Differences in Time-in-Range, Glycemic Variability, and the Glucose Management Indicator in Pregnant Women with Type 1 Diabetes, Type 2 Diabetes, and Gestational Diabetes

Sarit Polsky, MD

ADA 2020 - Oral session

3 minute listen
6 minute read

Key messages

  • Glycemic control was improved, and glucose variability was decreased for pregnant women with type 2 diabetes and gestational diabetes compared to pregnant women with type 1 diabetes when using continuous glucose monitoring.
  • Use of continuous glucose monitoring in pregnancy is useful in determining glucose variability.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Denice Feig, MD, MSc, FRCPC

Key messages

  • Glycemic control was improved, and glucose variability was decreased for pregnant women with type 2 diabetes and gestational diabetes compared to pregnant women with type 1 diabetes when using continuous glucose monitoring.
  • Use of continuous glucose monitoring in pregnancy is useful in determining glucose variability.

Background

What do we already know about this topic?

  • Glycemic control varies among different cohorts of pregnant women with diabetes.
  • Most studies examining differences between groups using continuous glucose monitoring (CGM) data were performed with older CGM systems worn for 2-7 days.

How was this study conducted?

  • This study examined differences in glycemic control and glycemic variability (GV) between pregnant women (n=32) with T1D (n=20), T2D (n=3), or gestational diabetes (GDM; n=9) in the 2nd and 3rd trimesters using the Dexcom G6 CGM system, worn for 10 days as part of a pregnancy CGM accuracy trial.
  • Pair-wise comparisons were made between groups and group heterogeneity testing was performed.
  • No adjustments were made for multiple comparisons analyses.

Findings

What does this study add?

  • Most women required insulin therapy (26/32, 81%).
  • Baseline HbA1C levels were similar between groups.
  • The glucose management indicator (GMI) was numerically similar to HbA1C for the T1D and GDM cohorts.
  • Time spent with glucose levels >140 mg/dL (p=0.009) was highest and time in range (63-140 mg/dL) was lowest (p=0.001) in women with T1D compared to the other groups.
  • The coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE) were highest in the T1D group, lowest in the GDM group, and intermediate in the T2D group (p <0.0001 for each).

Perspectives

How does this study impact clinical practice?

  • Glycemic control was better and GV was lower for pregnant women with T2D and GDM compared to women with T1D.
  • CGM use in pregnancy helps elucidate GV.

Perspectives

How does this study impact clinical practice?

  • Glycemic control was better and GV was lower for pregnant women with T2D and GDM compared to women with T1D.
  • CGM use in pregnancy helps elucidate GV.

This is a highlights summary of an oral session given at the ADA 2020 - 80th Scientific Sessions and presented by:

Sarit Polsky, MD
University of Colorado Denver, Barbara Davis Center for Childhood Diabetes, Denver, CO, USA

The content is produced by Infomedica, the official reporting partner of ADA 2020 Virtual Meeting. The summary text was drafted by Patrick Moore, PhD, and reviewed by Marco Gallo, MD, an independent external expert, and approved by Dana M. Dabelea, MD, PhD, the scientific editor of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Denice Feig, MD, MSc, FRCPC
Professor of Medicine, Obstetrics & Gynecology, and Health Policy, Management & Evaluation, University of Toronto
Clinician Scientist, Lunenfeld-Tanenbaum Research Institute,
Head, Diabetes & Endocrinology in Pregnancy Program

Denice Feig, MD, MSc, FRCPC
Professor of Medicine, Obstetrics & Gynecology, and Health Policy, Management & Evaluation, University of Toronto
Clinician Scientist, Lunenfeld-Tanenbaum Research Institute,
Head, Diabetes & Endocrinology in Pregnancy Program

Dr. Feig is head of the Diabetes in Pregnancy Program at Mount Sinai Hospital and University Health Network. She is professor at University of Toronto in the Department of Medicine, and has a Master's degree in clinical epidemiology. She is cross-appointed to both the Department of Obstetrics and Gynaecology and the Institute of Health Policy, Management and Evaluation. She is currently the chair of the American Diabetes Association Pregnancy Planning Committee, the past chair of the Canadian Diabetes in Pregnancy Study Group, the current chair of the University of Toronto/BBDC Diabetes in Pregnancy Study Group, and sits on the International Diabetes in Pregnancy Study Group. She participated in the recent CDA Clinical Practice Guidelines in the area of pregnancy. She has numerous grants and publications in the area of diabetes and pregnancy.



Diabetes
Therapeutics/New Technology


Scan to open on your mobile device