Effects of continuous glucose monitoring on maternal and neonatal outcomes in perinatal women with diabetes: A systematic review and meta-analysis of randomized controlled trials

doi:10.1016/j.diabres.2022.109192

Diabetes Research and Clinical Practice

Volume 184, February 2022, 109192

https://doi.org/10.1016/j.diabres.2022.109192 Get rights and content

Abstract

Aims

This systematic review aims to assess the effects of continuous glucose monitoring (CGM) on maternal and neonatal outcomes in perinatal women with diabetes.

Methods

A three-step comprehensive search was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Randomized controlled trials (RCTs) were retrieved from international databases of PubMed, Embase, Cochrane Library, CINAHL, PsycINFO and Scopus from their respective inception dates until 5th January 2021. Comprehensive Meta-Analysis Software Version 3 was used. The overall effect was determined using Hedges’ g. Cochrane collaboration’s tool version 1 and grading of recommendations, assessment, development and evaluation criteria were used for quality assessment.

Results

A total of 1215 records were identified and 10 RCTs involving a total of 1358 perinatal women were selected. The meta-analysis revealed that CGM significantly improved HbA1c levels (g = −0.43, 95% CI: −0.63, −0.22), lowered cesarean section rate (g = −0.17, 95% CI: −0.33, −0.02) and neonatal birth weight (g = −0.16, 95% CI: −0.27, −0.04) when compared to the comparator. The majority (86.67%) has a low risk of biases and certainty of evidence ranged from very low to moderate.

Conclusion

CGM improves maternal and neonatal outcomes. Future studies should use well-designed large-scale trials.

Section snippets

Background

Diabetes mellitus (DM) in pregnancy remains the most common antenatal complication. It can be categorized into pregestational diabetes (T1DM or T2DM) [1] and gestational diabetes mellitus (GDM) [2]. The prevalence of T1DM or T2DM ranges from 2.5 to 2.7%, whereas that of GDM ranges from 4.6 to 8.0% [3]. Notably, worldwide incidence is on a rising trend [4]. Pregnant women with poor glycemic control have a higher risk of preeclampsia, preterm delivery and birth trauma, whereas fetuses exposed to

Design and protocol registration

In this review, identification and screening of the literature was conducted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) [27]. The PRISMA checklist is presented in Supplementary Table S1. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO number: BLINDED).

Study selection and eligibility criteria

The eligibility criteria were formulated based on the population, intervention, comparison and outcomes (PICO)

Study selection

The PRISMA flow diagram (Fig. 1) shows the selection process. The initial search retrieved a total of 1217 studies. These records were imported into Endnote software and 339 records were curated to remove duplicates. Subsequently, 878 articles were screened and a total of 711 records were excluded based on the title, 116 records based on the analysis of abstracts and 8 records due to the unavailability of the full text. The remaining 43 full texts were downloaded and assessed based on

Summary of evidence

Our review involved 10 RCTs with a total of 1358 perinatal women with DM across 13 countries. The meta-analyses revealed that CGM significantly reduced maternal HbA1c levels, cesarean section rate and neonatal birth weight among pregnant women with diabetes, when compared to comparator. Our subgroup analyses highlighted that a retrospective approach to CGM was more effective on HbA1c than a real-time approach. Random-effects meta-regression indicated CGM’s effectiveness on neonatal birth weight

Conclusion

Our review supports the use of CGM as a beneficial and effective intervention to reduce maternal HbA1c, neonatal birth weight and incidence of cesarean section. However, CGM has no significant impact on maternal weight gain, macrosomia and neonatal hypoglycemia. Such evidence added value to the existing ones. Larger samples, longer assessment period and detailed description of CGM are needed to reaffirm the effects of CGM on maternal and neonatal outcomes among perinatal women.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors thank Dr. Jennie Wong from the Research Support Unit, National University Health System Singapore, for the assistance in the preparation of this manuscript.

Funding

None.

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Cited by (7)

Glycemic variability in diagnosis of gestational diabetes as predictor of pharmacological treatment
2024, Endocrinologia, Diabetes y Nutricion
Establecer si determinados parámetros de variabilidad glucémica (VG) al diagnóstico de diabetes mellitus gestacional (DMG) podrían ayudar a predecir la probabilidad de precisar tratamiento farmacológico y analizar su relación con el desarrollo de complicaciones materno-fetales.
Estudio prospectivo en 87 mujeres con DMG a las que se realizó una monitorización continua de glucosa (MCG) retrospectiva entre las semanas 26 y 32 de gestación durante 6 días, tras el diagnóstico. Se analizan glucemia media y parámetros de VG y su asociación con complicaciones materno-fetales y necesidad de tratamiento farmacológico. Se elaboran curvas ROC para estimar la validez para detectar la necesidad de tratamiento farmacológico.
Las pacientes con glucemia media más elevada (p < 0,001) y solapamiento continuo de la acción de la glucosa en un periodo de n horas (CONGA) (p = 0,001) precisaron tratamiento farmacológico. A partir de las curvas ROC se obtuvieron los puntos de corte de 98,81 mg/dl para glucemia media y de 86,70 mg/dl para CONGA, con una sensibilidad del 83,3% y una especificidad del 67,8% para ambos parámetros. No se observó una relación entre los distintos parámetros de VG y el desarrollo de complicaciones materno-fetales.
El uso de la MCG al diagnóstico de la DMG permite identificar a aquellas pacientes que se beneficiarían de una vigilancia más estrecha durante la gestación, lo que facilita el inicio de un tratamiento farmacológico precoz. No obstante, son necesarios estudios prospectivos con un mayor número de pacientes y que evalúen los costes asociados para poder recomendar el uso de la MCG tras el diagnóstico de DMG.
To establish whether glycemic variability (GV) parameters used when gestational diabetes mellitus (GDM) has been diagnosed could help predict the probability that a patient will need pharmacological treatment, and to analyze the link of these parameters to the development of maternal-fetal complications.
A prospective study of 87 women with GDM who underwent retrospective continuous glucose monitoring (CGM) for 6 days between weeks 26 and 32 of gestation, following diagnosis. The mean glycemia levels and GV variables were analyzed together with their link to maternal-fetal complications, and the need for pharmacological treatment. ROC (receiver operating characteristic) curves were developed to determine validity to detect the need for pharmacological treatment.
Patients with higher mean glycemia (P < 0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (P = 0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81 mg/dl for mean glycemia, and 86.70 mg/dl for CONGAn, with 83.3% sensitivity and 67.8% specificity for both parameters. No relation between the GV parameters and development of maternal-fetal complications was observed.
The use of CGM, once GDM is diagnosed, enables us to identify those patients who would benefit from closer monitoring during gestation, and facilitate a speedier take-up of pharmacological treatment. However, prospective studies involving a higher number of patients are needed, as well as a cost assessment for recommending the use of CGM following GDM diagnosis.
Continuous glucose monitor use in type 2 diabetes mellitus in pregnancy and perinatal outcomes: a systematic review and meta-analysis
2023, American Journal of Obstetrics and Gynecology MFM
This study aimed to assess whether continuous glucose monitor use in type 2 diabetes mellitus in pregnancy is associated with improved perinatal outcomes.
We searched Ovid MEDLINE, Scopus, ClinicalTrials.gov, and Cochrane library from inception through May 9, 2022.
We included all studies that compared continuous glucose monitor use with fingerstick glucose monitoring in women with type 2 diabetes mellitus.
The initial search yielded 2463 unique citations that were screened in Covidence by 2 independent reviewers. Study types included randomized controlled trials, cohort studies, and cross-sectional studies. Our outcomes of interest were macrosomia or large-for-gestational-age infants, hemoglobin A1c, cesarean delivery, hypertensive disorders of pregnancy including preeclampsia, gestational age at delivery, and neonatal hypoglycemia.
Three randomized controlled trials met the inclusion criteria. We performed random-effects meta-analyses of estimates from 2 studies without risk of significant bias and reported summary adjusted odds ratios and 95% confidence intervals. Meta-analysis of 56 women with continuous glucose monitor use and 53 control women without continuous glucose monitor use showed that there was no difference in the incidence of large-for-gestational-age infants between continuous glucose monitor users and standard-of-care controls (odds ratio, 0.78; 95% confidence interval, 0.34–1.78) with an I² of 0%. In addition, there was no difference in the development of preeclampsia between continuous glucose monitor users and standard-of-care controls (odds ratio, 1.63; 95% confidence interval, 0.34–7.22) with an I² of 0%.
Continuous glucose monitor use was not associated with improved perinatal outcomes as assessed by large-for-gestational-age infants and preeclampsia. This review is limited by the small amount of data available for this population, and further research is needed.
Asia-Pacific consensus recommendations for application of continuous glucose monitoring in diabetes management
2023, Diabetes Research and Clinical Practice
Glucose monitoring has evolved from self-monitoring of blood glucose to glycated hemoglobin, and the latest continuous glucose monitoring (CGM). A key challenge to adoption of CGM for management of diabetes in Asia is the lack of regional CGM recommendations. Hence, thirteen diabetes-specialists from eight Asia-Pacific (APAC) countries/regions convened to formulate evidence-based, APAC-specific CGM recommendations for individuals with diabetes. We defined CGM metrics/targets and developed 13 guiding-statements on use of CGM in: (1) people with diabetes on intensive insulin therapy, and (2) people with type 2 diabetes on basal insulin with/without glucose lowering drugs. Continual use of CGM is recommended in individuals with diabetes on intensive insulin therapy and suboptimal glycemic control, or at high risk of problematic hypoglycemia. Continual/intermittent CGM may also be considered in individuals with type 2 diabetes on basal insulin regimen and with suboptimal glycemic control. In this paper, we provided guidance for optimizing CGM in special populations/situations, including elderly, pregnancy, Ramadan-fasting, newly diagnosed type 1 diabetes, and comorbid renal disease. Statements on remote CGM, and stepwise interpretation of CGM data were also developed. Two Delphi surveys were conducted to rate the agreement on statements. The current APAC-specific CGM recommendations provide useful guidance for optimizing use of CGM in the region.
Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?
2024, Diabetes, Obesity and Metabolism
Practical Application of Continuous Glucose Monitoring in Clinical Practice: Case Studies
2023, Diabetes Technology and Therapeutics
Multigenerational diabetes mellitus
2023, Frontiers in Endocrinology

View all citing articles on Scopus

View full text

Effects of continuous glucose monitoring on maternal and neonatal outcomes in perinatal women with diabetes: A systematic review and meta-analysis of randomized controlled trials

Abstract

Aims

Methods

Results

Conclusion

Section snippets

Background

Design and protocol registration

Study selection and eligibility criteria

Study selection

Summary of evidence

Conclusion

Declaration of Competing Interest

Acknowledgements

Funding

Int J Gynecol Obstet

Clin Psychol Rev

Diab Res Clin Pract

Lancet

Clin Epidemiol Glob Health

Am J Orthod Dentofacial Orthop

Diab Res Clin Pract

Lancet

J Diab Complicat

Lance

Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care

Diab Care

Gestational diabetes mellitus: risks and management during and after pregnancy

Nat Rev Endocrinol

Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes

Diab Med

Diabetes and pregnancy: national trends over a 15 year period

Diabetologia

Management of preexisting diabetes in pregnancy: a review

JAMA

The fetal and maternal consequences of gestational diabetes mellitus

J Mertern Fetal Neonatal Med

Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective

Curr Diab Rep

Type 2 diabetes after gestational diabetes: the influence of changing diagnostic criteria

World J Diab

Role of continuous glucose monitoring in the management of diabetic pregnancy

Curr Diab Rep

Systematic review and meta-analysis of the effectiveness of continuous glucose monitoring (CGM) on glucose control in diabetes

Diabetol Metab Syndr

Utility of real-time and retrospective continuous glucose monitoring in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

J Diab Res

Continuous real-time glucose monitoring systems: time for a closer look

Pract Diab Int

The efficacy and effectiveness of continuous glucose monitoring during pregnancy: a systematic review

Obstet Gynecol Surv

Application and utility of continuous glucose monitoring in pregnancy: a systematic review

Front Endocrinol

Continuous glucose monitoring in non–insulin-using individuals with Type 2 diabetes: acceptability, feasibility, and teaching opportunities

Diab Technol Ther

Illness cognition: using common sense to understand treatment adherence and affect cognition interactions

Cognit Ther Res

A meta-analytic review of the common-sense model of illness representations

Psychol Health

A cybernetic model of self-attention processes

J Pers Soc Psychol

Effective techniques in healthy eating and physical activity interventions: a meta-regression

Health Psychol

Efficacy of continuous glucose monitoring in improving glycemic control and reducing hypoglycemia: a systematic review and meta-analysis of randomized trials

J Diab Sci Technol

Continuous glucose monitoring versus self-monitoring of blood glucose in type 2 diabetes mellitus: a systematic review with meta-analysis

Curēus

Effects of real-time continuous glucose monitoring in type 1 diabetes: a meta-analysis of randomized controlled trials

Acta Diabetol