[Clinical use of continuous glucose monitoring system in gestational diabetes mellitus and type 2 diabetes complicated with pregnancy]

Abstract

Objective: To compare the clinical use of continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG) when monitoring blood glucose level of patients with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (DM) complicated with pregnancy.

Methods: A total of 99 patients with GDM (n = 70) and type 2 DM complicated with pregnancy (n = 29) that whether hospitalized or in clinical of Peking University First Hospital were recruited from Aug 2012 to Apr 2013. The CGMS was used to monitor their blood glucose level during the 72-hour time period, while the SMBG was also taken seven times daily. The correlation between these blood glucose levels and their glycosylated hemoglobin (HbA1c) levels were analyzed by comparing the average value, the maximum and the minimum value of blood glucose, and the appeared time of these extremum values in these two monitoring methods, and the amount of insulin usage was recorded as well.

Results: (1) The maximum, minimum and the average blood glucose value in the GDM group were (8.7 ± 1.2), (4.5 ± 0.6)and (6.3 ± 0.6)mmol/L of SMBG vs. (10.1 ± 1.7), (3.1 ± 0.7), (6.0 ± 0.6) mmol/L of CGMS. These values in DM group were(10.1 ± 2.2), (4.5 ± 1.0), (6.9 ± 1.1)mmol/L of SMBG vs.(12.2 ± 2.6), (2.8 ± 0.8), (6.6 ± 1.1) mmol/L of CGMS. By using the two methods, the maximum and the average value of the two groups showed significant differences (P < 0.01) while the minimum value showed no significant differences (P > 0.05). (2) In the GDM group, the average blood glucose values of CGMS and SMBG were significantly correlated (r = 0.864, P < 0.01). The maximum values presented the same result (r = 0.734, P < 0.01). Correlation was not found in the minimum values of CGMS and SMBG (r = 0.138, P > 0.05). In the DM group, the average valves of two methods were significantly correlated (r = 0.962, P < 0.01), the maximum values showed the same result (r = 0.831, P < 0.01).It can also be observed in the minimum values (r = 0.460, P < 0.05). (3) There was significant correlation between the average value of CGMS and HbA1c level (r = 0.400, P < 0.01), and the average value of SMBG and HbA1c level were correlated (r = 0.031, P < 0.05) in the GDM group; the average values of CGMS (r = 0.695, P < 0.01) and SMBG (r = 0.673, P < 0.01) were both significantly correlated with the HbA1c level in the DM group. (4) In the GDM group, 37% (26/70) of the minimum values of SMBG appeared 30 minutes before breakfast, while 34% (24/70) of them appeared 30 minutes before lunch; 86% (60/70) of the maximum values of SMBG were evenly distributed 2 hours after each of the three meals. In the DM group, 41% (12/29) of the minimum values of SMBG presented 30 minutes before lunch, while 21% (6/29) and 14% (4/29) of them were showed 30 minutes before breakfast and dinner respectively; about 30% of the maximum values of SMBG appeared 2 hours after each of the three meals. (5) In the GDM group, 23% (16/70) of the minimum values of CGMS occurred between 0:00-2:59 am., and most of the other minimum values of CGMS were evenly distributed in the rest of the day, except for 3% (2/70) of them were found during 18:00- 20:59 pm. 43% (30/70) of the maximum values of CGMS appeared during 6:00-8:59 am., only 1% (1/70) and 3% (2/70) of them presented during 0:00-2:59 am. and 21:00-23:59 pm., and the rest were evenly distributed for the other times of the day. In the DM group, 34% (10/29) of the minimum values of CGMS were found during 0:00-2:59 am., 14% (4/29) of them appeared during 9:00-11:59 am. and 15:00-17:59 pm., 45% (13/29) of the maximum values of the CGMS presented during 6:00-8:59 am., none was found during 21:00-23:59 pm.,0:00-2:59 am. and 3:00-5:59 am., and the rest were evenly distributed for the other times of the day. (6) 64% (45/70) of the patients in the GDM group did not require for insulin treatment, while 36% (25/70) of them did. For those patients who received insulin treatment, after CGMS, 64% (16/25) of them adjusted the insulin dosage according to their blood glucose levels. In the DM group, 14% (4/29) of them did not receive insulin treatment, while for the others who did (86%, 25/29); 60% (15/25) of them adjusted the insulin dosage according to their blood glucose levels after CGMS.

Conclusions: Both CGMS and SMBG could correctly reflect patients' blood glucose levels. It was more difficult to control the blood glucose levels in patients with type 2 DM complicated with pregnancy than the GDM patients. Compared with SMBG, CGMS could detect postprandial hyperglycemia and nocturnal hypoglycemia more effectively.