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Using Continuous Glucose Monitoring for Diabetes Mellitus in Pregnancy

  • X. J. Ma
  • J. Zhou
Chapter

Abstract

Poor glycemic control in pregnant women with diabetes is closely related to the increased risk of adverse pregnancy outcomes. Therefore, it is very important to achieve strict glycemic control to improve maternal and neonatal outcomes. This chapter focuses on the introduction of the clinical application of continuous glucose monitoring (CGM) in pregnant women with diabetes mellitus. We will briefly introduce the clinical characteristics, diagnostic criteria, and glycemic control goals of diabetes mellitus in pregnancy. We will then classify and analyze the recent developments of CGM application in the clinical management of diabetes in pregnancy. We will use four typical cases as illustrations as how to use CGM technology to detect the glycemic variability in pregnant women with diabetes, as well as how to use the CGM data for individualized treatment, and how to improve pregnancy outcomes by CGM technology. The final section offers a clinical and academic prospective of CGM application in this area.

Keywords

Continuous glucose monitoring Pregestational diabetes mellitus Gestational diabetes mellitus Maternal and neonatal outcomes 

References

  1. 1.
    Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association, Group of Pregnancy with Diabetes Mellitus, Chinese Society of Perinatal Medicine, Chinese Medical Association, Obstetrics Subgroup Chinese Society of Obstetrics and Gynecology Chinese Medical Association, Group of Pregnancy with Diabetes Mellitus Chinese Society of Perinatal Medicine Chinese Medical Association. Diagnosis and therapy guideline of pregnancy with diabetes mellitus. Zhonghua Fu Chan Ke Za Zhi. 2014;49:561–9.  https://doi.org/10.3760/cma.j.issn.0529-567x.2014.08.001.CrossRefGoogle Scholar
  2. 2.
    HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.  https://doi.org/10.1056/NEJMoa0707943.CrossRefGoogle Scholar
  3. 3.
    Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr. 2012;4:41.  https://doi.org/10.1186/1758-5996-4-41.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, Lowe LP, Trimble ER, Coustan DR, Hadden DR, Persson B, Hod M, Oats JJ, HAPO Study Cooperative Research Group. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35:780–6.  https://doi.org/10.2337/dc11-1790.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bell R, Glinianaia SV, Tennant PW, Bilous RW, Rankin J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study. Diabetologia. 2012;55:936–47.  https://doi.org/10.1007/s00125-012-2455-y.CrossRefGoogle Scholar
  6. 6.
    Kerssen A, de Valk HW, Visser GH. Increased second trimester maternal glucose levels are related to extremely large-for-gestational-age infants in women with type 1 diabetes. Diabetes Care. 2007;30:1069–74.  https://doi.org/10.2337/dc05-1985.CrossRefPubMedGoogle Scholar
  7. 7.
    Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015;66 Suppl 2:14-20.  https://doi.org/10.1159/000371628.
  8. 8.
    Weng J, Ji L, Jia W, Lu J, Zhou Z, Zou D, Zhu D, Chen L, Chen L, Guo L, Guo X, Ji Q, Li Q, Li X, Liu J, Ran X, Shan Z, Shi L, Song G, Yang L, Yang Y, Yang W, Chinese Diabetes Society. Standards of care for type 2 diabetes in China. Diabetes Metab Res Rev. 2016;32:442–58.  https://doi.org/10.1002/dmrr.2827.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.  https://doi.org/10.2337/dc09-1848.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34 Suppl 1:62-9.  https://doi.org/10.2337/dc11-S062.
  11. 11.
    WHO Guidelines Approved by the Guidelines Review Committee. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Health Organization; 2013.Google Scholar
  12. 12.
    American Diabetes Association. 12. Management of diabetes in pregnancy. Diabetes Care. 2016;39 Suppl 1:94-8.  https://doi.org/10.2337/dc16-S015.
  13. 13.
    American Diabetes Association. 13. Management of diabetes in pregnancy. Diabetes Care. 2017;40 Suppl 1:114-9.  https://doi.org/10.2337/dc17-S016.
  14. 14.
    Chinese Diabetes Society. Chinese clinical guideline for continuous glucose monitoring (2012). Chin Med J. 2012;125:4167–74.  https://doi.org/10.3760/cma.j.issn.0366-6999.2012.23.002.CrossRefGoogle Scholar
  15. 15.
    Hernandez TL, Barbour LA. A standard approach to continuous glucose monitor data in pregnancy for the study of fetal growth and infant outcomes. Diabetes Technol Ther. 2013;15:172–9.  https://doi.org/10.1089/dia.2012.0223.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Murphy HR, Rayman G, Duffield K, Lewis KS, Kelly S, Johal B, Fowler D, Temple RC. Changes in the glycemic profiles of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care. 2007;30:2785–91.  https://doi.org/10.2337/dc07-0500.CrossRefPubMedGoogle Scholar
  17. 17.
    Dalfrà MG, Chilelli NC, Di Cianni G, Mello G, Lencioni C, Biagioni S, Scalese M, Sartore G, Lapolla A. Glucose fluctuations during gestation: an additional tool for monitoring pregnancy complicated by diabetes. Int J Endocrinol. 2013;2013:279021.  https://doi.org/10.1155/2013/279021.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tonoike M, Kishimoto M, Yamamoto M, Yano T, Noda M. Continuous glucose monitoring in patients with abnormal glucose tolerance during pregnancy: a case series. Jpn Clin Med. 2016;7:1–8.  https://doi.org/10.4137/JCM.S34825.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Combs CA. Continuous glucose monitoring and insulin pump therapy for diabetes in pregnancy. J Matern Fetal Neonatal Med. 2012;25:2025–7.  https://doi.org/10.3109/14767058.2012.670409.CrossRefPubMedGoogle Scholar
  20. 20.
    Petrovski G, Dimitrovski C, Bogoev M, Milenkovic T, Ahmeti I, Bitovska I. Is there a difference in pregnancy and glycemic outcome in patients with type 1 diabetes on insulin pump with constant or intermittent glucose monitoring? A pilot study. Diabetes Technol Ther. 2011;13:1109–13.  https://doi.org/10.1089/dia.2011.0081.CrossRefPubMedGoogle Scholar
  21. 21.
    Murphy HR, Elleri D, Allen JM, Harris J, Simmons D, Rayman G, Temple R, Dunger DB, Haidar A, Nodale M, Wilinska ME, Hovorka R. Closed-loop insulin delivery during pregnancy complicated by type 1 diabetes. Diabetes Care. 2011;34:406–11.  https://doi.org/10.2337/dc10-1796.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Murphy HR, Kumareswaran K, Elleri D, Allen JM, Caldwell K, Biagioni M, Simmons D, Dunger DB, Nodale M, Wilinska ME, Amiel SA, Hovorka R. Safety and efficacy of 24-h closed-loop insulin delivery in well-controlled pregnant women with type 1 diabetes: a randomized crossover case series. Diabetes Care. 2011;34:2527–9.  https://doi.org/10.2337/dc11-1430.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bergenstal RM, Garg S, Weinzimer SA, Buckingham BA, Bode BW, Tamborlane WV, Kaufman FR. Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. JAMA. 2016;316:1407–8.  https://doi.org/10.1001/jama.2016.11708.CrossRefPubMedGoogle Scholar
  24. 24.
    Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Brazg RL, Ilany J, Slover RH, Anderson SM, Bergenstal RM, Grosman B, Roy A, Cordero TL, Shin J, Lee SW, Kaufman FR. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19:155–63.  https://doi.org/10.1089/dia.2016.0421.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lowe LP, Metzger BE, Dyer AR, Lowe J, McCance DR, Lappin TR, Trimble ER, Coustan DR, Hadden DR, Hod M, Oats JJ, Persson B, HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care. 2012;35:574–80.  https://doi.org/10.2337/dc11-1687.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hewapathirana NM, O’Sullivan E, Murphy HR. Role of continuous glucose monitoring in the management of diabetic pregnancy. Curr Diab Rep. 2013;13:34–42.  https://doi.org/10.1007/s11892-012-0337-9.CrossRefPubMedGoogle Scholar
  27. 27.
    Ringholm L, Pedersen-Bjergaard U, Thorsteinsson B, Damm P, Mathiesen ER. Hypoglycaemia during pregnancy in women with type 1 diabetes. Diabet Med. 2012;29:558–66.  https://doi.org/10.1111/j.1464-5491.2012.03604.x.CrossRefPubMedGoogle Scholar
  28. 28.
    Secher AL, Mathiesen ER, Andersen HU, Damm P, Ringholm L. Severe hypoglycemia in pregnant women with type 2 diabetes-A relevant clinical problem. Diabetes Res Clin Pract. 2013;102:e17–8.  https://doi.org/10.1016/j.diabres.2013.09.011.CrossRefPubMedGoogle Scholar
  29. 29.
    Skupień J, Cyganek K, Małecki MT. Diabetic pregnancy: an overview of current guidelines and clinical practice. Curr Opin Obstet Gynecol. 2014;26:431–7.  https://doi.org/10.1097/GCO.0000000000000111.CrossRefPubMedGoogle Scholar
  30. 30.
    Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, Fowler D, Campbell PJ, Temple RC. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ. 2008;337:a1680.  https://doi.org/10.1136/bmj.a1680.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Voormolen DN, DeVries JH, Franx A, Mol BW, Evers IM. Effectiveness of continuous glucose monitoring during diabetic pregnancy (GlucoMOMS trial); a randomised controlled trial. BMC Pregnancy Childbirth. 2012;12:164.  https://doi.org/10.1186/1471-2393-12-164.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Secher AL, Stage E, Ringholm L, Barfred C, Damm P, Mathiesen ER. Real-time continuous glucose monitoring as a tool to prevent severe hypoglycaemia in selected pregnant women with type 1 diabetes-an observational study. Diabet Med. 2014;31:352–6.  https://doi.org/10.1111/dme.12383.CrossRefPubMedGoogle Scholar
  33. 33.
    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;36:1877–83.  https://doi.org/10.2337/dc12-2360.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Cordua S, Secher AL, Ringholm L, Damm P, Mathiesen ER. Real-time continuous glucose monitoring during labour and delivery in women with type 1 diabetes - observations from a randomized controlled trial. Diabet Med. 2013;30:1374–81.  https://doi.org/10.1111/dme.12246.CrossRefPubMedGoogle Scholar
  35. 35.
    Wei Q, Sun Z, Yang Y, Yu H, Ding H, Wang S. Effect of a CGMS and SMBG on maternal and neonatal outcomes in gestational diabetes mellitus: a randomized controlled trial. Sci Rep. 2016;6:19920.  https://doi.org/10.1038/srep19920.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018

Authors and Affiliations

  • X. J. Ma
    • 1
  • J. Zhou
    • 1
  1. 1.Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes InstituteShanghai Jiao Tong University, Affiliated Sixth People’s HospitalShanghaiChina

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