Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy
Abstract Background Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR a...
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BMC
2024-11-01
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| Series: | Diabetology & Metabolic Syndrome |
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| Online Access: | https://doi.org/10.1186/s13098-024-01508-4 |
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| author | Chee Wai Ku Ruther Teo Zheng Hong Ying Tan Jamie Yong Qi Lim Ling-Wei Chen Yin Bun Cheung Keith M. Godfrey Jerry Kok Yen Chan Fabian Yap Ngee Lek See Ling Loy |
| author_facet | Chee Wai Ku Ruther Teo Zheng Hong Ying Tan Jamie Yong Qi Lim Ling-Wei Chen Yin Bun Cheung Keith M. Godfrey Jerry Kok Yen Chan Fabian Yap Ngee Lek See Ling Loy |
| author_sort | Chee Wai Ku |
| collection | DOAJ |
| description | Abstract Background Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM). Methods CGM measurements were taken for 3–10 days at 18–24 weeks’ gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24–28 weeks’ gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape. Results This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7 years, body mass index of 22.9 kg/m2, and gestation of 20.3 weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24 h. Conclusions In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy. |
| format | Article |
| id | doaj-art-762adadccbca4b2f9c3bb492413b3ef0 |
| institution | Kabale University |
| issn | 1758-5996 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Diabetology & Metabolic Syndrome |
| spelling | doaj-art-762adadccbca4b2f9c3bb492413b3ef02024-11-17T12:39:16ZengBMCDiabetology & Metabolic Syndrome1758-59962024-11-0116111110.1186/s13098-024-01508-4Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancyChee Wai Ku0Ruther Teo Zheng1Hong Ying Tan2Jamie Yong Qi Lim3Ling-Wei Chen4Yin Bun Cheung5Keith M. Godfrey6Jerry Kok Yen Chan7Fabian Yap8Ngee Lek9See Ling Loy10Department of Reproductive Medicine, KK Women’s and Children’s HospitalEndocrinology Service, Department of Pediatrics, KK Women’s and Children’s HospitalYong Loo Lin School of Medicine, National University of SingaporeLee Kong Chian School of Medicine, Nanyang Technological UniversityInstitute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan UniversityProgram in Health Services & Systems Research, Duke-NUS Medical SchoolMedical Research Council Lifecourse Epidemiology Centre, University of SouthamptonDepartment of Reproductive Medicine, KK Women’s and Children’s HospitalDuke-NUS Medical SchoolEndocrinology Service, Department of Pediatrics, KK Women’s and Children’s HospitalDepartment of Reproductive Medicine, KK Women’s and Children’s HospitalAbstract Background Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM). Methods CGM measurements were taken for 3–10 days at 18–24 weeks’ gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24–28 weeks’ gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape. Results This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7 years, body mass index of 22.9 kg/m2, and gestation of 20.3 weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24 h. Conclusions In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy.https://doi.org/10.1186/s13098-024-01508-4Continuous glucose monitoringGlycemic control/variabilityGestational diabetes mellitusInsulin resistance |
| spellingShingle | Chee Wai Ku Ruther Teo Zheng Hong Ying Tan Jamie Yong Qi Lim Ling-Wei Chen Yin Bun Cheung Keith M. Godfrey Jerry Kok Yen Chan Fabian Yap Ngee Lek See Ling Loy Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy Diabetology & Metabolic Syndrome Continuous glucose monitoring Glycemic control/variability Gestational diabetes mellitus Insulin resistance |
| title | Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy |
| title_full | Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy |
| title_fullStr | Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy |
| title_full_unstemmed | Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy |
| title_short | Early continuous glucose monitoring-derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy |
| title_sort | early continuous glucose monitoring derived glycemic patterns are associated with subsequent insulin resistance and gestational diabetes mellitus development during pregnancy |
| topic | Continuous glucose monitoring Glycemic control/variability Gestational diabetes mellitus Insulin resistance |
| url | https://doi.org/10.1186/s13098-024-01508-4 |
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