Effect of continuous glucose monitoring compared with self-monitoring of blood glucose in gestational diabetes patients with HbA1c<6%: a randomized controlled trial

Mengyu Lai; Jianrong Weng; Jiaying Yang; Yujia Gong; Fang Fang; Na Li; Mei Kang; Xianming Xu; Yufan Wang

doi:10.3389/fendo.2023.1174239

Effect of continuous glucose monitoring compared with self-monitoring of blood glucose in gestational diabetes patients with HbA1c<6%: a randomized controlled trial

Front Endocrinol (Lausanne). 2023 Apr 19:14:1174239. doi: 10.3389/fendo.2023.1174239. eCollection 2023.

Authors

Mengyu Lai¹, Jianrong Weng², Jiaying Yang¹, Yujia Gong¹, Fang Fang¹, Na Li¹, Mei Kang³, Xianming Xu², Yufan Wang¹

Affiliations

¹ Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Objective: This study evaluated the effect of continuous glucose monitoring (CGM) versus self-monitored blood glucose (SMGB) in gestational diabetes mellitus (GDM) with hemoglobin A1c (HbA1c) <6%.

Methods: From January 2019 to February 2021, 154 GDM patients with HbA1c<6% at 24-28 gestational weeks were recruited and assigned randomly to either SMBG only or CGM in addition to SMBG, with 77 participants in each group. CGM was used in combination with fingertip blood glucose monitoring every four weeks until antepartum in the CGM group, while in the SMBG group, fingertip blood glucose monitoring was applied. The CGM metrics were evaluated after 8 weeks, HbA1c levels before delivery, gestational weight gain (GWG), adverse pregnancy outcomes and CGM medical costs were compared between the two groups.

Results: Compared with patients in the SMBG group, the CGM group patients had similar times in range (TIRs) after 8 weeks (100.00% (93.75-100.00%) versus 99.14% (90.97-100.00%), p=0.183) and HbA1c levels before delivery (5.31 ± 0.06% versus 5.35 ± 0.06%, p=0.599). The proportion with GWG within recommendations was higher in the CGM group (59.7% versus 40.3%, p=0.046), and the newborn birth weight was lower (3123.79 ± 369.58 g versus 3291.56 ± 386.59 g, p=0.015). There were no significant differences in prenatal or obstetric outcomes, e.g., cesarean delivery rate, hypertensive disorders, preterm births, macrosomia, hyperbilirubinemia, neonatal hypoglycemia, respiratory distress, and neonatal intensive care unit admission >24 h, between the two groups. Considering glucose monitoring, SMBG group patients showed a lower cost than CGM group patients.

Conclusions: For GDM patients with HbA1c<6%, regular SMBG is a more economical blood glucose monitoring method and can achieve a similar performance in glycemic control as CGM, while CGM is beneficial for ideal GWG.

Keywords: continuous glucose monitoring; cost; gestational diabetes mellitus; gestational weight gain; self-monitoring of blood glucose.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Glucose Self-Monitoring
Blood Glucose* / analysis
Diabetes, Gestational*
Female
Gestational Weight Gain
Glycated Hemoglobin
Glycemic Control
Hemoglobin C
Humans
Pregnancy

Substances

Blood Glucose
Glycated Hemoglobin
glycated hemoglobin C
Hemoglobin C

Grants and funding

National Natural Science Foundation of China (No. 81870610), the Shanghai Science and Technology Commission Foundation (No. 21Y11904800), Clinical Research Plan of SHDC (No. SHDC2020CR3065B).