Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Objective:

The use of continuous glucose monitors (CGM) for management of Type 1 diabetes mellitus (T1DM) is increasing in pregnancy. We aim to describe the concordance of point-of-care glucose (POC) and CGM in gravidas presenting for delivery with T1DM.

Study Design:

This was a retrospective study of T1DM patients with Dexcom CGM use intrapartum and postpartum between 2016-2020. Data from POC and CGM was compared from admission for delivery until discharge(Figure 1).  Patients were excluded if POC or CGM data were unavailable. POC data and outcomes were obtained from the electronic medical record. CGM data was obtained from Clarity report. The primary outcome was the mean absolute relative difference (MARD) between the CGM and POC glucose values.

Results:

15 pregnancies (14 patients) were included (Table 1). The mean age at diagnosis of T1DM was 14.7 ± 5.3 years and the mean first trimester hemoglobin A1c was 7.1 ± 1.1%.  The average first neonatal glucose was 47.6 ± 12.7 mg/dL. Seven infants (46.7%) required admission to the neonatal intensive care unit and 5 (33.3) required dextrose infusion for treatment of hypoglycemia. 17,392 CGM values were compared to 583 POC values. The mean glucose value on POC versus CGM before delivery was 123.2 mg/dL vs. 118.1 mg/dL, respectively, and 134.5 mg/dL vs. 134.8 mg/dL postpartum (Table 2). There was a high degree of accuracy between the CGM and POC glucose values with a MARD of 11.49% and 98% of points in zones A and B of the Clarke Error Grid (Figure 2).

Conclusion:

To our knowledge this is the first study to describe the MARD between Dexcom CGM and POC glucose values in the intrapartum and postpartum period. CGM devices may be useful for glycemic monitoring during the intrapartum and postpartum period. Larger studies are needed to validate our results.

Table 1. Maternal characteristics and select outcomes.

Continuous variables are reported as mean ± standard deviation. Categorical variables are reported as N(%). BMI: body mass index, Hb A1c: hemoglobin A1c.