Analysis of Continuous Glucose Monitoring in Pregnant Women With Diabetes:Distinct Temporal Patterns of Glucose Associated With Large-for-Gestational-Age Infants

Law, Graham R, Ellison, George T H, Secher, Anna L, Damm, Peter, Mathiesen, Elisabeth R, Temple, Rosemary, Murphy, Helen R and Scott, Eleanor M (2015) Analysis of Continuous Glucose Monitoring in Pregnant Women With Diabetes:Distinct Temporal Patterns of Glucose Associated With Large-for-Gestational-Age Infants. Diabetes Care, 38 (7). pp. 1319-1325. ISSN 0149-5992

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Abstract

OBJECTIVE: Continuous glucose monitoring (CGM) is increasingly used to assess glucose control in diabetes. The objective was to examine how analysis of glucose data might improve our understanding of the role temporal glucose variation has on large-for-gestational-age (LGA) infants born to women with diabetes. RESEARCH DESIGN AND METHODS: Functional data analysis (FDA) was applied to 1.68 million glucose measurements from 759 measurement episodes, obtained from two previously published randomized controlled trials of CGM in pregnant women with diabetes. A total of 117 women with type 1 diabetes (n = 89) and type 2 diabetes (n = 28) who used repeated CGM during pregnancy were recruited from secondary care multidisciplinary obstetric clinics for diabetes in the U.K. and Denmark. LGA was defined as birth weight ≥90th percentile adjusted for sex and gestational age. RESULTS: A total of 54 of 117 (46%) women developed LGA. LGA was associated with lower mean glucose (7.0 vs. 7.1 mmol/L; P < 0.01) in trimester 1, with higher mean glucose in trimester 2 (7.0 vs. 6.7 mmol/L; P < 0.001) and trimester 3 (6.5 vs. 6.4 mmol/L; P < 0.01). FDA showed that glucose was significantly lower midmorning (0900-1100 h) and early evening (1900-2130 h) in trimester 1, significantly higher early morning (0330-0630 h) and throughout the afternoon (1130-1700 h) in trimester 2, and significantly higher during the evening (2030-2330 h) in trimester 3 in women whose infants were LGA. CONCLUSIONS: FDA of CGM data identified specific times of day that maternal glucose excursions were associated with LGA. It highlights trimester-specific differences, allowing treatment to be targeted to gestational glucose patterns.

Item Type: Article
Additional Information: © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Uncontrolled Keywords: adult,birth weight,blood glucose,blood glucose self-monitoring,denmark,diabetes mellitus, type 1,diabetes mellitus, type 2,female,fetal macrosomia,gestational age,glucose,great britain,humans,infant, newborn,pregnancy,pregnancy in diabetics
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 09 Mar 2016 13:00
Last Modified: 07 Nov 2019 15:32
URI: https://ueaeprints.uea.ac.uk/id/eprint/57390
DOI: 10.2337/dc15-0070

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