Management Of Gestational Hyperglycemia By Continuous Glucose Monitoring: A Clinical Study

OBJECTIVE : Gestational hyperglycemia,one of the commonest pregnant related complications,increases adverse pregnancy outcomes.Continuous glucose monitoring(CGM)has been found to be safe and effective that it can identify glycemic patterns.The comprehensive glucose pentagon(CGP)uses five key metrics that are derived from continuous glucose monitoring.The purpose of this study was to use CGM in patients with gestational hyperglycemia,and to explore the glucose characteristics and the correlation between glycemic variability and adverse pregnancy outcomes.METHODS:Totally 252 patients with gestational hyperglycemia at 24-35 weeks of gestation attending the endocrinology clinic of Shanghai General Hospital from November2017 to December 2019 were enrolled.Among them,210 women were gestational diabetes mellitus(GDM),21 women were overt diabetes(ODM)during pregnancy,and21 women were type 2 diabetes(T2DM).General information was collected.Blood glucose,blood lipid,pancreatic islet function and glycosylated hemoglobin(HbA1c)were detected.The 3-day CGM was performed in the second or third trimester to calculate the glycemic variability,and the C GP was evaluated.The study included three parts:(1)133GDM,21 ODM and 21 T2 DM women in second trimester were enrolled and their glycemic variability parameters were compared.(2)86 GDM in the second trimester and77 GDM in the third trimester were enrolled and their glycemic variability parameters and the CGP were compared.(3)103 GDM patients were enrolled.CGM was performed in the second or third trimester to investigate the correlation between glycemic variability and adverse pregnancy outcomes.RESULT:(1)Compared with GDM in the second trimester,T2 DM and ODM had higher levels of Hb A1 c,mean blood glucose(MBG),standard deviation of blood glucose(SDBG),mean amplitude of glycemic excursions(MAGE)and mean of daily differences(MODD),and less time in range(TIR).Besides,T2 DM and ODM had higher Area of GCP.(2)Compared with GDM in the second trimester,patients in third trimester had higher levels of SDBG,MAGE,TOR,Area of GCP and lower TIR.However,there were no differences in Hb A1 c levels.Moreover,postprandial glucose excursion(PPGE)after breakfast was the highest in both two groups.Multiple linear regression analysis showed Hb A1 c was independently correlated with MBG.(3)CGM was performed during the second or third trimester.Logistic regression analysis showed large amplitude of glycemic excursions(LAGE)and MBG were independently correlated with large-for-gestational-age infant(LGA).MBG was independently correlated with premature delivery.CONCLUSIONS:(1)The mean blood glucose levels and glycemic variabilities of T2 DM and O DM in the second trimester were higher than those of GDM.(2)Compared to second trimester,GDM patients in third trimester had higher glycemic variability and less time in range.Postprandial after breakfast seemed to be the peak of the whole day.(3)LAGE and MBG were independent risk factors for LGA.Furthermore,MBG was independent risk factor for premature delivery.The glycemic variability and CGP parameters derived from CGM can comprehensively and accurately reflect glycemic profile better than Hb A1 c.