Continuous Glucose Monitoring Time-in-Range and HbA(1c) Targets in Pregnant Women with Type 1 Diabetes
Por:
Tundidor, D, Meek, CL, Yamamoto, J, Martinez-Bru, C, Gich, I, Feig, DS, Murphy, HR, Corcoy, R
Publicada:
1 oct 2021
Ahead of Print:
1 may 2021
Resumen:
The CONCEPTT trial compared real-time Continuous Glucose Monitoring (RT-CGM) to capillary glucose monitoring in pregnant women with type 1 diabetes. We analyzed CGM and glycated hemoglobin (HbA(1c)) measures in first (n = 221), second (n = 197), and third (n = 172) trimesters, aiming to examine target glucose attainment and associations with pregnancy outcomes. CGM targets were Time-in-range (TIR) > 70%, Time-above-range (TAR) <25%, and Time-below-range (TBR) < 4%, and HbA(1c) targets < 6.5% (National Institute for Health and Care Excellence [NICE]) and HbA(1c) < 6.0% in second and third trimesters (American Diabetes Association [ADA]). TIR/TAR/TBR targets were achieved by 7.7/14.5/30.3% participants in first, 10.2/14.2/52.8% in second, and 35.5/37.2/52.9% in third trimesters. CGM target attainment was low but increased during pregnancy and with RT-CGM use. In the adjusted analyses, achieving TBR target was associated with a higher risk of pre-eclampsia and neonatal hypoglycemia. ADA HbA(1c) target attainment was low and unchanged during pregnancy (23.5/27.9/23.8%) but increased with RT-CGM use. In the adjusted analyses, HbA(1c) target attainment was associated with a lower risk of preterm birth, large-for-gestational age and neonatal hypoglycemia. We conclude that CONCEPTT trial participants had a low rate of CGM and of HbA(1c) target attainment. Attainment of CGM and NICE HbA(1c) targets increased throughout gestation and all targets (both NICE/ADA HbA(1c) and CGM) were more likely to be achieved by RT-CGM users, at 34 weeks' gestation. ADA HbA(1c) target achievement was independently associated with better perinatal outcomes, while the independent association of TBR target achievement with increased risk warrants further study. ClinicalTrials.gov Registration Identifier NCT01788527.
Filiaciones:
Tundidor, D:
Inst Recerca Hosp Santa Creu & St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Meek, CL:
Univ Cambridge, Inst Metab Sci, Cambridge, England
Cambridge Univ NHS Fdn Trust, Cambridge, England
Yamamoto, J:
Univ Manitoba, Fac Med, Dept Internal Med, Winnipeg, MB, Canada
Univ Calgary, Cumming Sch Med, Dept Med, Calgary, AB, Canada
Martinez-Bru, C:
Hosp Santa Creu & Sant Pau, Dept Lab, Barcelona, Spain
Gich, I:
Hosp Santa Creu & Sant Pau, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Inst Salud Carlos III, CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Feig, DS:
Univ Toronto, Lunenfeld Tanenbaum Res Inst, Dept Med, Mt Sinai Hosp,Sinai Hlth Syst, Toronto, ON, Canada
Murphy, HR:
Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England
Kings Coll London, Sch Life Course Sci, London, England
Corcoy, R:
Inst Recerca Hosp Santa Creu & St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Serv Endocrinol & Nutr, Barcelona, Spain
CIBER BBN, Madrid, Spain
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