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Panel will address issues and challenges around CGM use in pregnancy


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4 minutes

Sarit Polsky, MD, MPH
Sarit Polsky, MD, MPH

Diabetes in pregnancy is associated with various risks. Optimal metrics for tracking glycemia and the approach for managing the disease during pregnancy are, therefore, of critical importance. Meanwhile, continuous glucose monitoring (CGM) technologies have transformed diabetes care, providing real-time and comprehensive data on glucose levels. A Sunday, June 23, symposium will explore evolving evidence for CGM use in pregnancy.

Controversies in Continuous Glucose Monitoring (CGM) Use during Pregnancy—Time in Range and Beyond Time in Range will take place from 4:30 p.m. – 6:00 p.m. ET in Room W415C, the Valencia Ballroom, of the Orange County Convention Center. The session will be available on-demand on the virtual meeting platform for registered meeting participants following the 84th Scientific Sessions.

Interpreting various CGM metrics in pregnancy—such as time in range (TIR), time above/below range (TAR/TBR), mean glucose, glucose management indicator (GMI), and others—and integrating them into routine practice to manage diabetes during pregnancy can be challenging, said Sarit Polsky, MD, MPH, Associate Professor and Director of the Pregnancy and Women’s Health Clinic at the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus.

She will discuss TIR versus conventional fasting and postprandial targets in pregnancy.

“I’m going to be talking about controversies and challenges around how clinicians decide which glucose measures are important, on an individualized basis, depending on the CGM data and the patient’s risk profile, and what aspects should be considered when interpreting CGM data and clinical decision-making,” Dr. Polsky said.

Claire L. Meek, MB, ChB, MRCP, FRCPath, PhD
Claire L. Meek, MB, ChB, MRCP, FRCPath, PhD

She will also discuss how CGM metrics impinge on the use of automated insulin delivery (AID) systems.

Claire L. Meek, MB, ChB, MRCP, FRCPath, PhD, Professor of Chemical Pathology & Diabetes in Pregnancy at the University of Leicester, United Kingdom, will explore the role of A1C as a measure of glycemic management in pregnancy in the era of CGM.

“There is international controversy about the best way to monitor glucose levels in women who are pregnant with diabetes, including type 1, type 2, and gestational diabetes,” Dr. Meek said. “We know that CGM metrics such as TIR, TAR, or average CGM glucose can be helpful in determining short-term risks and can help women learn about their glucose response to meals. However, data regarding which glucose measures are most relevant for pregnancy outcomes is sparse.”

A1C is used outside of pregnancy for managing diabetes, yet the increased turnover of red blood cells during pregnancy influences this measure, making it difficult to use A1C in pregnancy to monitor outcomes. Dr. Meek said that while A1C strongly correlated with pregnant women with type 1 diabetes in the CONCEPTT study, the utility of A1C in type 2 or gestational diabetes is unclear.

 “We know that some new technologies such as hybrid closed loop/AID can help improve early glucose levels in women with type 1 diabetes. We also know that CGM is very beneficial in type 1 diabetes,” Dr. Meek said. “There is a limited amount of evidence, unfortunately, in type 2 diabetes at present regarding interventions in early pregnancy to help bring glucose levels under control.”

Ashley N. Battarbee, MD, MSCR
Ashley N. Battarbee, MD, MSCR

Dr. Meek and her colleagues are conducting studies to improve the evidence base for pregnancy in individuals with gestational diabetes and type 2 diabetes.

Ashley N. Battarbee, MD, MSCR, Assistant Professor of Obstetrics and Gynecology at the University of Alabama, will review CGM metrics and glucose targets in pregnancy.

“The key to improving outcomes in pregnancy for people with diabetes is centered around achieving maternal glycemic control,” she said. “As CGM uptake among pregnant women and data on the impact of CGM metrics on outcomes in pregnancy increase, it is important for clinicians to determine how best to use CGM for diabetes management in pregnancy.”

Dr. Battarbee noted that the session will provide perspectives on CGM in pregnancy from multiple world regions and diverse clinical specialties, including endocrinology, maternal-fetal medicine, and obstetrics/gynecology.

“I think CGM is exciting because it has the potential to change how we manage diabetes in pregnancy and decrease diabetes-related pregnancy complications and other adverse outcomes,” she said.

Get On-Demand Access to the Scientific Sessions

There is still time to register for on-demand access to learn about the latest advances in diabetes research, prevention, and care presented at the 84th Scientific Sessions. Select session recordings will be available through Aug. 26.