Cochrane review of blood glucose monitoring techniques among pregnant women with pre-existing diabetes

  • Jones LV & al.
  • Cochrane Database Syst Rev
  • 23 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Low-quality evidence suggests that continuous glucose monitoring may be more effective in reducing hypertensive disorders of pregnancy (pre‐eclampsia and pregnancy‐induced hypertension), this did not translate into a clear reduction for pre‐eclampsia, and so this result should be viewed with caution.
  • However, this review found no evidence that any particular glucose monitoring technique was superior over other techniques in pregnant women with pre-existing type 1 or 2 diabetes.

Why this matters

  • Self-monitoring of blood glucose is recommended as a key component of the diabetes management plan during pregnancy.
  • The efficacy of various blood glucose monitoring techniques is unclear.

Study design

  • Cochrane review of 10 randomised controlled trials (RCTs) involving 538 women with type 1 (n=468) and 2 (n=70) diabetes.
  • Primary outcomes: hypertensive disorders of pregnancy, large-for-gestational age, glycaemic control, perinatal mortality (stillbirth and neonatal mortality), mortality or morbidity composite and neurosensory disability.
  • Funding: High Impact Research Grant, Malaysia, and others.

Key results

  • CGM vs intermittent CGM may reduce hypertensive disorders of pregnancy (pre‐eclampsia and pregnancy‐induced hypertension) (risk ratio [RR] 0.58, 95% CI 0.39-0.85; 2 studies, 384 women)
  • No clear difference was observed in pre-eclampsia (RR, 1.37; 95% CI, 0.52-3.59) between CGM and intermittent CGM.
  • There was no clear difference in caesarean section (RR, 0.96; 95% CI, 0.62-1.48) between constant CGM vs intermittent CGM (RR, 0.77; 95% CI, 0.33-1.79).
  • No clear difference was observed in caesarean section (risk ratio [RR], 0.78; 95% CI, 0.40-1.49) between self-monitoring and standard care.
  • Self-monitoring vs hospitalisation did not show any difference in:
    • pre-eclampsia (RR, 4.26; 95% CI, 0.52-35.16); and
    • gestational hypertension (RR, 0.43; 95% CI, 0.08-2.22).
  • Pre-prandial vs post-prandial glucose monitoring did not differ in:
    • caesarean section (RR, 1.45; 95% CI, 0.92-2.28); and
    • large-for-gestational age (RR, 1.16; 95% CI, 0.73-1.85).
  • Automated telemedicine monitoring vs conventional system did not differ in
    • caesarean section (RR, 0.96; 95% CI, 0.62-1.48); and
    • composite mortality or morbidity (RR, 1.18; 95% CI, 0.53-2.62).

Limitations

  • Very low-quality evidence.