Capillary Glucose Monitoring Research Articles

Protocolo diagnóstico y terapéutico de la diabetes en el embarazo

This clinical protocol addresses the diagnosis and treatment of diabetes during pregnancy, distinguishing between pregestational diabetes and gestational diabetes (GD). GD occurs when pancreatic beta cell function is insufficient to overcome the inherent insulin resistance of pregnancy. Universal screening is recommended between 24–28 weeks of gestation using two strategies: a one-step strategy (75g of glucose) or a two-step strategy (50g of glucose followed by 100g if the first test is abnormal). Management includes capillary glucose monitoring, diet, and exercise as well as insulin treatment if necessary. Patients should be screened for metabolic abnormalities 4–12 weeks after delivery.

7493 A Case Report of Recurrent Hypoglycemia With Polysubstance Abuse With Rhabdomyolysis and Capillary Glucose Monitoring Dilemma

7493 A Case Report of Recurrent Hypoglycemia With Polysubstance Abuse With Rhabdomyolysis and Capillary Glucose Monitoring Dilemma

FRI642 The Effect Of Early Basal Insulin Administration On Diabetic Ketoacidosis (DKA) Management

Abstract Disclosure: H. Al-Marsumi: None. S.Z. Pollack: None. N. Simon: None. Background: DKA and HHS are considered serious acute complications of diabetes and constitute endocrine emergencies. Management of DKA and HHS consists of fluid, potassium replacement and weight-based adjusted rate intravenous insulin infusion, with close monitoring of capillary glucose, serum electrolytes, venous PH, and Beta-hydroxybutyrate. Current Standard DKA management protocols introduce and overlap subcutaneous insulin with intravenous insulin infusion after anion gap closure. In United states, few studies looked at different outcomes after early administration of basal insulin (i.e. before anion gap closure) during DKA management. Objective: The purpose of this research is to study the effect of early administration of basal long-acting insulin in addition to intravenous insulin on the time to anion gap closure, incidence of rebound hyperglycemia, hypoglycemia, transitional failure, length of ICU stays and length of Hospital stays, compared to intravenous insulin infusion only. Methods: This was a single-center, retrospective chart review study of adults 21 years or older admitted to the hospital with DKA diagnosis between September 2020 and May 2022. The patients were divided into two groups (Study group which includes those with early administration of basal long-acting insulin in addition to intravenous insulin infusion and Standard group which includes patients who received intravenous insulin infusion only). The primary outcome was the time to anion gap closure. The other outcomes included incidence of rebound hyperglycemia, hypoglycemia, transitional failure, length of ICU stay, as well as the length of hospital stay. Results: A total of 231 admissions were included for analysis; 29 patients were included in the (Study group) and 202 in the (Standard group). The mean time ± standard deviation for hours till anion gap closure in the study group and standard group were (21.3938 ± 25.2603 and 12.7679 ± 9.3512) respectively showing no statistical difference between the two groups with a P value of 0.0789. The incidence of hypoglycemia was 21% in the study group and 24% in the standard group with P value of 0.8173. There was no statistical difference in length of ICU stays, length of hospital stays, incidence of rebound hyperglycemia, transitional failure between the study and control groups with a p value of (0.3867, 0.7207, 0.7758 and 0.1387) respectively. Conclusion: There was no statistical difference in time to anion gap closure, length of ICU stays, length of hospital stays, incidence of rebound hyperglycemia, hypoglycemia, transitional failure between the study and Standard groups. Further Studies are needed to evaluate the effect of early basal insulin administration on DKA management. Presentation: Friday, June 16, 2023

History and Evolution of Capillary Glucose Monitoring

Abstract Monitoring of blood glucose levels is an inevitable part of diabetes management. The last decade was marked by path-breaking and transformational changes in diabetes technologies that ushered in the introduction of a wide spectrum of glucose monitoring devices that are more reliable and user-friendly. This review describes the evolution of capillary glucose monitoring from simple urine sugar screening tests to reagent strip systems and to sophisticated glucose monitors over the past four decades since the introduction of the first glucose meter in 1970.

Clinical application guidelines for blood glucose monitoring in China (2022 edition).

Glucose monitoring is an important component of diabetes management. The Chinese Diabetes Society (CDS) has been producing evidence-based guidelines on the optimal use of glucose monitoring since 2011. In recent years, new technologies in glucose monitoring and more clinical evidence, especially those derived from Chinese populations, have emerged. In this context, the CDS organised experts to revise the Clinical application guidelines for blood glucose monitoring in China in 2021. In this guideline, we focus on four methods of glucose monitoring that are commonly used in clinical practice, including capillary glucose monitoring, glycated haemoglobin A1c, glycated albumin, and continuous glucose monitoring. We describe the definitions and technical characteristics of these methods, the factor that may interfere with the measurement, the advantages and caveats in clinical practice, the interpretation of glucose metrics, and the relevant supporting evidence. The recommendations for the use of these methods are also provided. The various methods of glucose monitoring have their strengths and limitations and cannot be replaced by one another. We hope that these guidelines could aid in the optimal application of common methods of glucose monitoring in clinical practice for better diabetes care.

Effect of divergent continuous glucose monitoring technologies on glycaemic control in type 1 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials.

AimsWe aimed to conduct a systematic review and meta‐analysis of randomised controlled clinical trials (RCTs) assessing separately and together the effect of the three distinct categories of continuous glucose monitoring (CGM) systems (adjunctive, non‐adjunctive and intermittently‐scanned CGM [isCGM]), compared with traditional capillary glucose monitoring, on HbA1c and CGM metrics.MethodsPubMed, Web of Science, Scopus and Cochrane Central register of clinical trials were searched. Inclusion criteria were as follows: randomised controlled trials; participants with type 1 diabetes of any age and insulin regimen; investigating CGM and isCGM compared with traditional capillary glucose monitoring; and reporting glycaemic outcomes of HbA1c and/or time‐in‐range (TIR). Glycaemic outcomes were extracted post‐intervention and expressed as mean differences and 95%CIs between treatment and comparator groups. Results were pooled using a random‐effects meta‐analysis. Risk of bias was assessed using the Cochrane Rob2 tool.ResultsThis systematic review was conducted between January and April 2021; it included 22 RCTs (15 adjunctive, 5 non‐adjunctive, and 2 isCGM)). The overall analysis of the pooled three categories showed a statistically significant absolute improvement in HbA1c percentage points (mean difference (95% CI): −0.22% [−0.31 to −0.14], I 2 = 79%) for intervention compared with comparator and was strongest for adjunctive CGM (−0.26% [−0.36, −0.16]). Overall TIR (absolute change) increased by 5.4% (3.5 to 7.2), I 2 = 71% for CGM intervention compared with comparator and was strongest with non‐adjunctive CGM (6.0% [2.3, 9.7]).ConclusionsFor individuals with T1D, use of CGM was beneficial for impacting glycaemic outcomes including HbA1c, TIR and time‐below‐range (TBR). Glycaemic improvement appeared greater for TIR for newer non‐adjunctive CGM technology.

Aerobic Exercise Reduce Blood Glucose in Type 2 Diabetes Mellitus

Diabetes mellitus type 2 is a metabolic disease caused by disruption of insulin action and characterized by hyperglycemia. Management of type 2 diabetes mellitus needs to be done to achieve optimal glycemic control to prevent various complications. Aerobic exercise walking is a way to lower blood glucose that is easy for people with type 2 diabetes mellitus. Determine the effect of aerobic exercise in lowering blood glucose in people with type 2 diabetes mellitus. The study is a literature review with the PICOC method for searching articles on databases such as Pubmed, Science Direct, Cochrane Library, and Proquest. The articles that were reviewed were limited to 2015-2020 and the types of research were quasi-experiments and randomized control trials. Seven articles match in criteria, four international articles and three national articles. Analysis of the articles showed that the characteristics of respondents were 49-65 years old, 209 men, 191 women, the average duration of type 2 diabetes mellitus was 5.3-9 years and the average HbA1C value was 6.4% - 8.4%. Glucose value in the research article showed a decrease in various glucose indicators such as HbA1C, capillary glucose, fasting glucose, and continuous glucose monitoring. Aerobic exercise in the frequency of seven days to 25 weeks with moderate to vigorous intensity, 15-60 minutes of exercise time/session, and the type of exercise is walking on a treadmill, walking 10,000 steps/day, and brisk walking. Aerobic walking exercise can lower blood glucose and is easily done by people with type 2 diabetes mellitus.

Accuracy of Continuous Glucose Monitors for Inpatient Diabetes Management.

In hospitalized patients, continuous glucose monitoring (CGM) may improve glycemic control, prevent hypoglycemic events, and reduce staff workload compared with point-of-care (POC) capillary glucose monitoring. To evaluate CGM accuracy and safety of use in the inpatient setting, two versions of CGM sensors were placed on 43 and 34 adult patients with diabetes admitted to non-intensive care unit (ICU) medical wards, respectively. CGM accuracy relative to POC and safety of use were measured by calculating mean absolute relative difference (MARD) and by Clarke Error Grid (CEG) analysis. CGM version 2 had improved accuracy compared with CGM version 1 with MARD 17.7 compared with 21.4%. CGM accuracy did not change with POC value or with time of sensor wear. On CEG, 98.8% of paired values fell within acceptable zones A and B. Despite reduced accuracy compared with the outpatient setting, both versions of CGMs had acceptable safety profiles in the inpatient setting.

Association of continuous glucose monitoring metrics and glycated hemoglobin (HbA1C) with perinatal outcomes

Intermittent capillary glucose monitoring and HbA1C are standard measures used to assess glycemic control in pregnancies complicated by diabetes. Recent data show improved neonatal outcomes with continuous glucose monitoring (CGM) in pregnancy. We sought to assess and compare the association of CGM measures and HbA1c with perinatal outcomes.

2020 NICE guideline update: Good news for pregnant women with type 1 diabetes and past or current gestational diabetes.

In December 2020, the National Institute for Health and Care Excellence (NICE) reviewed the evidence and updated their recommendations on intermittently scanned (commonly known as Flash) and Continuous Glucose Monitoring (CGM) during pregnancy for women with type 1 diabetes (1). The NICE guidelines now recommend offering CGM to all pregnant women with type 1 diabetes to help them meet their pregnancy glucose targets and improve neonatal outcomes. Their evidence review, based on the CONCEPTT randomised trial (2) and a Swedish observational study (3) found that, compared to capillary glucose monitoring, CGM resulted in more women achieving their blood glucose targets, fewer caesarean sections and fewer neonatal intensive care admissions.

Diabetes through transitions in life; from fit to frail

The accelerated ageing that occurs in diabetes results in earlier appearance of the geriatric phenotype, including frailty. Recent guidelines have stressed the need for assessing frailty in the evaluation of older adults living with diabetes. Once evaluated and identified, however, the presence of frailty marks a significant change for the individual. Treatments that have been continued and encouraged often for many years, may be discontinued. Life-prolonging medications such GLP-1 analogues, and SGLT-2 inhibitors are replaced with therapies designed to improve quality of life, reduce glycaemic variability and stabilise the sarcopaenia that characterises frailty, such as insulin. With this, however, comes new problems, such as the risk of hypoglycaemia, the need to for capillary glucose monitoring and sub cutaneous administration. Additionally, new diagnoses that are more common in people in diabetes, such as stroke, heart disease, dementia, falls and fractures will result in further changes, with the need for care and possibly even institutionalisation.

Virtual Simulation Games as an Educational Tool for University First Responders in Canada: A Usability Study

BackgroundCampus emergency response teams need continued education in order to retain critical skills and knowledge. Multiple studies have been conducted on the usefulness of virtual simulation games (VSGs); however, there is a gap in the literature for use in campus emergency response teams. MethodA mixed-methods usability study was designed to review three VSGs designed as an online training tool for Campus Emergency Response Teams (CERT) and First Response team members. Quantitative data collection included a participant demographic survey and the Virtual Simulation Technology Acceptance Survey VSTAS. Qualitative data were obtained from individual interviews. ResultsFindings suggest strong support for the ease of use and usefulness of these VSGs. Internet bandwidth should be considered when implementing virtual simulation training methods. A lack of understanding of CERT member-specific scope of practice related to capillary glucose monitoring, which can inform future training practices. ConclusionsThis study demonstrates the VSGs are a useful educational tool. Further testing is needed to assess effectiveness in relation to learning outcomes and knowledge retention.

Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self-care behaviour and emotion.

Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self-care behaviour and emotional state of women with type 1 diabetes and disordered eating. In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case-control study. We used a mixed-methods approach with a 7-day blinded continuous glucose monitoring and real-time record of non-prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann-Whitney U test or Fisher's exact test. We conducted thematic analyses of free-text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags. People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p=0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p=0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15mmol/L). Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.

Does the use of a colour coded inpatient capillary blood glucose monitoring chart influence outcomes?

Background: Dysglycaemia in hospital inpatients is associated with harm. However, bedside capillary glucose monitoring often occurs with inadequate frequency, with inappropriate action taken when dysglycaemia occurs.Aims: To assess whether the introduction of a colour coded blood glucose monitoring chart had an impact on glycaemic control, documentation of action taken, length of stay and mortality in an unselected cohort of hospital inpatients.Methods: A cross-sectional study before (2014) and after (2017) the introduction of the new chart was undertaken. Data were collected for the 24 hours prior to inclusion in the study.Results: Data from 56 individuals were collected in 2014 and from 161 in 2017. 57% and 22% experienced dysglycaemia in 2014 and 2017, respectively. Action was taken in 24.2% of cases in 2014 and in 56.8% in 2017. Median length of stay was 16.1 days (IQR 8.4–39.4) in 2014 and 13.1 days (5.7–25.3) in 2017. For those who experienced dysglycaemia and in whom action was not recorded, mortality was 30% and 20% in 2014 and 2017 compared with 6% and 15%, respectively, for those who had no dysglycaemia.Conclusions: The introduction of a colour coded blood glucose monitoring chart led to more action being recorded when dysglycaemia occurred and reduced length of hospital stay and mortality.

1402-P: Functional Data Analysis Reveals Differences in Temporal Glucose Profiles Hidden by Standard Continuous Glucose Monitoring Analysis: A Secondary Analysis of the CONCEPTT Trial

Background: The CONCEPTT randomized trial of CGM in pregnant women with type 1 diabetes showed significant improvement in pregnancy outcomes, but no difference in mean CGM glucose between those allocated to CGM vs. capillary glucose monitoring. Whilst summary statistics are recommended for the reporting of CGM data, they do not give dynamic information about the glucose profile across 24 hours. Aim: To determine, using novel functional data analysis (FDA), if differences in the temporal glucose profile occurred in women randomized to CGM. Methods: CGM data was available from 200 pregnant women (100 CGM intervention; 100 control) in the CONCEPTT study, at baseline, 24 and 34 weeks gestation. FDA was applied to the glucose data to generate functional glucose curves and multivariable statistical analysis applied. Results: Despite having the same mean CGM glucose as those on capillary glucose monitoring alone 121 vs. 126 mg/dL; 6.7 vs. 7.0 mmol/l p=0.14, FDA revealed that pregnant CGM users were in fact running a significantly lower glucose (by 9-14mg/dL; 0.5-0.8 mmol/l) for a total of 8 hours a day (08.30-12.30 and 15.00-19.00). Conclusion: Analysis of temporal glucose profiles gives key information about glucose control, missed by commonly reported CGM metrics. The women allocated to CGM ran a significantly lower glucose for 33% of the day. Disclosure E.M. Scott: Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott, Eli Lilly and Company. H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc. D. Feig: Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. G. Law: None. Funding JDRF; Canadian Clinical Trials Network; National Institute for Health Research

ASSOCIATION OF THE PRESENCE ANEMIA AND MALNUTRITION IN HOSPITALIZED PATIENTS WITH EXCLUSIVE ENTERAL NUTRITION

enteral nutrition therapy maintains and/or regains the nutritional status of the common patient in hospital settings, where anemia and malnutrition are food related and are very common diseases. to determine and associate the presence of anemia and malnutrition in hospitalized patients with exclusive enteral nutrition. a prospective, cross-sectional study with patients receiving exclusive enteral nutrition up to 72 hours after hospitalization. A nutritional evaluation was performed, consisting of anthropometric data, such as weight, circumferences, and skinfolds; dietary evaluation (data were collected through an electronic medical record) and biochemistry data (hemogram, albumin, C-reactive protein, capillary glucose monitoring). the population consists of 77 individuals. As the patients presented greater severity of anemia, corrected arm muscle area, calf circumference and serum albumin levels were reduced while C-reactive protein increased significantly (p < 0.05). In relation to the low weight classification according to the body mass index (BMI), it was observed that the anthropometric parameters such as corrected arm muscle area (R = 0.74, p < 0.001), adductor pollicis muscle thickness (R = 0.23, p = 0.046) and calf circumference (R = 0.81, p < 0.001) decreased as did biochemical parameters albumin (R = 0.26; p = 0.048) and capillary blood glucose (R = 0.34, p = 0.018). anemia has an important relation with anthropometric markers that evaluate the depletion of lean mass; the BMI has a strong association with all the anthropometric parameters evaluated, as well as the albumin and capillary blood glucose, except with the values of hemoglobin.

Maternal Postprandial Triglycerides in the Home Setting

Background and Aims: Elevated maternal triglycerides (TG) have been associated with adverse pregnancy outcomes including an increased risk of preeclampsia and macrosomia. Maternal TG are primarily measured in the fasting state and at single time points during pregnancy. Temporal and prandial changes in TG levels during pregnancy are not well described. The purpose of this study was to examine flux of capillary glucose and TG in late pregnancy, how they are influenced by high and low fat meals, and whether they relate to infant body composition. Materials and Methods: Women in the third trimester of pregnancy completed 4 days of home capillary glucose and TG monitoring (4 times a day (fasting and two hours post each meal)). Using the Roche Accutrend Plus meter. Each woman consumed an isocaloric high fat (41%) and a low fat (25%) breakfast meal on different days during the study period. Area under the curve (AUC) for the capillary glucose and TG measures after the standardized meals was calculated using trapezoidal approximation. AUC for women with and without GDM was compared for each meal and metabolic measure. Infant body fat % was measured by air displacement plethysmography. Results: To date, thirteen women, 7 with GDM and 6 normoglycaemic have completed the study. Median capillary glucose levels: fasting 5.0 (95% CI 4.6-5.2) mmol/L and postprandial 6.0 (95% CI 5.7-6.2) mmol/L. Median capillary TG: fasting 3.3 (95% CI 2.9-3.8) mmol/L and postprandial 3.6 (95% CI 3.2-3.8) mmol/L. Mean infant body fat % 10.6 (SD4.9)%. There were no significant differences in capillary glucose or triglycerides between the meals although capillary glucose trended higher with the low fat meal. GDM status did not affect the AUC glucose or AUC triglycerides for either meal. Conclusion: This study demonstrates that capillary triglycerides can be monitored at home in a similar fashion to capillary glucose. Capillary triglyceride levels were not related to infant anthropometry and did not vary significantly with meal fat content. Recruitment is ongoing. Disclosure H.L. Barrett: None. M. Dekker: Speaker's Bureau; Self; Abbott. Other Relationship; Self; Nestlé. S.J. de Jersey: None. M.C. d'Emden: Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company, Boehringer Ingelheim GmbH. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi, Novo Nordisk A/S, Novartis Pharmaceuticals Corporation. L. Callaway: None. H. McIntyre: Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Danish Diabetes Academy.

Are Black Pediatric Patients with Type 1 Diabetes (T1D) Prescribed Higher Doses of Insulin than White Patients?

Black youth with T1D have been noted to have higher HbA1c’s, less frequent monitoring of capillary glucose and higher reported occurrence of hypoglycemia compared to white patients. We hypothesized that this combination of factors would be associated with higher prescribed doses of insulin in black patients compared to whites. A retrospective analysis was performed on data collected from patients at the Children’s Diabetes Center, New Orleans, LA who participated in a study of racial differences in hemoglobin glycation. Patients self-identified as either black or white and were under the clinical care of several different attending diabetologists. The influence of race on total daily prescribed dose of insulin per kg body weight (TDDI), was evaluated in a general linear model adjusted for HbA1c, insulin delivery method, gender, and chronologic age as well as the interactive effect of race and HbA1c. Hemoglobin Glycation Index (HGI) was also calculated and substituted in the model for HbA1c. The population studied consisted of 33 (19F, 14M) black patients and 52 (22F,30 M)whites. Average age was 14.0±3.6 years and duration of diabetes 5.7±3.9 years. As previously reported from this population blacks had higher HbA1c even after adjustment for age and mean blood glucose level (MBG). Mean TDDI was 0.89±0.33 units/kg/d. TDDI was highly correlated with both HbA1c (r=0.40,p&amp;lt;0.0001)and MBG (r=0.43,p&amp;lt;0.0001) before adjustment. In the linear model TDDI was significantly associated with HbA1c (p=0.0003) but not race, age, gender or insulin delivery mode. There was no interactive effect of race and HbA1c. There was no significant effect of HGI. We found that prescribed TDDI increased with increasing HbA1c in both black and white patients. This preliminary study suggests that prescribing physicians increase insulin dosage in an attempt to bring HbA1c to goal for their patients but do not vary dose based on ethnicity. Disclosure S. Chalew: None. R. Gomez: None. J.M. Hempe: None.

Diagnosing Post-transplant Diabetes - The Need for Capillary Glucose Monitoring.

Diagnosing Post-transplant Diabetes - The Need for Capillary Glucose Monitoring.

Experience with FreeStyle Libre Flash glucose monitoring system in management of refractory dumping syndrome in pregnancy shortly after bariatric surgery.

Bariatric surgery is an effective therapy for obesity but is associated with long-term complications such as dumping syndromes and nutritional deficiencies. We report a case of a 26-year-old caucasian female, with history of morbid obesity and gestational diabetes (GDM), who became pregnant 4 months after Roux-en-Y bypass surgery. She developed GDM during subsequent pregnancy, which was initially managed with metformin and insulin. Nocturnal hypoglycaemia causing sleep disturbance and daytime somnolence occured at 19 weeks of pregnancy (19/40). Treatment with rapid-acting carbohydrates precipitated further hypoglycaemia. Laboratory investigations confirmed hypoglycaemia at 2.2 mmol/L with appropriately low insulin and C-peptide, intact HPA axis and negative IgG insulin antibodies. The patient was seen regularly by the bariatric dietetic team but concerns about compliance persisted. A FreeStyle Libre system was used from 21/40 enabling the patient a real-time feedback of changes in interstitial glucose following high or low GI index food intake. The patient declined a trial of acarbose but consented to an intraveneous dextrose infusion overnight resulting in improvement but not complete abolishment of nocturnal hypoglycaemia. Hypoglycaemias subsided at 34/40 and metformin and insulin had to be re-introduced due to high post-prandial blood glucose readings. An emergency C-section was indicated at 35 + 1/40 and a small-for-gestational-age female was delivered. There have been no further episodes of hypoglycaemia following delivery. This case illustrates challenges in the management of pregnancy following bariatric surgery. To our knowledge, this is the first use of FreeStyle Libre in dumping syndrome in pregnancy following bariatric surgery with troublesome nocturnal hypoglycaemia.Learning points:Bariatric surgery represents the most effective treatment modality in cases of severe obesity. With increasing prevalence of obesity, more people are likely to undergo bariatric procedures, many of which are women of childbearing age.Fertility generally improves after bariatric surgery due to weight reduction, but pregnancy is not recommended for at least 12–24 months after surgery. If pregnancy occurs, there are currently little evidence-based guidelines available on how to manage complications such as dumping syndromes or gestational diabetes (GDM) in women with history of bariatric surgery.Diagnosis of GDM relies on the use of a 75 g oral glucose tolerance test (OGTT). The use of this test in pregnant women is not recommended due to its potential to precipitate dumping syndrome. Capillary glucose monitoring profiles or continuous glucose monitoring (CGM) is being currently discussed as alternative testing modalities.As the CGM technology becomes more available, including the recently introduced FreeStyle Libre Flash glucose monitoring system, more pregnant women, including those after bariatric surgery, will have access to this technology. We suggest urgent development of guidelines regarding the use of CGM and flash glucose monitoring tools in these circumstances and in the interim recommend careful consideration of their use on a case-to-case basis.