leon DD. et al; Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr 2015; 167 (02) 238-245
• 25 Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
• 26 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186
• 27 Yamamoto JM, Murphy HR. Benefits of real-time continuous glucose monitoring in pregnancy. Diabetes Technol Ther 2021; 23 (S1): S8-S14
• 28 National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Accessed November 11, 2021 at: https://www.nice.org.uk/guidance/ng3
• 29 Secher AL, Ringholm L, Andersen HU, Damm P, Mathiesen ER. The effect of real-time continuous glucose monitoring in pregnant women with diabetes: a randomized controlled trial. Diabetes Care 2013; 36 (07) 1877-1883
• 30 Law GR, Ellison GT, Secher AL. et al. Analysis of continuous glucose monitoring in pregnant women with diabetes: distinct temporal patterns of glucose associated with large-for-gestational-age infants. Diabetes Care 2015; 38 (07) 1319-1325
• 31 Law GR, Alnaji A, Alrefaii L. et al. Suboptimal nocturnal glucose control is associated with large for gestational age in treated gestational diabetes mellitus. Diabetes Care 2019; 42 (05) 810-815
• 32 Yamamoto JM, Corcoy R, Donovan LE. et al; CONCEPTT Collaborative Group*. Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial. Diabet Med 2019; 36 (08) 1046-1053