Dessi P. Zaharieva, Canada
York University Kinesiology & Health SciencePresenter of 1 Presentation
ASSESSMENT OF GLYCAEMIA BY FINGERSTICK BLOOD GLUCOSE MONITORING MAY UNDERESTIMATE THE REQUIREMENT FOR INSULIN TO ADDRESS ELEVATED NOCTURNAL GLUCOSE LEVELS IN WOMEN WITH GDM
Abstract
Background and Aims
The commencement of insulin in women diagnosed with GDM is determined by health-care professional’s (HCP) perception of the patient’s glycaemia based on self-monitoring blood glucose (SMBG) and HbA1c. Macrosomia occurs in GDM patients despite optimal care. One reason may be that SMBG fails to correctly identify all patients requiring insulin.
Methods
We studied women attending two obstetric centres post-OGTT diagnosis of GDM. Within 2-weeks of GDM diagnosis, participants were provided dietary advice, taught SMBG, and 7-day CGM was initiated before insulin introduction with data masked to HCP and patients.
Results
Ninety women, mean age±SD 31±4 years; gestation 27±1 weeks were studied. Fasting OGTT glucose (5.2 vs 4.8mM; P=0.0004) and mean CGM glucose (5.7 vs 5.3mM; P<0.0001) was higher in those prescribed insulin (n=34). Figure 1 provides CGM profiles (median and IQR) and time >5.0mM overnight (0:00-03:00 and 03:00-06:00) and >6.5mM during the daytime. During the daytime, mean±SD time spent >6.5mM was 212±135 vs 123±98min for insulin prescribed vs non-insulin prescribed patients, respectively. Overnight (0:00-03:00 and 03:00-06:00) mean±SD time >5.0mM was 133±31 vs 96±29min and 118±42 vs 70±53min for insulin prescribed vs non-insulin prescribed patients. HCP time correlated with prescription of insulin (185 vs 108min in insulin vs non-insulin prescribed GDM; P=0.0001) but not with CGM and OGTT parameters.
Conclusions
More than 50% of women diagnosed with GDM not subsequently prescribed insulin during pregnancy had glucose levels above 5.0mM for >10% time between 0:00-03:00. CGM may facilitate triage of patients and an effective intervention by providing a better assessment of nocturnal hyperglycaemia vs SMBG.
