(608) Continuous glucose monitor time in range: Maternal outcomes amongst pregnant patients with T2DM & GDM

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Presenting Author(s)

Yara Hage Diab, MD

Research Fellow/Resident physician
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States

Coauthor(s)

Lauren A. Forbes, MD, MPH (she/her/hers)

Resident Physician
Eastern Virginia Medical School
Norfolk, Virginia, United States
EK

Erkan Kalafat, MD, MSc

Associate Professor
Koc University Hospital
Istanbul, Istanbul, Turkey
TC

Theresa Corbine

Advanced Practitioner
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
MM

Margaret Mlynarczyk, MD, PhD

Associate Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
MM

Marwan Ma'Ayeh, MD

Assistant Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
George R. Saade, MD (he/him/his)

Professor and Chair, Associate Dean for Women's Health Obstetrics and Gynecology
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States

Submitting Author(s)

Rebecca Horgan, MD

Assistant Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, VA, United States

Objective: The Advanced Technologies & Treatments for Diabetes consensus group recommends target time in range (TIR) with a continuous glucose monitor (CGM) of 70% for pregnant patients with type 1 diabetes but concluded that there is inadequate evidence to recommend target TIR for type 2 diabetes (T2DM) or gestational diabetes (GDM). Our objective was to determine the impact of TIR categories on maternal outcomes amongst pregnant patients with T2DM and GDM.

Study Design: This retrospective cohort study included pregnant patients with T2DM or GDM using CGM for at least 30 days at our tertiary center from January 2020 to December 2022. Exclusion criteria were type 1 diabetes, multiple gestation, and unavailable delivery records. Target range for glucose on CGM was 63-140 mg/dL. Mean TIR for duration of CGM use during pregnancy was recorded. Primary outcome was maternal adverse events defined as having a cesarean delivery, postpartum hemorrhage or developing a hypertensive disorder of pregnancy. Maternal outcome in TIR groups were compared with Fisher’s Exact test and logistic regression.

Results: 71 patients were included, of whom 48 and 23 had a mean TIR ≥70% and < 70%, respectively. Patients with mean TIR ≥70% had lower rates of cesarean delivery (56.2% vs. 78.3%, P=0.12), postpartum hemorrhage (14.6% vs. 21.7%, P=0.68) and hypertensive disorders of pregnancy (35.4% vs. 47.8%, P=0.46) but the differences did not reach statistical significance (Figure 1). Patients with mean TIR ≥70% had a reduced odds of composite maternal outcome after adjusting for maternal BMI and diabetes type (adjusted OR: 0.40, 95% CI: 0.10-1.37, P=0.166), but again the difference did not reach statistical significance.

Conclusion: All indicators trend towards better outcomes in pregnant patients with T2DM or GDM with mean TIR ≥70% on CGM compared with those with mean TIR < 70%. However, a larger sample size may be needed to statistically confirm this difference.