Continuous Glucose Monitoring for Type 2 Diabetes in Pregnancy

Overseen By Heidi Leftwich, DO

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Massachusetts, Worcester

Disqualifiers: Type 1 diabetes, Gestational diabetes, others

No Placebo Group

Approved in 5 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial aims to compare the use of a Continuous Glucose Monitor (CGM) to traditional fingerstick tests in pregnant women with type 2 diabetes. The CGM continuously tracks blood sugar levels, providing real-time data to help manage diabetes more effectively. The study will evaluate its impact on infant size, maternal blood sugar control, and overall patient satisfaction.

Do I have to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Continuous Glucose Monitoring for Type 2 Diabetes in Pregnancy?

Research shows that continuous glucose monitoring (CGM) can improve blood sugar control and pregnancy outcomes in women with diabetes, including type 1 diabetes. This suggests that CGM might also be beneficial for managing type 2 diabetes during pregnancy by helping to maintain better glucose levels, which is important for the health of both mother and baby. ^{1 2 3 4 5}

Is continuous glucose monitoring safe for pregnant women with type 2 diabetes?

Continuous glucose monitoring (CGM) is generally safe for pregnant women with diabetes, as studies show it can be used without severe side effects and helps manage blood sugar levels effectively. ^{3 4 6 7 8}

How is continuous glucose monitoring different from other treatments for type 2 diabetes in pregnancy?

Continuous glucose monitoring (CGM) is unique because it provides real-time tracking of blood sugar levels throughout the day and night, allowing for more precise management of glucose levels compared to traditional methods like self-monitoring blood glucose (SMBG). This continuous data can help improve outcomes for both the mother and baby by optimizing glucose control during pregnancy. ^{2 3 4 8 9}

Research Team

Gianna L Wilkie, MD

Principal Investigator

University of Massachusetts, Worcester

Eligibility Criteria

This trial is for pregnant women over 18 with type 2 diabetes, less than 14 weeks into their pregnancy, and receiving care at UMASS Memorial Health Care. They must have a confirmed diagnosis of T2DM and be able to consent. Women with multiple pregnancies or planning care outside UMMHC, or those with type 1 or gestational diabetes cannot join.

Inclusion Criteria

Able and willing to provide informed consent

Receiving prenatal care at UMASS Memorial Health Care (UMMHC) and plans to deliver at UMMHC

I am pregnant with one baby and less than 14 weeks along.

Exclusion Criteria

I have been diagnosed with type 1 or gestational diabetes.

Plan to receive prenatal care or delivery outside of UMMHC

You are pregnant with more than one baby.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are randomized to either continuous glucose monitoring (CGM) or standard fingerstick glucose monitoring for the duration of pregnancy until delivery

Until delivery

Follow-up

Participants are monitored for safety and effectiveness after delivery, including assessments of maternal and neonatal outcomes

Postpartum day 1

Treatment Details

Interventions

• Continuous Glucose Monitor (Continuous Glucose Monitor)
• Routine Capillary Blood Glucose Monitoring (Fingerstick Glucose) (Device)

Trial Overview The study compares the use of a continuous glucose monitor (CGM) versus routine fingerstick blood glucose monitoring in managing type 2 diabetes during pregnancy. It aims to see how each method affects baby's size at birth, mother's sugar control, satisfaction with treatment, and other pregnancy outcomes.

Participant Groups

Group I: Continuous Glucose Monitoring (CGM) Experimental Treatment 1 Intervention

Patients will be randomized to application of a continuous glucose monitor (CGM). They will apply the device in the clinical setting and be instructed how to download their information onto their smartphones or using the CGM device reader. They will use the CGM for the duration of the pregnancy until delivery.

Group II: Fingerstick Glucose Monitoring Active Control 1 Intervention

Patients will be randomized to checking their blood glucose with fingerstick monitors at time of fasting in the AM, and 2 hours after each meal. This is the standard of care for patients in the pregnancy diabetes clinic.

Continuous Glucose Monitor is already approved in Canada, Japan for the following indications:

Approved in Canada as Continuous Glucose Monitor for:

• Type 1 Diabetes
• Type 2 Diabetes

Approved in Japan as Continuous Glucose Monitor for:

• Type 1 Diabetes
• Type 2 Diabetes

Who Is Running the Clinical Trial?

University of Massachusetts, Worcester

Lead Sponsor

Trials

372

Recruited

998,000+

Findings from Research

In a study of 117 pregnant patients with type 1 or 2 diabetes, continuous glucose monitoring (CGM) metrics were linked to neonatal outcomes, showing that higher time in range (TIR) significantly reduces the odds of neonatal morbidity by 28% for every 5 percentage-point increase in TIR.

The optimal TIR for improving neonatal outcomes was found to be between 66-71%, supporting the American Diabetes Association's recommendation of aiming for at least 70% TIR during pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Continuous Glucose Monitoring Metrics With Pregnancy Outcomes in Patients With Preexisting Diabetes. Sanusi, AA., Xue, Y., McIlwraith, C., et al.[2023]

In a study involving 55 pregnant women with diabetes, the continuous glucose monitoring system (CGMS) provided valuable insights that altered clinical management decisions in 62% of cases, helping to identify previously undetected glucose fluctuations.

Patient feedback was largely positive, with 77% of respondents feeling that the benefits of using CGMS outweighed any inconvenience, indicating good tolerability and perceived usefulness in managing diabetes during pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy. McLachlan, K., Jenkins, A., O'Neal, D.[2009]

Continuous glucose monitoring system (CGMS) is more effective than self-monitoring blood glucose (SMBG) in detecting postprandial hyperglycemia and nocturnal hypoglycemia in pregnant patients with diabetes, as shown in a study of 99 patients over a 72-hour monitoring period.

Both CGMS and SMBG accurately reflect blood glucose levels, but controlling blood glucose is more challenging in patients with type 2 diabetes complicated by pregnancy compared to those with gestational diabetes mellitus (GDM).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Clinical use of continuous glucose monitoring system in gestational diabetes mellitus and type 2 diabetes complicated with pregnancy]. Song, Y., Yang, H.[2022]

The Continuous Glucose Monitoring System (CGMS) demonstrated a high accuracy in reflecting glucose levels in pregnant women with type 1 diabetes, with a correlation coefficient of 0.94 based on 239 analyzed blood glucose values.

An impressive 93.8% of the non-calibration glucose readings fell within the clinically acceptable range according to the Clarke error grid analysis, indicating that CGMS can be a reliable tool for monitoring glucose in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Continuous Glucose Monitoring System during pregnancy of women with type 1 diabetes mellitus: accuracy assessment. Kerssen, A., de Valk, HW., Visser, GH.[2006]

The use of continuous glucose monitors (CGM) in pregnancy shows mixed results; one small randomized controlled trial (RCT) indicated that retrospective CGM significantly reduced third-trimester HbA1c levels and neonatal macrosomia, while another RCT on real-time CGM found no impact on glycemic control or pregnancy outcomes.

Overall, the current evidence is limited and contradictory, highlighting the need for more comprehensive RCTs to assess the effectiveness and cost-effectiveness of CGM in improving pregnancy outcomes before it can be widely adopted in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy and effectiveness of continuous glucose monitoring during pregnancy: a systematic review. Voormolen, DN., DeVries, JH., Evers, IM., et al.[2018]

In 2022, there were 281,963 reported adverse events related to continuous glucose monitors (CGMs), highlighting a significant safety concern for people with diabetes.

The analysis of adverse events for four CGM products revealed that common issues included inaccuracy and device malfunctions, indicating a need for improved monitoring and device reliability to enhance user experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse Event Causes From 2022 for Four Continuous Glucose Monitors. Krouwer, JS.[2023]

Continuous glucose monitoring (CGM) is a safe and effective method for tracking blood glucose levels in pregnant women with gestational diabetes, helping to reduce the risk of serious complications such as hypertension and neonatal hypoglycemia.

Using CGM can lead to improved blood glucose control, as indicated by increased time in range (TIR), which is associated with better pregnancy outcomes for both the mother and the baby.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review. Song, Y., Zhai, X., Bai, Y., et al.[2023]

Continuous glucose monitoring (CGM) is feasible and safe for use during pregnancy in women with type 1 and type 2 diabetes, as shown by observational studies with no severe side effects reported.

A randomized controlled trial indicated that CGM leads to improved metabolic control and a reduced risk of macrosomia (large baby size), highlighting its potential benefits for pregnant women with diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Continuous glucose monitoring in pregnancies complicated by diabetes]. Madsen, AB., Secher, AL., Damm, P., et al.[2011]

Continuous glucose monitoring (CGM) is increasingly used in pregnancy to improve blood glucose management, with a focus on novel targets like time in range (TIR) that are linked to better pregnancy and neonatal outcomes.

Pregnant women require different TIR parameters compared to nonpregnant individuals, and integrating CGM with hybrid closed-loop insulin delivery systems could significantly enhance diabetes management during pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Time in Range in Pregnancy: Is There a Role? Wyckoff, JA., Brown, FM.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Association of Continuous Glucose Monitoring Metrics With Pregnancy Outcomes in Patients With Preexisting Diabetes. [2023]

2. Australia pubmed.ncbi.nlm.nih.gov

The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy. [2009]

3. China pubmed.ncbi.nlm.nih.gov

[Clinical use of continuous glucose monitoring system in gestational diabetes mellitus and type 2 diabetes complicated with pregnancy]. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

The Continuous Glucose Monitoring System during pregnancy of women with type 1 diabetes mellitus: accuracy assessment. [2006]

5. United States pubmed.ncbi.nlm.nih.gov

The efficacy and effectiveness of continuous glucose monitoring during pregnancy: a systematic review. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Adverse Event Causes From 2022 for Four Continuous Glucose Monitors. [2023]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Progress and indication for use of continuous glucose monitoring in patients with diabetes in pregnancy: a review. [2023]

8. Denmark pubmed.ncbi.nlm.nih.gov

[Continuous glucose monitoring in pregnancies complicated by diabetes]. [2011]

9. United States pubmed.ncbi.nlm.nih.gov

Time in Range in Pregnancy: Is There a Role? [2022]