Gestational Diabetes Clinical Trial
Official title:
Glucose Fluctuations During Gestation: an Additional Tool for a Better Monitoring of Pregnancy Complicated by Diabetes
Continuous glucose monitoring (CGM) methods provide details of magnitude and duration of glucose fluctuations, giving a unique insight on daily blood sugar control. Limited data are available on glucose variability (GV) in pregnancy. The aim of this study was to assess GV in normal pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM), and its possible association with HbA1c.
Recent evidence in the literature suggests that glucose variability, characterized by
extreme glucose excursions, may overlap with HbA1c levels in determining the risk of
diabetes-related complications. Fluctuating blood glucose levels prompt an increase in free
radicals and endothelial dysfunction, which are the links between hyperglycemia and the
activation of pathological pathways that lead to tissue damage. Reece and Homko postulated
an association between maternal hyperglycemia-induced oxygen free radical overproduction and
fetal abnormalities, with the onset of diabetes-related embryopathy.Numerous studies have
demonstrated that macrosomia and congenital malformations relate to glycemic control. In one
study, 48-hour continuous glucose monitoring (CGM) of diurnal glucose profiles in pregnant
women with type 1 diabetes was more sensitive than HbA1c alone in identifying an increased
risk of offspring with congenital malformations. Such studies give the impression that
transient hyperglycemic spikes in pregnant patients with diabetes can cause a high incidence
of fetal overweight, regardless of whether or not the mother has chronic hyperglycemia.
Glucose variability is still a factor that has been inadequately studied in pregnancies
complicated by diabetes, and little is known about its relationship with maternal-fetal
outcomes.A number of studies have demonstrated the utility of CGM for monitoring diabetes in
pregnancy , but none have focused the attention on the importance of glucose fluctuations
during gestation. Meanwhile, there has been a rapid increase in the number of new glucose
variability indicators considered, although none of them seems to be definitively reliable.
A better understanding of the pattern of blood glucose fluctuations in all the three
trimesters of pregnancy, could help us to optimize glycemic control in pregnant women with
diabetes.
The aim of this study was therefore to assess glucose variability throughout the three
trimesters of pregnancy in healthy women and in cases of type 1 diabetes mellitus or
gestational diabetes, identifying the more representative and useful indicators of glucose
fluctuations, to provide more accurate clinical informations along with HbA1c and beyond.
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Observational Model: Cohort, Time Perspective: Retrospective
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