Continuous Glucose Monitoring in Pregnancy: Importance of Analyzing Temporal Profiles to Understand Clinical Outcomes
Eleanor Scott, Denice S. Feig, Helen R. Murphy, Graham R. Law, The CONCEPTT Collaborative Group, Helen Murphy, Jeannie Grisoni, Carolyn Byrne, Sandra Neoh, Katy Davenport, Lois Donovan, Claire Gougeon, Carolyn Oldford, Catherine A. Young, Stephanie A. Amiel, Katharine F. Hunt, Louisa Green, Helen Rogers, Benedetta Rossi, Denice S. Feig, Barbara Cleave, Michelle Strom, Rosa Corcoy, Alberto de Leiva, Juan M. Adelantado, Ana Chico, Diana Tundidor, Erin Keely, Janine Malcolm, Kathy Henry, Damian Morris, Gerry Rayman, Duncan Fowler, Susan L. Mitchell, Josephine Rosier, Rosemary Temple, Jeremy Turner, Gioia Canciani, Niranjala Hewapathirana, Leanne Piper, Ruth McManus, Anne Kudirka, Margaret Watson, Matteo Bonomo, Basilio Pintaudi, Federico Bertuzzi, Giuseppina Daniela Corica, Elena Mion, Julia Lowe, Ilana Halperin, Anna Rogowsky, Sapida Adib, Robert S. Lindsay, David Carty, Isobel Crawford, Fiona Mackenzie, Therese McSorley, John N. Booth, Natalia McInnes, Ada Smith, Irene Stanton, Tracy Tazzeo, John Weisnagel, Peter Mansell, Nia Jones, Gayna Babington, Dawn Spick, Malcolm MacDougall, Sharon Chilton, Terri Cutts, Michelle Perkins, Eleanor Scott, Del Endersby, Anna R. Dover, Frances Dougherty, Susan Johnston, Simon Heller, Peter Novodorsky, Sue Hudson, Chloe Nisbet, Thomas Ransom, Jillian Coolen, Darlene Baxendale, Richard I. G. Holt, Jane Forbes, Nicki Martin, Fiona Walbridge, Fidelma Dunne, Sharon Conway, Aoife M. Egan, Collette Kirwin, Michael Maresh, Gretta Kearney, Juliet Morris, Susan J. Quinn, Rudy Bilous, Rasha Mukhtar, Ariane Godbout, Sylvie Daigle, Alexandra Lubina Solomon
Abstract
OBJECTIVE To determine if temporal glucose profiles differed between 1) women who were randomized to real-time continuous glucose monitoring (RT-CGM) or self-monitored blood glucose (SMBG), 2) women who used insulin pumps or multiple daily insulin injections (MDIs), and 3) women whose infants were born large for gestational age (LGA) or not, by assessing CGM data obtained from the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT). RESEARCH DESIGN AND METHODS Standard summary metrics and functional data analysis (FDA) were applied to CGM data from the CONCEPTT trial (RT-CGM, n = 100; SMBG, n = 100) taken at baseline and at 24- and 34-weeks’ gestation. Multivariable regression analysis determined if temporal differences in 24-h glucose profiles occurred between comparators in each of the three groups. RESULTS FDA revealed that women using RT-CGM had significantly lower glucose (0.4–0.8 mmol/L [7–14 mg/dL]) for 7 h/day (0800 h to 1200 h and 1600 h to 1900 h) compared with those with SMBG. Women using pumps had significantly higher glucose (0.4–0.9 mmol/L [7–16 mg/dL]) for 12 h/day (0300 h to 0600 h, 1300 h to 1800 h, and 2030 h to 0030 h) at 24 weeks with no difference at 34 weeks compared with MDI. Women who had an LGA infant ran a significantly higher glucose by 0.4–0.7 mmol/L (7–13 mg/dL) for 4.5 h/day at baseline, by 0.4–0.9 mmol/L (7–16 mg/dL) for 16 h/day at 24 weeks, and by 0.4–0.7 mmol/L (7–13 mg/dL) for 14 h/day at 34 weeks. CONCLUSIONS FDA of temporal glucose profiles gives important information about differences in glucose control and its timing, which are undetectable by standard summary metrics. Women using RT-CGM were able to achieve better daytime glucose control, reducing fetal exposure to maternal glucose.