Real-time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes - observations from a randomized controlled trial

• Published in: Diabetic medicine Vol. 30; no. 11; pp. 1374 - 1381
• Main Authors: Cordua, S., Secher, A. L., Ringholm, L., Damm, P., Mathiesen, E. R.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-11-2013; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - methods; Clinical trials; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glucose; Humans; Hyperglycemia - diagnosis; Hypoglycemia - diagnosis; Infant, Newborn; Medical sciences; Obstetric Labor Complications - diagnosis; Perinatal Care; Pregnancy; Pregnancy in Diabetics - blood; Prenatal Diagnosis - methods; Retrospective Studies; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Denmark; Endocrinopathy; Human; Immunopathology; Obesity; Nutrition; Continuous; Nutrition disorder; Autoimmune disease; Metabolic diseases; Real time; Randomized controlled trial; Randomization; Surveillance; Type 1 diabetes; Continuous Glucose Monitoring System; Observation; Clinical trial; Female; Delivery; Woman; Endocrinology; Nutritional status; Glycemia
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12246

Aims
To explore whether real‐time continuous glucose monitoring during labour and delivery supplementary to hourly self‐monitored plasma glucose in women with Type 1 diabetes reduces the prevalence of neonatal hypoglycaemia.
Methods
Women with Type 1 diabetes participating in a randomized controlled trial on the effect of real‐time continuous glucose monitoring in pregnancy were included in this study. Twenty‐seven of 60 (45%) women in the intervention arm used real‐time continuous glucose monitoring during labour and delivery, supplementary to hourly self‐monitored plasma glucose. Real‐time continuous glucose monitoring glucose data covering the last 8 h prior to delivery were retrospectively evaluated, and maternal hypo‐ and hyperglycaemia were defined as glucose values ≤ 3.9 mmol/l and > 7.0 mmol/l, respectively. Women in the control arm (n = 59) solely used self‐monitored plasma glucose. Neonatal hypoglycaemia was defined as a 2‐h plasma glucose < 2.5 mmol/l.
Results
In infants of women using real‐time continuous glucose monitoring during labour and delivery, 10 (37%) developed neonatal hypoglycaemia vs. 27 (46%) infants in the control arm (P = 0.45). Among 10 infants with and 17 infants without neonatal hypoglycaemia within the real‐time continuous glucose monitoring arm, median maternal self‐monitored plasma glucose was 6.2 (range 4.2–7.8) vs. 5.6 (3.3–8.5) mmol/l (P = 0.26) during labour and delivery, with maternal hyperglycaemia present in 17 (0–94) vs. 4 (0–46)% of the time (P = 0.02), and birthweight was 4040 (3102–4322) vs. 3500 (1829–4320) g (P = 0.04). Maternal hypoglycaemia up to delivery was relatively rare.
Conclusions
The prevalence of neonatal hypoglycaemia was comparable between infants of women using real‐time continuous glucose monitoring supplementary to self‐monitored plasma glucose during labour and delivery and infants of women solely using self‐monitored plasma glucose.
What's new?
In women with Type 1 diabetes using real‐time continuous glucose monitoring supplementary to hourly self‐monitored plasma glucose measurements during labour and delivery, the prevalence of neonatal hypoglycaemia was comparable with that of infants of women solely using self‐monitored plasma glucose.
Despite median plasma glucose values within target range, mothers of infants with neonatal hypoglycaemia spent more time with glucose levels > 7.0 mmol/l during the last 8 h up to delivery compared with mothers of infants without neonatal hypoglycaemia.
Maternal hypoglycaemia during the last 8 h up to delivery was relatively rare with this protocol on subcutaneous insulin administration.