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Q&A

Diabetes

Poster Session 4

(998) Relationship Between Intrapartum Blood Glucose Values and Adverse Outcomes in Individuals with Diabetes

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Patients with diabetes mellitus (DM) are typically managed with frequent monitoring and tight control of blood glucose (BG) during labor to reduce adverse outcomes, notably neonatal hypoglycemia (NH). However, there is limited evidence to support this method. Continuous glucose monitoring (CGM) is becoming more ubiquitous for managing DM and may soon replace fingerstick (FS). We sought to evaluate the relationship between intrapartum glucose levels and outcomes using FS and CGM.

Study Design:

We conducted a multicenter prospective study (11/2021-12/2022) of parturients with pregestational or gestational DM at ≥ 34 wks. Cohorts had a blinded CGM (Dexcom G6 PRO) placed from admission through delivery and were monitored with FS according to usual care. Time in the target range (TIR; range 70–110 mg/dL), time above the target range (TAR; >110mg/dL) expressed as % of all CGM readings, and mean glucose was obtained for both CGM and FS. We evaluated the association of these measures with NH and compared CGM versus FS in the prediction of NH and outcomes related to glucose control. Youden index was used to choose the cut-off point for TAR and prediction of NH.

Results: Of 9,479 deliveries during the study period, 202 (2.1%) met inclusion criteria, and 112 (56%) were enrolled (n=7 did not have CGM data). Of these, 45 (40%) had pregestational DM, and 65 (60%) had gestational DM. The mean BG using a CGM was 102 mg/dL (IQR: 89.9,113.5 mg/dL), and the average TIR was 62.1% (IQR: 36.9,85.6). CGM and FS were poor predictors of NH, with no differences in AUC (0.61, 95% CI: 0.49,0.73 vs. 0.54, 95% CI: 0.43,0.65). Using a threshold of time >120 mg/dL (AUC: 0.58, 95% CI: 0.46,0.70) or >130 mg/dL (AUC: 0.55, 95% CI: 0.43,0.67) did not improve prediction of NH. The best cutoff for the prediction of NH was a TAR of 61%, with 23% being above the threshold. The rate of NH was similar for TAR >61% vs < 61% (45.8% vs 25.9%, p=0.06) (Table).  

Conclusion:

We could not find a glucose measure by CGM or FS associated with or predictive of neonatal hypoglycemia. Intrapartum management of diabetic patients may need to be re-evaluated.