Tatiana Munhoz da Rocha Lemos Costa, Josiane Melchioretto Detsch, Augusto Pimazoni-Netto, Ana Cristina Ravazzani de Almeida, Shoshana Sztal-Mazer, Larissa Marques Tondin de Oliveira, Dênis José Nascimento and Rosângela Roginski Réa
Background : Gestational Diabetes Mellitus (GDM) incurs a risk of morbidity and mortality to mother, fetus and subsequent neonate which necessitates intensive monitoring and treatment. Recently, weekly blood glucose and, more importantly, glycemic variability have been explored as means of assessing glycemic control and altering management in type 2 diabetes. For the first time in GDM, we aimed to assess the applicability of these methods and determine whether they affect complications.
Methods : We conducted a prospective, randomized un-blinded single centre study (n=30) where the intervention arm (n=15) was assessed and managed using seven point self blood glucose monitoring, glycemic variability and mean blood glucose while the control arm received standard GDM management. Blood glucose variables, glycemic target achievement and outcome variables to mother, fetus and neonate were recorded.
Results : Weight and HbA1c did not differ significantly between or within groups over the study period and ≥80% of participants in both groups achieved glycemic targets (p=0.850). In the intervention arm, glycemic variability decreased significantly (p=0.016), however the weekly mean blood glucose did not. The difference between groups in therms of gestational hypertension and pre-eclampsia did not reach statistical significance. Fetal abnormalities only occurred in the control group (n=4, 26.66%, p=0.032). Furthermore, there were more neonatal complications in the control group compared to the intervention group (n=8; 53.33% versus n=1; 6.66%; p=0.007).
Conclusions : We have shown that glycemic variability and mean weekly glucose measurements can easily be implemented in the management of GDM. As both groups achieved target glycemic control and glycemic variability was the only parameter that improved over the study period, we believe that this may explain improved fetal and neonatal outcomes in the intervention arm. Larger, properly powered studies are required to further explore this finding.