Emerging treatments

Continuous glucose monitoring

Continuous glucose monitoring (CGM) enables determination of peak post-prandial glucose levels, mean glucose level, episodes of nocturnal hуреrglyϲaеmiа, and percent time in range (TIR) for a 24-hour period. It is widely recommended for pregnancies complicated by type 1 diabetes due to compelling data showing that even 4% to 7% improvements in TIR can result in an approximate 50% decrease in large for gestational age infants and neonatal intensive care unit (NICU) admissions.[3][108]​​​ CONCEPTT, a multicentre international randomised controlled trial, concluded that CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy.[108] Accordingly, the UK National Institute for Health and Care Excellence recommends offering CGM to all pregnant women with type 1 diabetes.​​​[4] The data for type 2 diabetes and gestational diabetes mellitus (GDM) are more limited and conflicting and not sufficient to recommend TIR or mean glucose targets specific to these conditions.[109][110][111]​​​​ The American Diabetes Association (ADA) notes that CGM can help to achieve haemoglobin A1c (HbA1c) targets in women with GDM when used in addition to pre- and post-prandial blood glucose monitoring. However, it concludes that data are insufficient to recommend CGM for all patients with GDM, and the decision to use CGM in these populations should be individualised.[3] Research among women with GDM found that mothers who went on to deliver large-for-gestational-age (LGA) infants had higher overnight glucose levels during pregnancy compared with mothers without LGA infants, suggesting that detecting and addressing nocturnal glucose control may help to reduce rates of LGA infants in women with GDM. However, the study was unable to conclude whether CGM used throughout pregnancy reduces the risk of delivering a LGA infant.[112] One systematic review found evidence to suggest CGM is superior to self-monitoring of blood glucose among women with GDM in terms of detecting hypoglycaemic and hyperglycaemic episodes, which might result in an improvement of maternal and fetal outcomes.[113] Larger sample sizes and complete pregnancy coverage is needed to determine the effectiveness of CGM in GDM. 

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