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- Klinische proef NCT03326232
Real-time Continuous Glucose Monitoring
21 november 2017 bijgewerkt door: Eastern Virginia Medical School
Real-time Continuous Glucose Monitoring for the Treatment of Gestational Diabetes: a Randomized Trial
Gestational diabetes (GDM) is a condition of carbohydrate intolerance with onset or first recognition in pregnancy.
The prevalence of GDM is as high as 25% in some populations and continues to rise with the increase in obesity and type-2 diabetes.
GDM places the pregnancy at great risk to both the mother and the neonate.
Recent studies have proven that interventions including dietary and medications lower the risk to the pregnancy.
Both the American College of Obstetrics and Gynecology (ACOG) and the American Diabetes Association (ADA) recommend dietary interventions with daily glucose monitoring as the initial treatment of choice.
Meanwhile, outside of pregnancy, promising new technologies such as continuous glucose monitors (CGM) are revolutionizing diabetic care.
The investigators seek to determine if the constant feedback of a real-time CGM system would improve glycemic control compared to traditional management in GDM
Studie Overzicht
Toestand
Onbekend
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
The investigators' proposed study will add new information to the emerging use of CGM in pregnant women with GDM.
First, most studies only use CGM for 48 - 72hours at a time, while the investigators will be using CGM for 7 day intervals.
Both groups will use the same Enlite sensor (Medtronic).
The blinded CGM group will be using the Medtronic iPro2 system (Enlite sensor + transmitter).
The real-time CGM group will be using the 530g system (iPro2 (Enlite sensor + transmitter) + inactivated 530g pump set only to display glucose values, no insulin will be administered).
This CGM system has been FDA approved to for up to 7 days between sensor changes.26,27
Second, no previous study has used real time CGM in pregnant patients with GDM in the US.
The investigators will be the first to describe the use of this technology in this patient population.
Third, most of these trials have been performed on populations that are not representative of the investigators' patient population at EVMS.
This will be the largest US study of CGM in GDM.
Fourth wearable medical and fitness technology is already popular, but as both the technology and the demand continues to grow, it will become the future of diabetes management.
Studies have already shown that real time CGM is an effective educational and motivational tool in type-1 and type-2 DM.28,29
Studietype
Ingrijpend
Inschrijving (Verwacht)
40
Fase
- Niet toepasbaar
Contacten en locaties
In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.
Studie Locaties
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Virginia
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Norfolk, Virginia, Verenigde Staten, 23507
- Werving
- Eastern Virginia Medical School
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Onderonderzoeker:
- Alfred Abuhamad, MD
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Contact:
- Joanne Audouin, MS
- Telefoonnummer: 757-446-5121
- E-mail: audouij@evms.edu
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Contact:
- Andrew Lane, MD
- Telefoonnummer: 864-608-4134
- E-mail: laneas@evms.edu
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Hoofdonderzoeker:
- Malgorzata Mlynarczyk, MD, PhD
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Onderonderzoeker:
- Andrew Lane, MD
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Onderonderzoeker:
- Margarita de Veciana, MD
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Deelname Criteria
Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
18 jaar tot 45 jaar (Volwassen)
Accepteert gezonde vrijwilligers
Nee
Geslachten die in aanmerking komen voor studie
Vrouw
Beschrijving
Inclusion Criteria:
- maternal age 18 to 45
- singleton gestation
- gestational age less than 32 weeks gestation at study inclusion
- BMI less than 45
- 50g glucose challenge greater than 135 mg/dL
- 100 g 3 hr oral glucose tolerance test greater than 2 abnormal values using the Carpenter Coustan cut offs (fasting greater than 95 mg/dL, 1 hr greater than 180 mg/dL, 2 hr greater than 155 mg/dL, 3 hr greater than 140 mg/dL)
- attended the maternal-fetal medicine diabetes education class
Exclusion Criteria:
- maternal age less than18 or greater than 45
- multifetal gestation
- gestational age greater than 32 weeks study inclusion
- BMI greater than 45
- pregestational diabetes
- gestational diabetes diagnosed before 24 weeks
- did not attend the diabetes education class
- known fetal anomaly
- known fetal aneuploidy
- required ongoing treatment with medications that can exacerbate hyperglycemia (steroids, hydroxyprogesterone caproate injections (Makena), highly active antiretroviral therapy HIV medications)
- learning disability
- concern for non compliance with medical care
- imminent preterm delivery due to maternal disease or fetal conditions
- is not willing to wear CGM
Studie plan
Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
---|---|
Experimenteel: Blinded continuous glucose monitoring
The blinded CGM group will be using the Medtronic iPro2 system (Enlite sensor + iPro2 transmitter).
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The blinded CGM group will be using the Medtronic iPro2 system (Enlite sensor + iPro2 transmitter).
The real-time CGM group will be using the 530g system (inactivated 530g insulin pump (no insulin used, only used as display for CGM), Enlite sensor, MiniLink transmitter)
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Experimenteel: Real time continuous glucose monitoring
The real-time CGM group will be using the 530g system (inactivated 530g insulin pump (no insulin used, only used as display for CGM), Enlite sensor, MiniLink transmitter)
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The blinded CGM group will be using the Medtronic iPro2 system (Enlite sensor + iPro2 transmitter).
The real-time CGM group will be using the 530g system (inactivated 530g insulin pump (no insulin used, only used as display for CGM), Enlite sensor, MiniLink transmitter)
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Mean blood glucose (mg/dL)
Tijdsspanne: week 1 vs. week 4
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Mean blood glucose (mg/dL) in the real-time CGM group compared to self-monitoring of blood glucose (SMBG) group during the 4th week of study from data collected on the 6 day of CGM use during that week.
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week 1 vs. week 4
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
---|---|---|
Failed dietary therapy
Tijdsspanne: week 1 vs. week 4
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Failed dietary therapy (started on medication),
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week 1 vs. week 4
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Time spent in normoglycemia
Tijdsspanne: week 1 vs. week 4
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Time spent in normoglycemia (min/day)
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week 1 vs. week 4
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Time spent in hypoglycemia
Tijdsspanne: week 1 vs. week 4
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Time spent in hypoglycemia (min/day)
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week 1 vs. week 4
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BMI at time of delivery
Tijdsspanne: BMI at time of delivery
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BMI at time of delivery (kg/m2)
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BMI at time of delivery
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Gestational hypertension
Tijdsspanne: enrollement vs delivery.
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Gestational hypertension (defined as systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mmg Hg, on 2 occasions at least 4 hrs apart
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enrollement vs delivery.
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Preeclampsia
Tijdsspanne: enrollement vs delivery.
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Preeclampsia (defined as gestational hypertension plus either new-onset proteinuria (> 300 mg/24 2hrs, protein:creatinine > 0.3 mg/dL), thrombocytopenia (platelet count < 100,000/uL), elevated Aspartate aminotransferase or alanine aminotransferase (> 2x upper limit of normal), renal insufficiency (serum creatinine > 1.1 mg/dL or an unexplained doubling of creatinine), pulmonary edema, or cerebral or visual symptoms
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enrollement vs delivery.
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HbA1C values
Tijdsspanne: HbA1C values week 1 compared to week 4 (%)
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HbA1C values (%)
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HbA1C values week 1 compared to week 4 (%)
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Polyhydramnios
Tijdsspanne: Through study completion, an average of 9 months
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Polyhydramnios (MVP > 8 cm at any point in the pregnancy)
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Through study completion, an average of 9 months
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Cesarean delivery
Tijdsspanne: Delivery
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Cesarean delivery (w/ indication: macrosomia, malpresentation, failed induction, fetal distress, failed trial of labor after cesarean, scheduled repeat, other)
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Delivery
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Induction of labor
Tijdsspanne: Delivery
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Induction of labor (w/ indication)
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Delivery
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Operative vaginal delivery
Tijdsspanne: Delivery
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Operative vaginal delivery (yes/no) and type (forceps/vacuum)
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Delivery
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Shoulder dystocia
Tijdsspanne: Delivery
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Shoulder dystocia (diagnosed clinically)
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Delivery
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Fetal macrosomia
Tijdsspanne: Most recent ultrasound before delivery
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Fetal macrosomia (> 4,000g at 38 wk u/s)
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Most recent ultrasound before delivery
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3rd or 4th degree perineal laceration
Tijdsspanne: Delivery
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3rd or 4th degree perineal laceration at time of delivery
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Delivery
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Gestational age at delivery
Tijdsspanne: Delivery
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Gestational age at delivery (weeks, days)
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Delivery
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Preterm delivery
Tijdsspanne: Delivery
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Preterm delivery (< 37 weeks gestational age at birth)
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Delivery
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Birth weight
Tijdsspanne: Delivery
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Birth weight (grams)
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Delivery
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Perinatal morbidity composite outcome
Tijdsspanne: Delivery
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Delivery
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Large for gestational age
Tijdsspanne: Delivery
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Large for gestational age (yes/no): defined as birth weight > 90%
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Delivery
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Small for gestational age
Tijdsspanne: Delivery
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Small for gestational age (yes/no): defined as birth weight < 10%
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Delivery
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Admission to neonatal intensive care unit
Tijdsspanne: Delivery
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Admission to neonatal intensive care unit (yes/no) and length of neonatal intensive care unit stay (days)
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Delivery
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Respiratory distress syndrome
Tijdsspanne: Delivery
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Respiratory distress syndrome (defined as need to supplemental oxygen > 4 hrs after birth)
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Delivery
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Medewerkers en onderzoekers
Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.
Sponsor
Medewerkers
Onderzoekers
- Hoofdonderzoeker: Malgorzata Mlynarczyk, MD, PhD, Eastern Virginia Medical School
Publicaties en nuttige links
De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.
Algemene publicaties
- Gillman MW, Rifas-Shiman S, Berkey CS, Field AE, Colditz GA. Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics. 2003 Mar;111(3):e221-6. doi: 10.1542/peds.111.3.e221.
- Correa A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J. 2015 Mar;19(3):635-42. doi: 10.1007/s10995-014-1553-5.
- Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005 Mar;115(3):e290-6. doi: 10.1542/peds.2004-1808.
- Murphy HR, Rayman G, Lewis K, Kelly S, Johal B, Duffield K, Fowler D, Campbell PJ, Temple RC. Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial. BMJ. 2008 Sep 25;337:a1680. doi: 10.1136/bmj.a1680.
- Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med. 2013 Jul 16;159(2):123-9. doi: 10.7326/0003-4819-159-2-201307160-00661.
- Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005 Jun 16;352(24):2477-86. doi: 10.1056/NEJMoa042973. Epub 2005 Jun 12.
- Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009 Oct 1;361(14):1339-48. doi: 10.1056/NEJMoa0902430.
- Klonoff DC. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care. 2005 May;28(5):1231-9. doi: 10.2337/diacare.28.5.1231. No abstract available.
- de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, Evans AT. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995 Nov 9;333(19):1237-41. doi: 10.1056/NEJM199511093331901.
- HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991-2002. doi: 10.1056/NEJMoa0707943.
- Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol. 2013 Aug;122(2 Pt 1):406-416. doi: 10.1097/01.AOG.0000433006.09219.f1.
- Moyer VA; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Mar 18;160(6):414-20. doi: 10.7326/M13-2905.
- England LJ, Dietz PM, Njoroge T, Callaghan WM, Bruce C, Buus RM, Williamson DF. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol. 2009 Apr;200(4):365.e1-8. doi: 10.1016/j.ajog.2008.06.031. Epub 2008 Aug 8.
- Malcolm JC, Lawson ML, Gaboury I, Lough G, Keely E. Glucose tolerance of offspring of mother with gestational diabetes mellitus in a low-risk population. Diabet Med. 2006 May;23(5):565-70. doi: 10.1111/j.1464-5491.2006.01840.x.
- Mastrototaro J, Shin J, Marcus A, Sulur G; STAR 1 Clinical Trial Investigators. The accuracy and efficacy of real-time continuous glucose monitoring sensor in patients with type 1 diabetes. Diabetes Technol Ther. 2008 Oct;10(5):385-90. doi: 10.1089/dia.2007.0291.
- Kestila KK, Ekblad UU, Ronnemaa T. Continuous glucose monitoring versus self-monitoring of blood glucose in the treatment of gestational diabetes mellitus. Diabetes Res Clin Pract. 2007 Aug;77(2):174-9. doi: 10.1016/j.diabres.2006.12.012. Epub 2007 Jan 16.
- Moy FM, Ray A, Buckley BS. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes. Cochrane Database Syst Rev. 2014 Apr 30;(4):CD009613. doi: 10.1002/14651858.CD009613.pub2.
- Porter H, Lookinland S, Belfort MA. Evaluation of a new real-time blood continuous glucose monitoring system in pregnant women without gestational diabetes. A pilot study. J Perinat Neonatal Nurs. 2004 Apr-Jun;18(2):93-102. doi: 10.1097/00005237-200404000-00004.
- McLachlan K, Jenkins A, O'Neal D. The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy. Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):186-90. doi: 10.1111/j.1479-828X.2007.00716.x.
- Yu F, Lv L, Liang Z, Wang Y, Wen J, Lin X, Zhou Y, Mai C, Niu J. Continuous glucose monitoring effects on maternal glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus: a prospective cohort study. J Clin Endocrinol Metab. 2014 Dec;99(12):4674-82. doi: 10.1210/jc.2013-4332.
- Alfadhli E, Osman E, Basri T. Use of a real time continuous glucose monitoring system as an educational tool for patients with gestational diabetes. Diabetol Metab Syndr. 2016 Jul 26;8:48. doi: 10.1186/s13098-016-0161-5. eCollection 2016.
- Glowinska-Olszewska B, Tobiaszewska M, Luczynski W, Bossowski A. Monthly use of a real-time continuous glucose monitoring system as an educational and motivational tool for poorly controlled type 1 diabetes adolescents. Adv Med Sci. 2013;58(2):344-52. doi: 10.2478/ams-2013-0024.
Studie record data
Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.
Bestudeer belangrijke data
Studie start (Werkelijk)
13 november 2017
Primaire voltooiing (Verwacht)
1 juli 2018
Studie voltooiing (Verwacht)
1 juli 2018
Studieregistratiedata
Eerst ingediend
25 oktober 2017
Eerst ingediend dat voldeed aan de QC-criteria
27 oktober 2017
Eerst geplaatst (Werkelijk)
31 oktober 2017
Updates van studierecords
Laatste update geplaatst (Werkelijk)
24 november 2017
Laatste update ingediend die voldeed aan QC-criteria
21 november 2017
Laatst geverifieerd
1 november 2017
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- 17-07-FB-0181
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
NEE
Beschrijving IPD-plan
Do not plan to share.
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Nee
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
Ja
product vervaardigd in en geëxporteerd uit de V.S.
Nee
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .
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