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- Title
Continuous glucose monitoring results in lower HbA<sub>1c</sub> in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial.
- Authors
Paramasivam, S. S.; Chinna, K.; Singh, A. K. K.; Ratnasingam, J.; Ibrahim, L.; Lim, L. L.; Tan, A. T. B.; Chan, S. P.; Tan, P. C.; Omar, S. Z.; Bilous, R. W.; Vethakkan, S. R.
- Abstract
Aims To determine if therapeutic, retrospective continuous glucose monitoring (CGM) improves HbA1cc with less hypoglycaemia in women with insulin-treated gestational diabetes mellitus (GDM). Methods This prospective, randomized controlled, open-label trial evaluated 50 women with insulin-treated GDM randomized to either retrospective CGM (6-day sensor) at 28, 32 and 36 weeks' gestation (Group 1, CGM, n = 25) or usual antenatal care without CGM (Group 2, control, n = 25). All women performed seven-point capillary blood glucose (CBG) profiles at least 3 days per week and recorded hypoglycaemic events (symptomatic and asymptomatic CBG < 3.5 mmol/l; non-fasting < 4.0 mmol/l). HbA1cc was measured at 28, 33 and 37 weeks. In Group 1, both CGM and CBG data were used to manage diabetes, whereas mothers in Group 2 were managed based on CBG data alone. Results Baseline characteristics (age, pre-pregnancy BMI, HbA1cc, total insulin dose) were similar between groups. There was a lower increase in HbA1cc from 28 to 37 weeks' gestation in the CGM group [ΔHbA1cc: CGM + 1 mmol/mol (0.09%), control + 3mmol/mol (0.30%); P = 0.024]. Mean HbA1cc remained unchanged throughout the trial in the CGM group, but increased significantly in controls as pregnancy advanced. Mean HbA1cc in the CGM group was lower at 37 weeks compared with controls [33± 4 mmol/mol (5.2 ± 0.4%) vs. 38 ± 7 mmol/mol (5.6 ± 0.6%), P < 0.006]. Some 92% of the CGM group achieved an HbA1cc ≤ 39 mmol/mol (≤ 5.8%) at 37 weeks compared with 68% of the control group (P = 0.012). Neither group experienced severe hypoglycaemia. Conclusion CGM use may be beneficial in insulin-treated GDM because it improves HbA1cc compared with usual antenatal care without increasing severe hypoglycaemia. (Clinical Trials Registry No.: NCT02204657).
- Subjects
MALAYSIA; HYPOGLYCEMIA; INSULIN therapy; BLOOD sugar monitoring; GESTATIONAL diabetes; GLYCOSYLATED hemoglobin; INSULIN; LONGITUDINAL method; PRENATAL care; WOMEN'S health; BODY mass index; RANDOMIZED controlled trials; PREVENTION
- Publication
Diabetic Medicine, 2018, Vol 35, Issue 8, p1118
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.13649