From the Guidelines
There is currently insufficient evidence to support the routine use of continuous glucose monitoring (CGM) for gestational diabetes mellitus (GDM) to help monitor blood sugar trends, as stated in the most recent study 1. The use of CGM in pregnancy is mainly supported for type 1 diabetes, with studies such as CONCEPTT demonstrating its value in improving maternal and neonatal outcomes 1. However, for GDM, the decision to use CGM should be individualized based on treatment regimen, circumstances, preferences, and needs, as there are insufficient data to support its routine use in this population 1. Some key points to consider when using CGM in pregnancy include:
- CGM devices can provide real-time glucose readings every 5-15 minutes, offering more comprehensive data than traditional fingerstick testing.
- CGM can help identify post-meal glucose spikes and overnight patterns that might be missed with standard testing.
- Patients should still perform occasional fingerstick tests for calibration and verification, especially when making treatment decisions.
- The benefits of CGM include immediate feedback on how food, activity, and stress affect glucose levels, potentially reducing the risk of macrosomia and other GDM complications.
- Insurance coverage for CGM in GDM varies, and patients should discuss with their healthcare provider whether this monitoring approach is appropriate for their specific situation and how to interpret the additional data effectively. It is essential to weigh the potential benefits of CGM against the lack of strong evidence supporting its use in GDM and consider individual patient factors when making decisions about its use 1.
From the Research
Evidence for Continuous Glucose Monitoring in Gestational Diabetes
- There is evidence to suggest that continuous glucose monitoring (CGM) can be used to help monitor sugar trends in gestational diabetes, with studies showing its potential to improve glycemic outcomes and reduce pregnancy complications 2, 3, 4, 5.
- CGM has been shown to detect patterns of hyperglycemia at different times of the day, which can help predict the development of maternal-fetal complications and the need for pharmacological treatment 3.
- A study comparing CGM with self-monitoring of blood glucose in the treatment of gestational diabetes mellitus found that CGM detected a higher proportion of patients needing antihyperglycemic medication 5.
- The use of CGM in gestational diabetes has been associated with a reduced incidence of maternal and neonatal complications, although more research is needed to fully understand its benefits and challenges 2, 4.
Key Findings
- CGM can identify patients with gestational diabetes who would benefit from closer monitoring and early pharmacological treatment 3.
- The technology can detect hyperglycemia patterns before meals, after meals, and overnight, which can inform treatment decisions 3.
- CGM has been shown to reduce the risk of hypoglycemia and hyperglycemia, and improve patient quality of life 6.
- The use of CGM in gestational diabetes is becoming more widespread, with expanding insurance coverage and FDA approval 2.
Study Limitations
- Some studies have limited data on the role of CGM in improving pregnancy outcomes in patients with gestational diabetes 2.
- Further large-scale studies are needed to evaluate the effectiveness of CGM-guided initiation of antihyperglycemic therapy in reducing macrosomia and perinatal complications related to gestational diabetes 5.