EXPRESS: Monitoring Motherhood: monitoring and optimising glycaemia in women with pre-existing diabetes in pregnancy

2021 ◽  
pp. 000456322110358
Author(s):  
Claire L Meek
Keyword(s):  
Glycaemic Control ◽  
Continuous Glucose Monitoring ◽  
Multiple Pregnancy ◽  
Glucose Monitoring ◽  
Insulin Dosage ◽  
Diabetes In Pregnancy ◽  
Short Term ◽  
Increased Risk ◽  
Mother And Child ◽  
In Pregnancy

Despite recent advances in care, women with diabetes in pregnancy are still at increased risk of multiple pregnancy complications. Offspring exposed to hyperglycaemia in utero also experience long-term health sequelae affecting neurocognitive and cardiometabolic status. Many of these adverse consequences can be prevented or ameliorated with good medical care, specifically to optimise glycaemic control. The accurate assessment of glycaemia in pregnancy is therefore vital to safeguard the health of mother and child. However, there is no consensus about the best method of monitoring glycaemic control in pregnancy. Short-term changes in insulin dosage and lifestyle, with altered appetite, insulin sensitivity and red cell turnover create difficulties in interpretation of standard laboratory measures such as HbA1c. The ideal marker would provide short-term feedback on daily or weekly glycaemic control, with additional capability to predict pregnancies at high risk of suboptimal outcomes. Several novel biochemical markers are available which allow assessment of dynamic changes in glycaemia over weeks rather than months. Continuous glucose monitoring devices have advanced in accuracy and provide new opportunities for robust assessment of glycaemia in pregnancy. Recent work from the continuous glucose monitoring in pregnant women with type 1 diabetes trial (CONCEPTT) has provided information about the ability of different markers of glycaemia to predict pregnancy outcomes. The aim of this review is to summarise the care for women with pre-existing diabetes in pregnancy, and to highlight the important role of glycaemic monitoring in pregnancy.

The role of continuous glucose monitoring in pregnancy

2021 ◽  
pp. 1753495X2110147
Author(s):  
Adrian Li ◽  
Anna Brackenridge
Keyword(s):  
Continuous Glucose Monitoring ◽  
Congenital Anomalies ◽  
Glucose Monitoring ◽  
Review Article ◽  
Diabetes In Pregnancy ◽  
Current Guidance ◽  
In Pregnancy

The risks associated with diabetes in pregnancy include congenital anomalies, stillbirth and miscarriage, and correlate with glycaemia. The optimisation of diabetes during pregnancy is therefore both challenging and essential. Technology has revolutionised how clinicians and patients manage diabetes. This review article focuses on the role of continuous glucose monitoring (CGM) in pregnancy, assessing the evidence available and providing an update on current guidance.

scholarly journals Role of continuous subcutaneous glucose monitoring in intensive care

2013 ◽  
Vol 154 (27) ◽  
pp. 1043-1048 ◽  
Author(s):  
Gábor Marics ◽  
Levente Koncz ◽  
Anna Körner ◽  
Borbála Mikos ◽  
Péter Tóth-Heyn
Keyword(s):  
Intensive Care ◽  
Glycaemic Control ◽  
Intensive Care Units ◽  
Continuous Glucose Monitoring ◽  
Pediatric Population ◽  
Glucose Monitoring ◽  
Tissue Perfusion ◽  
Close Monitoring ◽  
Beneficial Effects ◽  
Increased Risk

Critical care associated with stress hyperglycaemia has gained a new view in the last decade since the demonstration of the beneficial effects of strong glycaemic control on the mortality in intensive care units. Strong glycaemic control may, however, induce hypoglycaemia, resulting in increased mortality, too. Pediatric population has an increased risk of hypoglycaemia because of the developing central nervous system. In this view there is a strong need for close monitoring of glucose levels in intensive care units. The subcutaneous continuous glucose monitoring developed for diabetes care is an alternative for this purpose instead of regular blood glucose measurements. It is important to know the limitations of subcutaneous continuous glucose monitoring in intensive care. Decreased tissue perfusion may disturb the results of subcutaneous continuous glucose monitoring, because the measurement occurs in interstitial fluid. The routine use of subcutaneous continuous glucose monitoring in intensive care units is not recommended yet until sufficient data on the reliability of the system are available. The Medtronic subcutaneous continuous glucose monitoring system is evaluated in the review partly based on the authors own results. Orv. Hetil., 2013, 154, 1043–1048.

scholarly journals Use of new technologies in pregnancy

2019 ◽  
Vol 22 (3) ◽  
pp. 146
Author(s):  
Ragusa, I.
Keyword(s):  
Continuous Glucose Monitoring ◽  
Glucose Control ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
New Technologies ◽  
Glucose Monitoring ◽  
Subcutaneous Insulin ◽  
Diabetes In Pregnancy ◽  
Fetal Outcomes ◽  
In Pregnancy

Diabetes in pregnancy is associated with an increased risk of maternal and neonatal complications. Several trials have showed that adequate pregnancy planning and optimal glucose control are essential to reduce the risk of fetal malformations and to improve maternal-fetal outcomes. In clinical practice it’s hard to reach an optimal glucose control in pregnancy. Thus, the new technologies designed to assist patient with diabetes (Continuous subcutaneous insulin infusion and/or Continuous Glucose Monitoring) are widely used during pregnancy planning and management. This article discusses the use of new technologies in the management of diabetes during pregnancy and their effects on glicemic control and maternal-fetal outcomes KEY WORDS diabetes in pregnancy; continuous subcutaneous insulin infusion; continuous glucose monitoring; efficacy; safety

Use of Continuous Glucose Monitoring Can Address Patient Fears and Facilitate Improved Glycaemic Management

2010 ◽  
Vol 7 (2) ◽  
pp. 88
Author(s):  
Jeff Unger ◽  
Chris Parkin ◽  
◽  
Keyword(s):  
Glycaemic Control ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Monitoring Strategies ◽  
Increased Risk ◽  
Patients At Risk ◽  
Intensively Managed ◽  
Chronic Hyperglycaemia

Effective diabetes management can delay or prevent many of the complications of diabetes. Achieving optimal glycaemic control, however, often requires intensive insulin treatment, which is associated with an increased risk of severe hypoglycaemia. Many intensively managed patients are reluctant to follow and/or adjust their insulin regimens as needed because of fear of hypoglycaemia. This lack of adherence can result in exposure to chronic hyperglycaemia, oxidative stress and long-term complications. Severe hypoglycaemia can be prevented through vigilance in identifying patients at risk, using appropriate medications and medication regimens, and effective glucose monitoring strategies and technologies. This article reviews some evidence relevant to hypoglycaemia in intensively managed patients and discusses how tools such as continuous glucose monitoring (CGM) can help patients overcome their fear of hypoglycaemia and safely achieve optimal glycaemic control.

Clinical Experience of Continuous Glucose Monitoring in Pregnancy

2021 ◽  
pp. 193229682110246
Author(s):  
Grenye O’Malley ◽  
Barak Rosenn ◽  
Emily V. Nosova ◽  
Yogish C. Kudva ◽  
Sophia Scarpelli Shchur ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
In Pregnancy
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