Flash glucose monitoring in gestational diabetes mellitus: possibilities for assessing glycemic variability
https://doi.org/10.21518/2079-701X-2021-12-414-419
Abstract
Introduction. Blood glucose monitoring is critical in maintaining glycemic control in women with GDM and in reducing adverse maternal and fetal outcomes. One of the tools that can help achieve optimal glycemic control during pregnancy is continuous glucose monitoring, which empowers clinicians to assess the characteristics of daily glycemic variability.
The aim. Compare biweekly glycemic profiles and glycemic variability in pregnant women with GDM and in healthy pregnant women using the FreeStyle Libre flash glycemic monitoring system.
Materials and methods. Analysis of the glycemic profile of 49 pregnant women aged 33.2 ± 6.1 years. The average gestational age of the women included in the study was 12.6 ± 6.4 weeks. Pregnant women were divided into 2 groups: 37 pregnant women with GDM and 12 healthy pregnant women. Each group underwent two-week glucose profile monitoring using the FreeStyle Libre continuous monitoring system. Statistical analysis was carried out using Microsoft Office Excel 2016, STATISTICA 10 programs (developed by StatSoft.Inc), EasyGV, version 9.
Results. The average glycemic level in the groups was 4.724 ± 0.37 mmol/L vs 4.24 ± 0.34 mmol/L, respectively (p˂0.001). Comparative analysis of GV parameters in groups of pregnant women with and without GDM: SD – 0.908 vs 0.7213 (p˂0.05); LI – 1.5 vs 0.8 (p˂0.05); HBGI – 0.503 vs 0.42 (p˂0.05); J-index – 10.343 vs 7.9870 (p˂0.001); MOOD – 0.956 vs 0.7992 (p˂0.05); MAGE – 2.326 vs 1.8042 (p˂0.05); ADDR – 2.216 vs 0.4210 (p˂0.05); MAG – 4.612 vs 2.6163 (p˂0.001), respectively. The CONGA index did not show a statistically significant difference in both groups: 3.95 vs 3.7 (p = 0.5).
Conclusions. Flash-glycemic monitoring can be used to obtain more detailed information about the glycemic profile, especially when it is difficult to assess the degree of GDM compensation. Continuous glucose monitoring can facilitate the optimization of glycemic control and provide a basis for treatment decisions.
About the Authors
F. O. UshanovaRussian Federation
Assistant of the Department of Endocrinology of the Medical Faculty,
1, Ostrovityanov St., Moscow, 117997
T. Yu. Demidova
Russian Federation
Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology, Faculty of Medicine,
1, Ostrovityanov St., Moscow, 117997
M. Ya. Izmaylova
Russian Federation
Medical Resident of the Department of Endocrinology, Faculty of Medicine,
1, Ostrovityanov St., Moscow, 117997
References
1. Sacks D.A., Hadden D.R., Maresh M., Deerochanawong C., Dyer A.R., Metzger B.E. et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care. 2012;35(3):526–528. https://doi.org/10.2337/dc11-1641.
2. Hedderson M.M., Ferrara A., Sacks D.A. Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth. Obstet Gynecol. 2003;102(4):850–856. https://doi.org/10.1016/s0029-7844(03)00661-6.
3. Rayanagoudar G., Hashi A.A., Zamora J., Khan K.S., Hitman G.A., Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia. 2016;59(7):1403–1411. https://doi.org/10.1007/s00125-016-3927-2.
4. Lowe W.L.Jr., Scholtens D.M., Kuang A., Linder B., Lawrence J.M., Lebenthal Y. et. al. HAPO Follow-up Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): Maternal Gestational Diabetes Mellitus and Childhood Glucose Metabolism. Diabetes Care. 2019;42(3):372–380. https://doi.org/10.2337/dc18-1646.
5. 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;27(6):19920. https://doi.org/10.1038/srep19920.
6. Retnakaran R. Hyperglycemia in pregnancy and its implications for a woman’s future risk of cardiovascular disease. Diabetes Res Clin Pract. 2018;145:193–199. https://doi.org/10.1016/j.diabres.2018.04.008.
7. Dedov I.I., Shestakova M.V., Mayorov A.Yu. (eds.). Standards of specialized diabetes care. 9th ed. Sakharnyy diabet = Diabetes Mellitus. 2019;22(S1). (In Russ.) Available at: https://diabetmed.net/wp-content/uploads/2019/12/12211-29550-6-PB.pdf.
8. Murphy H.R., Rayman G., Lewis K., Kelly S., Johal B., Duffield K. et al. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ. 2008;337:a1680. https://doi.org/10.1136/bmj.a1680.
9. Thorsell A., Gordon M., Jovanovic L. Continuous glucose monitoring: a stepping stone in the journey towards a cure for diabetes. J Matern Fetal Neonatal Med. 2004;15(1):15–25. https://doi.org/10.1080/14767050310001650671.
10. Klonoff D.C. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. 2005;28(5):1231–1239. https://doi.org/ 10.2337/diacare.28.5.1231.
11. De Block C., Manuel-y-Keenoy B., Van Gaal L. A review of current evidence with continuous glucose monitoring in patients with diabetes. J Diabetes Sci Technol. 2008;2(4):718–727. https://doi.org/10.1177/19322 9680800200426.
12. Murphy H.R., Rayman G., Duffield K., Lewis K.S., Kelly S., Johal B. et al. Changes in the Glycemic Profiles of Women With Type 1 and Type 2 Diabetes During Pregnancy. Diabetes Care. 2007;30(11):2785–2791. https://doi.org/10.2337/dc07-0500.
13. Dalfrà M.G., Chilelli N.C., Di Cianni G., Mello G., Lencioni C., Biagioni S. et al. 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.
14. Dedov I.I., Krasnopol’skiy V.I., Sukhikh G.T. Russian National Consensus Statement on gestational diabetes: diagnostics, treatment and postnatal care. Sakharnyy diabet = Diabetes Mellitus. 2012;15(4):4–10. (In Russ.) Available at: https://www.dia-endojournals.ru/jour/article/view/5531.
15. McDonnell C.M., Donath S.M., Vidmar S.I., Werther G.A., Cameron F.J. A novel approach to continuous glucose analysis utilizing glycemic variation. Diabetes Technol Ther. 2005;7(2):253–263. https://doi.org/10.1089/dia.2005.7.253.
16. Ryan E.A., Shandro T., Green K., Paty B.W., Senior P.A., Bigam D. et al. Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation. Diabetes. 2004;53(4):955–962. https://doi.org/10.2337/diabetes.53.4.955.
17. Wójcicki J.M. “J”-index. A new proposition of the assessment of current glucose control in diabetic patients. Horm Metab Res. 1995;27(1):41–42. https://doi.org/10.1055/s-2007-979906.
18. Rodbard D. A semilogarithmic scale for glucose provides a balanced view of hyperglycemia and hypoglycemia. J Diabetes Sci Technol. 2009;3(6):1395–1401. https://doi.org/10.1177/193229680900300620.
19. Molnar G.D., Taylor W.F., Ho M.M. Day-to-day variation of continuously monitored glycaemia: a further measure of diabetic instability. Diabetologia. 1972;8(5):342–348. https://doi.org/10.1007/BF01218495.
20. Kovatchev B.P., Otto E., Cox D., Gonder-Frederick L., Clarke W. Evaluation of a new measure of blood glucose variability in diabetes. Diabetes Care. 2006;29(11):2433–2438. https://doi.org/10.2337/dc06-1085.
21. Metzger B.E., Lowe L.P., Dyer A.R., Trimble E.R., Chaovarindr U., Coustan D.R. et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002. https://doi.org/10.1056/NEJMoa0707943.
Review
For citations:
Ushanova FO, Demidova TY, Izmaylova MY. Flash glucose monitoring in gestational diabetes mellitus: possibilities for assessing glycemic variability. Meditsinskiy sovet = Medical Council. 2021;(12):414-419. (In Russ.) https://doi.org/10.21518/2079-701X-2021-12-414-419