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Clinical Trial
. 2021 Dec;23(12):783-790.
doi: 10.1089/dia.2021.0093. Epub 2021 Nov 3.

Relationship Between Time-in-Range, HbA1c, and the Glucose Management Indicator in Pregnancies Complicated by Type 1 Diabetes

Viral N Shah  1 , Janet K Snell-Bergeon  1 , Jamie K Demmitt  1 , Prakriti Joshee  1 , Rachel Garcetti  1 , Laura Pyle  1   2 , Sarit Polsky  1
Affiliations
Clinical Trial

Relationship Between Time-in-Range, HbA1c, and the Glucose Management Indicator in Pregnancies Complicated by Type 1 Diabetes

Viral N Shah et al. Diabetes Technol Ther. 2021 Dec.

Abstract

Objective: We aimed to evaluate relationships between time-in-range (TIR 63-140 mg/dL), glycated hemoglobin A1c (HbA1c) level, and the glucose management indicator (GMI) in pregnant women with type 1 diabetes. Research Design and Methods: Continuous glucose monitoring (CGM) data from 27 women with type 1 diabetes were collected prospectively throughout pregnancy. Up to 90-days of CGM data were correlated with point-of-care HbA1c levels measured in the clinic at each trimester. GMI levels were calculated using a published regression formula. Liner models were used to compare TIR, HbA1c, and GMI by each trimester. Results: There was a significant negative correlation between TIR and HbA1c; each 10% increase in TIR was associated with a 0.3% reduction in HbA1c. The correlation between TIR and HbA1c was stronger (r = -0.8) during the second and third trimesters than during the first trimester (r = -0.4). There was good correlation between TIR and GMI during each trimester (r = 0.9 for each trimester). The relationship between GMI and HbA1c especially during second (r = 0.8) and third trimesters (r = 0.8) was strong. Conclusion: In the first trimester, the correlation between HbA1c level and TIR was relatively small, while that of TIR and GMI was very strong, thus GMI may better reflect glycemic control than HbA1c in early pregnancy. Each 10% increase in TIR was associated with a 0.3% reduction in HbA1c throughout pregnancy, which was lower than other published studies in nonpregnant populations reporting a 0.5%-0.8% reduction in HbA1c. Further studies are needed to understand the relationship between TIR and GMI and how GMI may affect maternal and fetal complications. Clinical Trial Registration number: NCT02556554.

Keywords: Continuous glucose monitoring; Glucose management indicator; Pregnancy; Time in range; Type 1 diabetes.

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Conflict of interest statement

V.N.S. reports receiving research grants from NIH (NIDDK and NIAMS), Eli-Lilly, Novo Nordisk, Abbott, Dexcom, Insulet, and JDRF. V.N.S. had served on advisory board for Sanofi. S.P. reports research funding from Dexcom, Inc., Eli Lilly, JDRF, Leona & Helmsley Charitable Trust, NIDDK, and Sanofi, medical advisory board for Medtronic MiniMed, Inc., and consulting for the JAEB center. R.G., L.P., P.J., J.D., and J.S.B reported no potential conflicts of interest relevant to this article.

Figures

FIG. 1.
FIG. 1.
Correlation between CGM time-in-range (63–140 mg/dL) and HbA1c in each trimester. CGM, continuous glucose monitoring; HbA1c, glycated hemoglobin A1c.
FIG. 2.
FIG. 2.
Correlation between CGM time-in-range (63–140 mg/dL) and GMI in each trimester. GMI, glucose management indicator.
FIG. 3.
FIG. 3.
Correlations between GMI and HbA1c in each trimester.
See this image and copyright information in PMC

References

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