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Oral Concurrent Session 2 - Diabetes

Oral Concurrent Sessions

(31) Association of glucose profiles based on daily continuous glucose monitoring metrics with adverse perinatal outcomes

Tuesday, February 13, 2024
3:00 PM – 3:15 PM  
Location: Potomac Ballroom C, Ballroom Level
Objective: While individual continuous glucose monitoring (CGM) metrics are associated with pregnancy outcomes, the combination of CGM metrics is more difficult to study. Our goal was to 1) identify discrete glucose profiles based on daily CGM metrics among pregnant individuals with pregestational diabetes and 2) investigate their association with adverse perinatal outcomes.

Study Design: Retrospective cohort study of pregnant individuals with type 1 or type 2 diabetes who used Dexcom G6 CGM from at least 24-30wga and delivered at a tertiary center (2019-2023). CGM data was transformed into eight daily CGM metrics: minimum, maximum, mean, standard deviation, mean amplitude of glucose excursion, and time spent in range (65-140 mg/dL), above range, and below range. K-means clustering identified distinct glucose profiles, and individuals were classified based on which profile best summarized their CGM data. Last, the association between glucose profiles and outcomes was estimated using logistic regression adjusted for diabetes type, maternal age, insurance, CGM use before pregnancy, and parity.

Results: Of 90 pregnant individuals, 53 (58.9%) had type 1 diabetes and 47 (41.1%) had type 2 diabetes. We identified three glucose profiles: 1) well-controlled, 2) suboptimal control with hyperglycemia, and 3) suboptimal control with high glucose variability (Figure). Compared to the well-controlled profile, the hyperglycemia profile had higher odds of preterm birth (aOR 3.23, 95%CI 1.04-11.0), cesarean (aOR 3.42, 95%CI 1.09-11.9), LGA (aOR 3.88, 95%CI 1.14-15.1), neonatal hypoglycemia (aOR 4.10, 95%CI 1.36-13.5), and NICU admission (aOR 7.82, 95%CI 2.44-29.0). Compared to the well-controlled profile, the high variability profile had higher odds of preterm birth (aOR 5.49, 95%CI 1.34-25.8) and NICU admission (aOR 10.7, 95%CI 2.41-58.5). Neither was associated with preeclampsia.

Conclusion: In addition to avoiding maternal hyperglycemia in pregnant individuals with pregestational diabetes, high glucose variability with excursions in both directions should be minimized given high risk of preterm birth and NICU admission.