Continuous glucose monitor use with and without remote monitoring in pregnant women with type 1 diabetes: A pilot study.

BACKGROUND:To examine whether continuous glucose monitoring (CGM) with remote monitoring by followers (family/friends) changes glucose management, follower interventions, and health outcomes compared to CGM alone in pregnant women with diabetes. METHODS:We prospectively stratified first trimester pregnant women with Type 1 Diabetes to CGM Share (remote monitoring) or CGM Alone. We enrolled a main follower per woman. We retrospectively acquired data for pregnant women who did not use CGM (no CGM). We compared hemoglobin A1c (HbA1c) between groups. We compared sensor glucose, follower interventions, and gestational outcomes between CGM Alone and CGM Share. Longitudinal mixed effects models were used for analyses of changes in outcomes over time. RESULTS:HbA1c decreased in all groups throughout pregnancy and was significantly lower over time in women using CGM Share (n = 15) compared to CGM Alone (n = 13) or no CGM (n = 8) (p = 0.0042). CGM Share users had lower median sensor glucose levels (p = 0.0331) and percent time spent >180 mg/dL (p = 0.0228) across pregnancy. There were no significant differences in maternal and fetal outcomes between groups. CGM Share followers had more alerts for hypoglycemia, but did fewer interventions. CONCLUSIONS:In this small pilot study, use of CGM with remote monitoring improved some glycemic metrics in pregnant women with diabetes

Maternal and fetal outcomes^a.

Maternal and fetal outcomesa.</p

HbA1c throughout gestation.

After adjusting for preconception HbA1c, there was a significant difference in changes in HbA1c over time between groups (p = 0.0042). Bold line represents CGM Share group, dashed line represents CGM Alone group, and dotted line represents no CGM group.</p

Absolute number of follower interventions.

Fig 3A is the proportion of followers who intervened for hypoglycemia on behalf of their pregnant partners. Fig 3B is the number of mild hypoglycemic interventions performed by followers on behalf of their pregnant partners. Fig 3C is the proportion of followers who intervened for hyperglycemia on behalf of their pregnant partners. Fig 3D is the number of mild interventions for hyperglycemia performed by followers on behalf of their pregnant partners.</p

1405-P: Glycemic Variability among Pregnant Women with Type 1 Diabetes (T1D) Based on Use of CGM Share Technology

Pregnancies complicated by T1D have more glycemic variability than pregnancies associated with other kinds of diabetes. We examined whether remote monitoring of Continuous Glucose Monitoring (CGM) data by family/friends affects glycemic variability during pregnancy. Women with T1D were stratified to groups during preconception or the 1st trimester: (1) CGM Alone (n=13): women without Apple devices, or (2) CGM Share (n=15, DexCom, San Diego, CA): women with iPhone and followers with data viewing devices. Data within 12 hours of acetaminophen use were excluded. Linear mixed models were used to compare indices of glycemic variability over time between groups. A1C decreased in both groups over time and was lower in CGM Share compared to CGM Alone (p=0.0376, Table). Mean sensor glucose was lower in CGM Share than CGM Alone (p=0.0492). Times spent within targeted pregnancy ranges were not different between groups. CGM Alone had a significantly higher High Blood Glucose Index (HGBI) than CGM Share (p=0.0347). CGM Share was associated with a lower risk of hyperglycemia (as measured by HBGI) than CGM Alone among pregnant women with T1D, but other measures of glycemic variability were similar between groups. Disclosure S. Polsky: Consultant; Self; Jaeb Center for Health Research. Research Support; Self; Barbara Davis Center for Diabetes, Children's Diabetes Foundation, Dexcom, Inc., Eli Lilly and Company, JDRF, Leona &amp; Harry Helmsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi US. J.K. Snell-Bergeon: None. P. Joshee: None. J.K. Demmitt: None. R. Garcetti: None. T.B. Vigers: None. L. Pyle: None. Funding Dexcom, Inc.; National Center for Research Resources/Colorado Clinical and Translational Science Institute (UL1RR025780) </jats:sec