Continuous glucose monitoring offers hope to pregnant women with type 1 diabetes

From the time Holly Byrne was diagnosed with type 1 diabetes (T1D) at the age of 10, achieving a healthy blood sugar level was considered an elusive goal.  Managing her condition was very challenging and she was often reminded by her mother to focus on her health. Yet all that changed right before her 30th birthday when Byrne decided she wanted to start trying to have a family. Determined to bring her A1C levels into target range so that she would have an uncomplicated pregnancy, Byrne was referred to Mount Sinai’s Diabetes in Pregnancy and Endocrinology Program in Toronto when she learned she was expecting. It was after getting acquainted with Dr. Denice Feig, head of the program and co-principal investigator of the JDRF-funded study, CONCEPTT: Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy that Byrne decided to participate in the trial with the hope of healthier outcomes for her and her baby.

As part of a group of 325 women aged 18-40 with T1D who were either pregnant or planning to conceive, Byrne was randomly assigned to use a Continuous Glucose Monitor (CGM) for approximately 24 weeks (from 10-12 weeks until the end of her pregnancy).

 “I had used a diabetes sensor a few years ago, but I didn’t wear it long enough to see results,” says Byrne. “I wanted to try again so I could have the best experience possible during pregnancy with limited complications to my baby and myself.”

Among the researchers’ findings, expectant mothers who used a CGM had improved glucose control overall and spent an extra 100 minutes per day with blood sugar levels in the recommended target range in late pregnancy as compared to those who were trying to conceive. The results of this landmark randomized international trial, held across 31 hospitals in Canada (including 11 sites in Alberta, Ontario, Quebec and Nova Scotia), the United Kingdom, Spain, Ireland, Italy and the United States, prompted the authors to call for physicians to extend CGM devices to all pregnant women with T1D.

“A multinational study of this calibre and magnitude that offers promising clinical outcomes for mothers and their newborns is an incredible accomplishment in the global diabetes research agenda,” says Dave Prowten, President and CEO at JDRF Canada. “Working together, we can accelerate this type of transformative research and ensure it becomes available to all women in the T1D community.” 

Neonatal complications such as premature birth or higher-than-average birth weights currently affect one in two babies born to women with T1D. As well, many of these new mothers are more likely to have pre-eclampsia and Caesarean sections. CGM systems have the potential to revolutionize diabetes management among pregnant women with T1D because they allow them to take immediate action in response to high or low blood sugars and avoid other serious health-related issues.

“Maternal and fetal outcomes for women with T1D in pregnancy are worse than those for the rest of the population, and it has been difficult to improve these outcomes,” states Dr. Denice Feig, head of the Diabetes in Pregnancy Program at the Mount Sinai Hospital and University Health Network in Toronto, as well as co-principal investigator of the study.  “Our research shows that using real time continuous glucose monitoring leads to a reduction in neonatal health complications. One needed to treat only six women to prevent a large baby and a neonatal hypoglycemic event, and eight women to prevent a neonatal intensive care unit admission over 24 hours. This study offers a new option to help pregnant women with diabetes and their children.”

Byrne will always be grateful for the experience that enabled her to have an easier pregnancy and a healthy baby boy.

“Continuous glucose monitoring in diabetes management is vital to understanding blood glucose trends and insulin dosing, and I was happy that I was able to help contribute to such an important study,” says Byrne. “It provided me with A1C results that I never thought I would achieve and I no longer have anxiety when dealing with low blood sugars.”

Funded by JDRF’s Canadian Clinical Trial Network – a partnership between JDRF Canada and FedDev Ontario, an agency of the Government of Canada – this ground-breaking study will serve as a catalyst for improved access to life-saving CGM technology for pregnant women worldwide.

 

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