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Q&A

Diabetes

Poster Session 3

(882) Impact of continuous glucose monitoring on glycemic control in type 1 diabetes in pregnancy

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Shannon McCloskey, MD

Fellow
Ochsner Clinic Foundation
New Orleans, LA, United States

Coauthor(s)

Joseph R. Biggio, Jr., MD, MSc

System Chair, Women's Services
Ochsner Health
New Orleans, LA, United States
Naiha Mussarat, MD

Fellow
Ochsner Clinical Foundation
New Orleans, LA, United States
John A. Morgan, MD

Fellow
Ochsner Clinic
Metairie, LA, United States
James D. Toppin, MD, MPH

Ochsner Health
New Orleans, LA, United States
SS

Sarah Sternlieb, MD

Ochsner
New Orleans, LA, United States
NM

Nicholas Manuel, DO

Ochsner
New Orleans, LA, United States
KJ

Kali Juracek, N/A

Ochsner
New Orleans, LA, United States
SS

Sharon Shu, N/A

Ochsner
New Orleans, LA, United States
JS

Jesse Stone, N/A

Ochsner
New Orleans, LA, United States
FW

Frank Williams, MD, MPH

Ochsner Clinic
New Orleans, LA, United States

Objective: Continuous glucose monitoring (CGM) is an expanding technology with potential benefits in pregnancy related outcomes. We aim to determine the effect of CGM use on glycemic control in patients with type 1 diabetes mellitus (T1DM) in pregnancy.

Study Design: This was a retrospective cohort study of patients with T1DM with singleton pregnancy who received prenatal or diabetes care and delivered within a single large hospital system from 1/2016 - 1/2023. Patients using CGM were compared to those using traditional blood glucose monitoring (TBGM). Patients were excluded if missing delivery information, care was established after 20 weeks, or if unable to determine CGM status in pregnancy. Logistic regression was used to control for maternal age, body mass index, chronic hypertension, and insurance. Primary outcome was glycemic control in pregnancy, with on-target defined as hemoglobin A1c (HgA1c) < 6.5%. Secondary outcomes included baseline poor glycemic control (HgA1c ≥10%), DKA admission, hypertensive disorders of pregnancy, indicated preterm birth, and primary cesarean delivery.

Results: Among 288 patients with T1DM, 145 (50.3%) used CGM compared to 143 using TBGM monitoring. Patients using CGM were more likely to use insulin pumps and were less likely to be Black, nulliparous, or to use publicly funded insurance. On-target baseline glycemic control was more common in the CGM group (24.8% vs 9.8%, aOR 2.15, 95% CI 1.04-4.46) while p</span>oor glycemic control at baseline was less common in the CGM group (10.3% vs 28.7%, aOR 0.26, 95% CI 0.13-0.51). Differences in glycemic control persisted through pregnancy with on-target A1C values more common in the CGM group in second (55.2% vs 25.2%, OR 3.28, 95% CI 1.88-5.71) and third trimesters (42.1% vs 18.2%, OR 3.44, 95% CI 1.90-6.24). Persistent suboptimal or worsening glycemic control was less common in the CGM group (31% vs 46.2%, OR 0.29, 95% CI 0.16-0.53). Non-glycemic outcomes were similar between groups.

Conclusion: CGM use in T1DM is predictive of glycemic control throughout pregnancy, even when controlling for factors associated with poor glycemic outcomes.