Poster Session 2
Annkay Alexander, MD (she/her/hers)
University of Alabama at Birmingham
Birmingham, Alabama, United States
Amber Sanders
Lincoln Memorial University DeBusk College of Osteopathic Medicine
Harrogate, Tennessee, United States
Claire A. McIlwraith, MD
Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States
Brian E. Brocato, DO
Assistant Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States
Ashley N. Battarbee, MD, MSCR
Assistant Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
For pregnant persons with type 1 diabetes (T1D) using CGM, the recommended time in target range (TIR, 63-140 mg/dL) is > 70%. However, TIR recommendations for pregnant persons with type 2 diabetes (T2D) are uncertain. Our objectives were to evaluate TIR achieved before delivery among pregnant persons with T2D and identify barriers to achieving TIR > 70%.
Study Design:
Retrospective cohort study of gravidae with T2D who used CGM and received care at a single, tertiary center (2019-2024). Timed CGM data was downloaded, and TIR in 30 days pre-delivery was calculated. Factors were compared between persons with TIR > 70% vs £ 70%. Multivariable logistic regression with backward selection identified the factors independently associated with TIR > 70%. Sensitivity analyses evaluated factors associated with TIR > 70% in 2 weeks and %TIR 30 days pre-delivery.
Results:
Of 134 pregnant persons included, the average TIR during 30 days pre-delivery was 59.5±19.2% with 43 (32%) achieving TIR > 70% pre-delivery. Of 22 sociodemographic and clinical factors, only pre-pregnancy HbA1c and baseline insulin dose differed between TIR > 70% vs £ 70% (Table 1) and were independently associated with TIR > 70% in regression models (Table 2). For every 1% increase in pre-pregnancy HbA1c, there was 26% lower odds of TIR > 70% (aOR 0.74, 95% CI 0.60-0.94). For every 10 unit increase in baseline insulin dose, there was 16% lower odds of TIR > 70% (aOR 0.84, 95% CI 0.74-0.94). These findings were unchanged in sensitivity analyses evaluating TIR > 70% in 2 weeks and %TIR in 30 days pre-delivery.
Conclusion:
In this cohort of gravidae with T2D, the average TIR in 30 days pre-delivery was 60% with only 1/3 achieving the T1D-recommendation of TIR > 70%. Barriers to achieving TIR > 70% that should be addressed include improving glycemic control before pregnancy and identifying effective interventions for gravidae with high insulin requirements. The lack of association with other factors suggests that patients may be able to achieve TIR > 70% pre-delivery despite unfavorable social determinants or later access to prenatal care and CGM.
