CGM reveals nighttime hyperglycemia in gestational diabetes
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Gestational diabetes mellitus (GDM) management using self-monitoring blood glucose (SMBG) does not normalize pregnancy outcomes.

Researchers aimed to conduct an observational study to explore if continuous glucose monitoring (CGM) could identify elevated glucose levels not apparent in women with GDM managed using SMBG.

A 7-day masked-CGM was performed within 2 weeks of GDM diagnosis, immediately post-GDM education, but before insulin commencement as determined by SMBG. CGM data regarding hyperglycemia, time with health care professionals, treatment, and pregnancy outcome were collected. Comparisons (Mann–Whitney test) were performed between subjects subsequently commenced on insulin versus those continued with diet and lifestyle measures alone.

-- Ninety women of mean gestational age weeks 27 were studied. Those prescribed insulin (n=34) compared with those managed with diet and lifestyle alone (n=56) had a greater time in hyperglycemia.

-- Of those not prescribed insulin, 35/56 (61%) breached CGM cutoffs between 00:00 and 06:00 h; 11/56 (20%) breached 6.00–00.00 h CGM cutoffs for more than 10% of the time; and 21/45 (47%) with optimal CGM glucose levels during the daytime spent greater than 10% time in hyperglycemia between 00.00 and 06:00h.

-- In contrast, SMBG measurements exceeded the clinical targets of less than 120mg/dL postdinner in 5.4% and less than 100mg/dL fasting in 0% of the subjects.

Conclusively, CGM provides a more comprehensive assessment of nocturnal hyperglycemia than SMBG and could improve targeting of interventions in GDM. Larger studies to better define CGM targets are required, which once established will inform studies aimed at targeting nocturnal glucose levels.