Continuous Glucose Monitoring Time-in-Range and HbA 1c Targets in Pregnant Women with Type 1 Diabetes

著者: Diana Tundidor, Claire L. Meek, Jennifer M. Yamamoto, Cecília Martínez-Brú, Ignasi Gich, Denice S. Feig, Helen Murphy, Rosa Corcoy, On Behalf of the CONCEPTT Collaborative Group, Helen Murphy, Jeannie Grisoni, Carolyn Byrne, Sandra Neoh, Katy Davenport, Lois Donovan, Claire Gougeon, Carolyn Oldford, Catherine A. Young, Stephanie A. Amiel, Katharine F. Hunt, Louisa Green, Helen Rogers, Benedetta Rossi, Denice S. Feig, Barbara Cleave, Michelle Strom, Alberto de Leiva, Juan M. Adelantado, Ana Chico, Erin Keely, Janine Malcolm, Kathy Henry, Damian Morris, Gerry Rayman, Duncan Fowler, Susan L. Mitchell, Josephine Rosier, Rosemary Temple, Jeremy Turner, Gioia Canciani, Niranjala Hewapathirana, Leanne Piper, Ruth McManus, Anne Kudirka, Margaret Watson, Matteo Bonomo, Basilio Pintaudi, Federico Bertuzzi, Giuseppina Daniela Corica, Elena Mion, Julia Lowe, Ilana Halperin, Anna Rogowsky, Sapida Adib, Robert S. Lindsay, David Carty, Isobel Crawford, Fiona Mackenzie, Therese McSorley, John N. Booth, Natalia McInnes, Ada Smith, Irene Stanton, Tracy Tazzeo, John Weisnagel, Peter Mansell, Nia Jones, Gayna Babington, Dawn Spick, Malcolm MacDougall, Sharon Chilton, Terri Cutts, Michelle Perkins, Eleanor Scott, Del Endersby, Anna R. Dover, Frances Dougherty, Susan Johnston, Simon Heller, Peter Novodorsky, Sue Hudson, Chloe Nisbet, Thomas Ransom, Jillian Coolen, Darlene Baxendale, Richard I. G. Holt, Jane Forbes, Nicki Martin, Fiona Walbridge, Fidelma Dunne, Sharon Conway, Aoife M. Egan, Collette Kirwin, Michael Maresh, Gretta Kearney, Juliet Morris, Susan J. Quinn, Rudy Bilous, Rasha Mukhtar, Ariane Godbout, Sylvie Daigle, Alexandra Lubina Solomon, Margaret Jackson, Emma Paul, Julie Taylor, Robyn L. Houlden, Adriana Breen, Anita Banerjee, Anna Brackenridge, Annette Briley, Anna Reid, Claire Singh, Jill Newstead Angel, J. Baxter, Sam Philip, Martyna Chlost, Lynne Murray, Kristin Castorino, Lois Jovanovič, Donna Frase, Sonya Mergler, Kathryn Mangoff, Johanna Sanchez, Gail Klein, Katrina J. Ruedy, Craig Kollman, Olivia Lou, Marlon Pragnell - Diabetes Technology & Therapeutics 2021 被引用: 50

The CONCEPTT trial compared real-time Continuous Glucose Monitoring (RT-CGM) to capillary glucose monitoring in pregnant women with type 1 diabetes. We analyzed CGM and glycated hemoglobin (HbA 1c ) measures in first ( n = 221), second ( n = 197), and third ( n = 172) trimesters, aiming to examine target glucose attainment and associations with pregnancy outcomes. CGM targets were Time-in-range (TIR) > 70%, Time-above-range (TAR) <25%, and Time-below-range (TBR) < 4%, and HbA 1c targets < 6.5% (National Institute for Health and Care Excellence [NICE]) and HbA 1c < 6.0% in second and third trimesters (American Diabetes Association [ADA]). TIR/TAR/TBR targets were achieved by 7.7/14.5/30.3% participants in first, 10.2/14.2/52.8% in second, and 35.5/37.2/52.9% in third trimesters. CGM target attainment was low but increased during pregnancy and with RT-CGM use. In the adjusted analyses, achieving TBR target was associated with a higher risk of pre-eclampsia and neonatal hypoglycemia. ADA HbA 1c target attainment was low and unchanged during pregnancy (23.5/27.9/23.8%) but increased with RT-CGM use. In the adjusted analyses, HbA 1c target attainment was associated with a lower risk of preterm birth, large-for-gestational age and neonatal hypoglycemia. We conclude that CONCEPTT trial participants had a low rate of CGM and of HbA 1c target attainment. Attainment of CGM and NICE HbA 1c targets increased throughout gestation and all targets (both NICE/ADA HbA 1c and CGM) were more likely to be achieved by RT-CGM users, at 34 weeks' gestation. ADA HbA 1c target achievement was independently associated with better perinatal outcomes, while the independent association of TBR target achievement with increased risk warrants further study. ClinicalTrials.gov Registration Identifier NCT01788527.