Exploratory Analysis of Glycemic Control and Variability Over Gestation Among Pregnant Women with Type 1 Diabetes

Abstract

In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with lower glycemic measures, including estimated HbA1c (eHbA1c) (0.14% decrease in HbA1c per 1-week greater gestational age, P = 0.0035), mean sensor glucose (-3.9 mg/dL P = 0.0039), time spent >140 mg/dL (-3.1%, P = 0.0029), and higher time in range (TIR) of 63-140 mg/dL (3.2%, P = 0.0029). Third trimester measured HbA1c was significantly associated with gestational age at delivery (P = 0.0081). Preeclampsia was associated with less TIR in first (50.5% vs. 69.9%, P = 0.0034) and second trimesters (47.1% vs. 66.7%, P = 0.0025), but not with measured HbA1c. There were significant differences in other markers of GV (continuous overall net glycemic action, high blood glucose index, J-index, mean amplitude of glycemic excursions) with infant birth weight and gestational age at delivery. Thus, multiple markers of glycemia and GV were associated with gestational health outcomes in T1D pregnancies in this pilot study. Clinical Trial Registration number: NCT02556554.

Keywords: Continuous glucose monitoring; Gestational outcomes; Glycemic variability; Type 1 diabetes.

Conflict of interest statement

S.P. receives research funding from Barbara Davis Center for Diabetes, Children's Diabetes Foundation, DexCom, Inc., Eli Lilly and Company, JDRF, Leona & Harry Helmsley Charitable Trust, NIDDK, and Sanofi US. Medical advisory board for Medtronic MiniMed, Inc. and is consultant for Jaeb Center for Health Research. E.O. B. receives research funding from JDRF and DexCom, Inc.; J.K.S.-B., P.J., J.K.D., R.G., and L.P. have no conflicts of interest related to this study.