Glucose Fluctuations during Gestation: An Additional Tool for Monitoring Pregnancy Complicated by Diabetes.

M G Dalfrà,G Mello,A Lapolla,S Biagioni,N C Chilelli,G Di Cianni,C Lencioni,G Sartore,M Scalese

doi:10.1155/2013/279021

Abstract

Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycemic index (LBGI) were also measured as indicators of hyperhypoglycemic risk. Women with type 1 diabetes showed higher GV, with a 2-fold higher risk of hyperglycemic spikes during the day, than healthy pregnant women or GDM ones. GDM women had only slightly higher GV parameters than healthy controls. HbA1c did not correlate with GV indicators in type 1 diabetes or GDM pregnancies. We provided new evidence of the importance of certain GV indicators in pregnant women with GDM or type 1 diabetes and recommended the use of CGM specifically in these populations.

Highlights

Recent evidence in the literature suggests that glucose variability, characterized by extreme glucose excursions, may overlap with HbA1c levels in giving rise to a risk of diabetesrelated complications [1, 2]
Glucose variability is a factor that has yet to be adequately studied in pregnancies complicated by diabetes, and little is known about its relationship with maternal-fetal outcomes [9]
For patients in Group 1, there generally tended to be an increase in all glucose variability indicators, for example, mean amplitude of glycemic excursions (MAGE) (1.53 [range 1.33–2.33], 1.73 [1.47–1.93], 1.71 [1.34–2.64] mmol/L—determined in the 3 trimesters, resp.), standard deviation (SD) (1.03 [0.82–1.76], 1.14 [0.96–1.41], 1.20 [0.94–1.61] mmol/L), continuous overlapping net glycemic action (CONGA) 1 (1.02 [0.92–1.43], 1.15 [0.91–1.32], 1.21 [0.96–1.71] mmol/L), and interquartile range (IQR) (1.47 [1.09–2.33], 1.46 [1.39– 1.87], 1.43 [1.12–2.13] mmol/L)

Summary

Introduction

Recent evidence in the literature suggests that glucose variability, characterized by extreme glucose excursions, may overlap with HbA1c levels in giving rise to a risk of diabetesrelated complications [1, 2]. 48-hour continuous glucose monitoring (CGM) of diurnal glucose profiles in pregnant women with type 1 diabetes proved more sensitive than HbA1c alone in identifying a higher risk of offspring developing congenital malformations [8]. Such studies give the impression that transient hyperglycemic spikes in pregnant patients with diabetes could relate to a higher incidence of fetal overweight, via a mechanism at least partly independent of chronic hyperglycemia. Glucose variability is a factor that has yet to be adequately studied in pregnancies complicated by diabetes, and little is known about its relationship with maternal-fetal outcomes [9]

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